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The effect of core stabilization training on functional performance, balance and quality of life in patients with total knee arthroplasty
S468
Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534
Methods: Baseline data of 573 patients with knee OA of the Amsterdam-Osteoarthritis cohort were used. Upper leg muscle strength (Nm/ kg) was measured isokinetically. Activity limitations were measured with the timed Get Up and Go (GUG) test and timed Stair Climb Test (SCT), subdivided in stair-ascending and stair-descending. In order to determine whether the relationships between muscle strength and activity limitations are nonlinear, it was tested whether nonlinear (exponential) models fitted the data significantly better than linear models. Finally, linear plus constant models were used to detect thresholds. Results: Nonlinear models improved model fit compared to linear models. The improvement was 5.9, 8.2 and 5.2 percentage points for respectively the GUG, stair-ascend and stair-descend time. Muscle strength thresholds were 0.93 Nm/kg (95%CI 0.80e1.05), 0.89 Nm/kg (95%CI 0.77e1.00) and 0.97 Nm/kg (95%CI 0.86e1.09) for relationships with respectively GUG, stair-ascend and stair-descend time. Conclusions: In a large population of patients with knee OA, relationships between muscle strength and activity limitations are nonlinear (i.e., exponential), allowing detection of muscle strength thresholds. Patients with muscle strength below these thresholds might benefit more from muscle strength training to reduce limitations in daily activities than patients with muscle strength above the thresholds. Future research is needed to assess the clinical value of the thresholds determined.
Methods: Thirty-four patients undergoing total knee arthroplasty surgery (Trunk Stabilization Exercise Group, 17; Control Group, 17) were included. Both groups were given a 6-week standard home exercise program whereas the trunk stabilization exercise group was assigned to body stabilization exercises along with the standard exercise program. All patients were assessed before ana after the completion of the 6week exercise program. Trunk Stabilization muscle activity was evaluated with the activation of the multifidus muscle via pressure biofeedback device. Balance was assessed with the Berg Balance Scale (BBS). Knee function was evaluated using the Western Ontario ana McMaster Universities Osteoarthritis Index (WOMAC). Health-related quality of life (HRQL) assessed using the Short-Form-36 (SF-36) questionnaire. Functional performance was evaluated with the Timed Up & Go, 5-Time Sit to Stand, and Step Tests. The 6-Minute Walk Test was used to assess physical endurance. Results: Both groups had significant improvements (p < 0.05) except for the SF-36 subscore of bodily pain and the WOMAC subscore of stiffness after the 6-week exercise program compared with the baseline status. Adding Stabilization exercises to the Standard home exercise program produced superior results in terms of balance (z ¼ 3.72; p ¼ 0.00), trunk stability (z ¼ 4.18; p ¼ 0.00), SF-36 physical function (z ¼ 2.76; p ¼ 0.00), physical role (z ¼ 2.58; p ¼ 0.01) and, total physical function scores (z ¼ 2.94; p ¼ 0.00) and the 6-Minute Walk Test (z ¼ 3.39; p ¼ 0.01) in patients with total knee arthroplasty. Conclusions: This study demonstrated the benefit of integrating core Stabilization exercises into a standard home exercise program in terms of functional Performance, balance ana quality of life in patients with total knee arthroplasty. 801 REDUCED HIP ADDUCTION IS ASSOCIATED WITH IMPROVED FUNCTION AFTER MOVEMENT PATTERN TRAINING IN PEOPLE WITH PREARTHRITIC HIP DISEASE M. Harris-Hayes y, G.B. Salsich z, K. Steger-May y, J.C. Clohisy y, L.R. Van Dillen y, M. Schootman z, S. Czuppon y, P.K. Commean y, T.J. Hillen y, S.A. Sahrmann y, M.J. Mueller y. y Washington Univ. Sch. of Med., Saint Louis, MO, USA; z Saint Louis Univ., Saint Louis, MO, USA
Figure 1. Relationships between upper leg muscle strength and activity limitations. Solid red line ¼ threshold, dashed line ¼ 95%CI, solid pink line ¼ bilinear model. A ¼ Upper leg muscle strength and timed GUG test, B ¼ Upper leg muscle strength and timed stair-ascend test, C ¼ Upper leg muscle strength and timed stair-descend test. More time to perform the test reflects more limitations in daily activities. Therefore, muscle strength below the threshold is related to activity limitations. Note: A strength of 0 Nm/kg means that the patient was not able to move the isok inetic dynamometer at a velocity of 60º/seconds. 800 THE EFFECT OF CORE STABILIZATION TRAINING ON FUNCTIONAL PERFORMANCE, BALANCE AND QUALITY OF LIFE IN PATIENTS WITH TOTAL KNEE ARTHROPLASTY A. Karaman y, I. Yuksel y, G.I. Kinikli y, B. Atilla z. y Hacettepe Univ., Faculty of Hlth. Sci., Dept. of Physiotherapy and Rehabilitation, Ankara, Turkey; z Hacettepe Univ., Faculty of Med., Dept. of Orthopaedics and Traumatology, Ankara, Turkey Purpose: Currently, little information describing the effect of core stabilization training on functional performance and balance in patients with total knee arthroplasty exists. This study aimed to examine the effects of the addition of trunk stability exercise program to standard home exercise programs following total knee arthroplasty on functional performance, balance, and quality of life.
