THE EFFECT OF NEUROMUSCULAR EXERCISES ON FUNCTIONALITY, PHYSICAL ACTIVITY AND BALANCE IN PATIENTS WITH OSTEOARTHRITIS: RANDOMIZED CONTROLLED STUDY

Yıl 2024, , 190 - 203, 19.02.2024

Gülfem Ezgi Özaltın , Burcu Talu

https://doi.org/10.33715/inonusaglik.1390064

Öz

This study was planned as single- blinded randomized controlled trial to examine the effects of neuromuscular exercises on functionality, physical activity, and balance in patients with osteoarthritis. Sixty patients with osteoarthritis were included. Patients were selected using the random sampling method and allocated to two groups: The experimental group (n=30), and the control group (n=30). The exercises were administered to both groups 6 days a week for 6 weeks, with one set under the physiotherapist’s control and two sets of home exercises repeated 10 times. Pain (VAS), physical activity level, functionality, and balance were evaluated before and after treatment. We found a significant difference in levels of functionality, pain (p <0.001), physical activity, and balance (p <0.05) in both groups at the end of our study. Although the above-mentioned parameters improved significantly in both the groups after treatment, the pre-and post-treatment evaluations in the experimental group were higher than those in the control group in a positive way (p <0.05). We postulate that in addition to classical physiotherapy, neuromuscular exercises are necessary for osteoarthritic patients and are more effective for pain and increased physical activity, function, and balance than conventional knee exercises.

Anahtar Kelimeler

Arthritis, Exercise, Physical activity, Proprioception, Rehabilitation

Osteoartritli Hastalarda Nöromusküler Egzersizlerin Fonksiyonellik, Fiziksel Aktivite ve Denge Üzerine Etkisi: Randomize Kontrollü Çalışma

Öz

Bu çalışma osteoartritli hastalarda nöromusküler egzersizlerin fonksiyonellik, fiziksel aktivite ve denge üzerine etkisini incelemek amacıyla randomize kontrollü, tek kör olarak randamize kontrollü, tek kör olarak planlandı. Osteoartritli 60 hasta dahil edildi. Hastalar randomize örneklem yöntemi ile seçildi ve iki gruba bölündü Deney grubu (n=30), kontrol grubu (n=30). Egzersizler her iki gruba da 6 hafta boyunca haftada 6 gün, bir set fizyoterapist kontrolünde ve iki set ev egzersizi olarak 10 kez tekrarlanarak uygulandı. Ağrı (VAS), fiziksel aktivite düzeyi, fonksiyonellik ve denge tedavi öncesi ve sonrası değerlendirildi. Çalışmanın sonunda her iki grupta da fonksiyonellik, ağrı (p<0,001), fiziksel aktivite ve denge (p<0,05) düzeylerinde anlamlı farklılık bulduk. Yukarıda belirtilen parametrelerde tedavi sonrası her iki grupta da anlamlı düzelme olmasına rağmen deney grubunda tedavi öncesi ve sonrası değerlendirmeler kontrol grubuna göre olumlu yönde daha yüksekti (p<0,05). Osteoartrit hastaları için klasik fizyoterapiye ek olarak nöromüsküler egzersizlerin de gerekli olduğunu ve ağrı, artan fiziksel aktivite, fonksiyon ve denge açısından geleneksel diz egzersizlerine göre daha etkili olduğunu düşünüyoruz.

Anahtar Kelimeler

Artrit, Egzersiz, Fiziksel Aktivite, Propriosepsiyon, Rehabilitasyon.

