Publication: Influence of neuromuscular exercise and patient education in patients with knee osteoarthritis and ınstability
Abstract
Amaç: Bu çalışmanın hedefi, diz osteoartriti (OA) ve instabilitesi olan hastalarda hasta eğitimi ve nöromüsküler egzersiz programının, (GLA:D programının) etkisini incelemektir. Çalışmanın amacı, instabilitesi olan ve olmayan hastalarda programın ağrı ve yürüme hızındaki değişime etkisini karşılaştırmayı ve programın instabilite, dizde güvensizlik ve dizi kıvırma/ kendi ekseninde döndürme zorluğundaki değişime etkisini değerlendirmektir. Gereç ve Yöntem: Çalışma, sertifikalı klinisyenler tarafından verilen 8 haftalık bir egzersiz ve hasta eğitimi olan GLA:D programına kayıtlı, yaş ortalaması 66,1 ve %69'u kadın olan 3633 katılımcıyı içerdi. Hasta tarafından bildirilen diz instabilitesi değişkenine göre 2466 katılımcı dört gruba ayrıldı ve diz ağrısı şiddeti ve yürüyüş hızları başlangıçta ve program sonrasında değerlendirildi. Diz instabilitesi ile ağrı şiddeti ve yürüyüş hızındaki değişiklikler arasındaki ilişki, doğrusal regresyon analizi kullanılarak, cinsiyet, yaş, vücut kitle indeksi, fiziksel aktivite düzeyi ve önceki diz ameliyatı karıştrıcı faktörler olarak kullanılarak incelendi. İkinci hedef için, 3633 katılımcının tamamı için diz instabilitesindeki, dizde güvensizlik ve dizi kıvırmakkendi ekseninde döndürme zorluğundaki değişiklikler 5’li Likert ölçeği ve McNemar-Bowker testi kullanılarak değerlendirildi. Bulgular: Çalışmanın başlangıcında çoğu zaman veya her zaman diz instabilitesi yaşayan hastalar, nadiren instabilite yaşayan hastalara göre ağrı şiddeti (4,3 mm (1,2 ila 7,5) ve yürüme hızında (0,01 m/ s (-0,02 ila 0,03)) daha fazla iyileşme gösterdi. Programdan sonra, diz instabilitesini hiç yaşamayan ya da nadiren yaşayan, diz güvensizliği hiç olmayan ya da hafif düzeyde olan ve dizi kıvırmak/ kendi ekseninde döndürmede hiç zorluk yaşamayan ya da hafif zorluk yaşayan katılımcıların oranlarının arttığı görüldü (p<0.001). Sonuç: Bu çalışma, egzersiz ve hasta eğitimi sonrasında daha şiddetli diz instabilitesi olan OA hastalarının ağrı ve yürüme hızında daha iyi iyileşme sağladığını göstermiştir. GLA:D sonrasında diz OA'li hastalarda instabilite, diz güvensizliği ve dizi kıvırma/ kendi ekseninde döndürme semptomları azalmıştır.
Objective: The objective of this study was to evaluate the influence of a neuromuscular exercise and patient education program, particularly the GLA:D® regimen, in patients with knee osteoarthritis (OA) and associated instability. The study aimed to compare the program's influence on changes in pain and gait speed in patients with and without instability and assess changes in symptoms of instability, lack of knee confidence, and difficulty with twisting/ pivoting after the program. Materials and Methods: The study involved 3633 participants, with a mean age of 66.1 years and 69% females, who were enrolled in the GLA:D program, an 8-week exercise and education program delivered by certified clinicians. Based on their self-reported knee instability, 2466 participants were divided into four groups and their knee pain intensity and gait speed were assessed at baseline and after the program. The association between knee instability and changes in pain intensity and gait speed was examined using linear regression analysis, adjusting for sex, age, BMI, physical activity level, and previous knee surgery. For the second objective, the changes in knee instability, lack of knee confidence, and difficulty with twisting/ pivoting were evaluated for all 3633 participants using a 5-point Likert-like scale and the McNemar-Bowker test. Results: Patients who experienced knee instability most or all the time at the outset of the study demonstrated greater improvements in pain (4.3 mm (1.2 to 7.5) and gait speed (0.01 m/ s (-0.02 to 0.03) than those who rarely experienced instability. After the program, there were increased proportions of participants who reported never or only rarely experiencing knee instability, as well as more patients experiencing no or mild lack of knee confidence and no or mild difficulty with twisting and pivoting (p<0.001). Conclusion: The study found a relationship between more severe knee instability and better improvements in pain and gait speed after exercise and education. OA. After participating in GLA:D program, symptoms of instability, lack of confidence, and difficulty twisting in patients with knee OA was reduced.
Objective: The objective of this study was to evaluate the influence of a neuromuscular exercise and patient education program, particularly the GLA:D® regimen, in patients with knee osteoarthritis (OA) and associated instability. The study aimed to compare the program's influence on changes in pain and gait speed in patients with and without instability and assess changes in symptoms of instability, lack of knee confidence, and difficulty with twisting/ pivoting after the program. Materials and Methods: The study involved 3633 participants, with a mean age of 66.1 years and 69% females, who were enrolled in the GLA:D program, an 8-week exercise and education program delivered by certified clinicians. Based on their self-reported knee instability, 2466 participants were divided into four groups and their knee pain intensity and gait speed were assessed at baseline and after the program. The association between knee instability and changes in pain intensity and gait speed was examined using linear regression analysis, adjusting for sex, age, BMI, physical activity level, and previous knee surgery. For the second objective, the changes in knee instability, lack of knee confidence, and difficulty with twisting/ pivoting were evaluated for all 3633 participants using a 5-point Likert-like scale and the McNemar-Bowker test. Results: Patients who experienced knee instability most or all the time at the outset of the study demonstrated greater improvements in pain (4.3 mm (1.2 to 7.5) and gait speed (0.01 m/ s (-0.02 to 0.03) than those who rarely experienced instability. After the program, there were increased proportions of participants who reported never or only rarely experiencing knee instability, as well as more patients experiencing no or mild lack of knee confidence and no or mild difficulty with twisting and pivoting (p<0.001). Conclusion: The study found a relationship between more severe knee instability and better improvements in pain and gait speed after exercise and education. OA. After participating in GLA:D program, symptoms of instability, lack of confidence, and difficulty twisting in patients with knee OA was reduced.