Purpose: Effective treatment strategies for people with pre-arthritic hip disorders (PAHD) are needed to improve function and prevent or delay the onset of hip osteoarthritis. Previously, we completed an exploratory treatment trial to assess the effectiveness of movement pattern training (MPT), a rehabilitation approach to reduce hip adduction during functional tasks, for people with PAHD. To understand better the factors associated with treatment outcomes, we performed a secondary analysis to determine the association among mechanical factors and treatment outcomes among those who participated in MPT. Methods: Participants, 18e40 years old, with chronic PAHD were recruited. Baseline assessment included questionnaires, kinematic assessment, strength testing and magnetic resonance imaging (MRI) for bony morphology. Questionnaires included patient-reported outcome measures to assess hip-specific function, the modified Harris Hip Score (MHHS) and the Hip disability and Osteoarthritis Outcome Score (HOOS). Kinematic data of the single leg squat were captured using an 8camera motion capture system. The independent kinematic variable was hip adduction motion, represented by adduction angle at peak hip flexion. Data from 3 trials were collected and averaged. Hip abductor strength was tested in sidelying with the hip in 15 of abduction. Break tests were performed using a hand-held dynamometer to determine maximum muscle force. Three trials were averaged and multiplied by the moment arm of the external resistance to determine average torque (T). Torque was normalized by body weight and height. Femoral headneck concavity, an indicator of cam impingement, was assessed using MRI. A 1.5T MR system was used to obtain a 3D fat suppressed gradient echo image centered at the pelvis. Radial reformat along the femoral neck axis was performed to obtain alpha angle (AA) measurements at 3, 2, 1 and 12 o’clock. The maximum value of AA was used for analysis. After baseline assessment, participants completed 6 weeks of MPT that included supervised sessions and home program. MPT protocol included 1) task-specific instruction to optimize lower extremity movement patterns during functional tasks and 2) hip muscle strengthening. After treatment, participants returned and completed follow up testing. Paired t-tests were used to assess change in MHHS, HOOS, hip adduction motion and hip abductor strength. Pearson correlation coefficients and Spearman correlation coefficients were used to assess the relationship
Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534
Methods: Baseline data of 573 patients with knee OA of the Amsterdam-Osteoarthritis cohort were used. Upper leg muscle strength (Nm/ kg) was measured isokinetically. Activity limitations were measured with the timed Get Up and Go (GUG) test and timed Stair Climb Test (SCT), subdivided in stair-ascending and stair-descending. In order to determine whether the relationships between muscle strength and activity limitations are nonlinear, it was tested whether nonlinear (exponential) models fitted the data significantly better than linear models. Finally, linear plus constant models were used to detect thresholds. Results: Nonlinear models improved model fit compared to linear models. The improvement was 5.9, 8.2 and 5.2 percentage points for respectively the GUG, stair-ascend and stair-descend time. Muscle strength thresholds were 0.93 Nm/kg (95%CI 0.80e1.05), 0.89 Nm/kg (95%CI 0.77e1.00) and 0.97 Nm/kg (95%CI 0.86e1.09) for relationships with respectively GUG, stair-ascend and stair-descend time. Conclusions: In a large population of patients with knee OA, relationships between muscle strength and activity limitations are nonlinear (i.e., exponential), allowing detection of muscle strength thresholds. Patients with muscle strength below these thresholds might benefit more from muscle strength training to reduce limitations in daily activities than patients with muscle strength above the thresholds. Future research is needed to assess the clinical value of the thresholds determined.