Kaynakça

• Bennell, K. L., Kyriakides, M., Metcalf, B., Egerton, T., Wrigley, T. V., Hodges, P. W., . . . Hinman, R. S. (2014). Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial. Arthritis Rheumatol, 66(4), 950-959. doi:10.1002/art.38317
• Brosseau, L., Pelland, L., Wells, G., Macleay, L., Lamothe, C., Michaud, G., . . . Tugwell, P. (2004). Efficacy of aerobic exercises for osteoarthritis (part II): a meta-analysis. J Physical Therapy Reviews, 9(3), 125-145.
• Çelik, D., Coşkunsu, D., Kılıçoğlu, Ö., Ergönül, Ö., & Irrgang, J. J. (2014). Translation and cross-cultural adaptation of the international knee documentation committee subjective knee form into Turkish. Journal of Orthopaedic and Sports Physical Therapy, 44(11), 899-909.
• Diracoglu, D., Aydin, R., Baskent, A., & Celik, A. (2005). Effects of kinesthesia and balance exercises in knee osteoarthritis. J Clin Rheumatol, 11(6), 303-310. doi:10.1097/01.rhu.0000191213.37853.3d
• Dong, R., Wu, Y., Xu, S., Zhang, L., Ying, J., Jin, H., . . . Tong, P. (2018). Is aquatic exercise more effective than land-based exercise for knee osteoarthritis? Medicine (Baltimore), 97(52), e13823. doi:10.1097/md.0000000000013823
• Eyigor, S., Hepguler, S., & Capaci, K. (2004). A comparison of muscle training methods in patients with knee osteoarthritis. Clin Rheumatol, 23(2), 109-115. doi:10.1007/s10067-003-0836-9 Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine, 49(24), 1554-1557. doi:10.1136/bjsports-2015-095424
• Goh, S. L., Persson, M. S. M., Stocks, J., Hou, Y., Lin, J., Hall, M. C., . . . Zhang, W. (2019). Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine, 62(5), 356-365. doi:10.1016/j.rehab.2019.04.006
• Holm, I., Fosdahl, M. A., Friis, A., Risberg, M. A., Myklebust, G., & Steen, H. (2004). Effect of neuromuscular training on proprioception, balance, muscle strength, and lower limb function in female team handball players. Clinical Journal of Sport Medicine, 14(2), 88-94.
• Hootman, J. M., Macera, C. A., Helmick, C. G., & Blair, S. N. (2003). Influence of physical activity-related joint stress on the risk of self-reported hip/knee osteoarthritis: a new method to quantify physical activity. Prev Med, 36(5), 636-644. doi:10.1016/s0091-7435(03)00018-5
• Huang, M. H., Lin, Y. S., Yang, R. C., & Lee, C. L. (2003). A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Seminars in Arthritis and Rheumatism, 32(6), 398-406. doi:10.1053/sarh.2003.50021
• Juhl, C., Christensen, R., Roos, E. M., Zhang, W., & Lund, H. (2014). Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol, 66(3), 622-636. doi:10.1002/art.38290
• Koralewicz, L. M., & Engh, G. A. (2000). Comparison of proprioception in arthritic and age-matched normal knees. J Bone Joint Surg Am, 82(11), 1582-1588. doi:10.2106/00004623-200011000-00011
• Kovar, P. A., Allegrante, J. P., MacKenzie, C. R., Peterson, M. G., Gutin, B., & Charlson, M. E. (1992). Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med, 116(7), 529-534. doi:10.7326/0003-4819-116-7-529
• Lin, D. H., Lin, Y. F., Chai, H. M., Han, Y. C., & Jan, M. H. (2007). Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis. Clin Rheumatol, 26(4), 520-528. doi:10.1007/s10067-006-0324-0
• Manninen, P., Riihimaki, H., Heliovaara, M., & Suomalainen, O. (2001). Physical exercise and risk of severe knee osteoarthritis requiring arthroplasty. Rheumatology (Oxford), 40(4), 432-437. doi:10.1093/rheumatology/40.4.432
• Myer, G. D., Ford, K. R., Palumbo, J. P., & Hewett, T. E. (2005). Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. Journal of Strength and Conditioning Research, 19(1), 51-60. doi:10.1519/13643.1
• Parr, J. J., Yarrow, J. F., Garbo, C. M., & Borsa, P. A. (2009). Symptomatic and functional responses to concentric-eccentric isokinetic versus eccentric-only isotonic exercise. J Athl Train, 44(5), 462-468. doi:10.4085/1062-6050-44.5.462
• Peter, W. F., Nelissen, R. G., & Vlieland, T. P. (2014). Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice? Musculoskeletal Care, 12(3), 125-131. doi:10.1002/msc.1067
• Recondo, J. A., Salvador, E., Villanúa, J. A., Barrera, M. C., Gervás, C., & Alústiza, J. M. (2000). Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with MR imaging. Radiographics, 20 Spec No, S91-s102. doi:10.1148/radiographics.20.suppl_1.g00oc02s91
• Risberg, M. A., Mørk, M., Jenssen, H. K., & Holm, I. (2001). Design and implementation of a neuromuscular training program following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther, 31(11), 620-631. doi:10.2519/jospt.2001.31.11.620
• Rogers, M. W., Tamulevicius, N., Coetsee, M. F., Curry, B. F., & Semple, S. J. (2011). Knee Osteoarthritis and the Efficacy of Kinesthesia, Balance & Agility Exercise Training: A Pilot Study. Int J Exerc Sci, 4(2), 124-132.
• Roos, E. M., Herzog, W., Block, J. A., & Bennell, K. L. (2011). Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis. Nature Reviews: Rheumatology, 7(1), 57-63. doi:10.1038/nrrheum.2010.195
• Saglam, M., Arikan, H., Savci, S., Inal-Ince, D., Bosnak-Guclu, M., Karabulut, E., & Tokgozoglu, L. (2010). International physical activity questionnaire: reliability and validity of the Turkish version. Perceptual and Motor Skills, 111(1), 278-284.
• Sandmark, H., Hogstedt, C., & Vingård, E. (2000). Primary osteoarthrosis of the knee in men and women as a result of lifelong physical load from work. Scand J Work Environ Health, 26(1), 20-25. doi:10.5271/sjweh.505
• Song, R., Lee, E. O., Lam, P., & Bae, S. C. (2003). Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. J Rheumatol, 30(9), 2039-2044.
• Tüzün, E. H., Eker, L., Aytar, A., Daşkapan, A., & Bayramoğlu, M. (2005). Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis and Cartilage, 13(1), 28-33.
• Uysal FG, B. S. (2009). Knee Osteoarthritis. Turkish Journal of Physical Medicine and Rehabilitation, 55, 1-7.
• Villadsen, A., Overgaard, S., Holsgaard-Larsen, A., Christensen, R., & Roos, E. M. (2014). Immediate efficacy of neuromuscular exercise in patients with severe osteoarthritis of the hip or knee: a secondary analysis from a randomized controlled trial. The Journal of rheumatology, 41(7), 1385-1394.
• Wanaratna, K., Muangpaisan, W., Kuptniratsaikul, V., Chalermsri, C., & Nuttamonwarakul, A. (2019). Prevalence and Factors Associated with Frailty and Cognitive Frailty Among Community-Dwelling Elderly with Knee Osteoarthritis. Journal of Community Health, 44(3), 587-595. doi:10.1007/s10900-018-00614-5
• Zech, A., Huebscher, M., Vogt, L., Banzer, W., Hänsel, F., & Pfeifer, K. J. (2009). Neuromuscular training for rehabilitation of sports injuries: a systematic review. Medicine science in sports exercise, 41(10), 1831-1841.