Methods: Thirty-four patients undergoing total knee arthroplasty surgery (Trunk Stabilization Exercise Group, 17; Control Group, 17) were included. Both groups were given a 6-week standard home exercise program whereas the trunk stabilization exercise group was assigned to body stabilization exercises along with the standard exercise program. All patients were assessed before ana after the completion of the 6week exercise program. Trunk Stabilization muscle activity was evaluated with the activation of the multifidus muscle via pressure biofeedback device. Balance was assessed with the Berg Balance Scale (BBS). Knee function was evaluated using the Western Ontario ana McMaster Universities Osteoarthritis Index (WOMAC). Health-related quality of life (HRQL) assessed using the Short-Form-36 (SF-36) questionnaire. Functional performance was evaluated with the Timed Up & Go, 5-Time Sit to Stand, and Step Tests. The 6-Minute Walk Test was used to assess physical endurance. Results: Both groups had significant improvements (p < 0.05) except for the SF-36 subscore of bodily pain and the WOMAC subscore of stiffness after the 6-week exercise program compared with the baseline status. Adding Stabilization exercises to the Standard home exercise program produced superior results in terms of balance (z ¼ 3.72; p ¼ 0.00), trunk stability (z ¼ 4.18; p ¼ 0.00), SF-36 physical function (z ¼ 2.76; p ¼ 0.00), physical role (z ¼ 2.58; p ¼ 0.01) and, total physical function scores (z ¼ 2.94; p ¼ 0.00) and the 6-Minute Walk Test (z ¼ 3.39; p ¼ 0.01) in patients with total knee arthroplasty. Conclusions: This study demonstrated the benefit of integrating core Stabilization exercises into a standard home exercise program in terms of functional Performance, balance ana quality of life in patients with total knee arthroplasty. 801 REDUCED HIP ADDUCTION IS ASSOCIATED WITH IMPROVED FUNCTION AFTER MOVEMENT PATTERN TRAINING IN PEOPLE WITH PREARTHRITIC HIP DISEASE M. Harris-Hayes y, G.B. Salsich z, K. Steger-May y, J.C. Clohisy y, L.R. Van Dillen y, M. Schootman z, S. Czuppon y, P.K. Commean y, T.J. Hillen y, S.A. Sahrmann y, M.J. Mueller y. y Washington Univ. Sch. of Med., Saint Louis, MO, USA; z Saint Louis Univ., Saint Louis, MO, USA
Figure 1. Relationships between upper leg muscle strength and activity limitations. Solid red line ¼ threshold, dashed line ¼ 95%CI, solid pink line ¼ bilinear model. A ¼ Upper leg muscle strength and timed GUG test, B ¼ Upper leg muscle strength and timed stair-ascend test, C ¼ Upper leg muscle strength and timed stair-descend test. More time to perform the test reflects more limitations in daily activities. Therefore, muscle strength below the threshold is related to activity limitations. Note: A strength of 0 Nm/kg means that the patient was not able to move the isok inetic dynamometer at a velocity of 60º/seconds. 800 THE EFFECT OF CORE STABILIZATION TRAINING ON FUNCTIONAL PERFORMANCE, BALANCE AND QUALITY OF LIFE IN PATIENTS WITH TOTAL KNEE ARTHROPLASTY A. Karaman y, I. Yuksel y, G.I. Kinikli y, B. Atilla z. y Hacettepe Univ., Faculty of Hlth. Sci., Dept. of Physiotherapy and Rehabilitation, Ankara, Turkey; z Hacettepe Univ., Faculty of Med., Dept. of Orthopaedics and Traumatology, Ankara, Turkey Purpose: Currently, little information describing the effect of core stabilization training on functional performance and balance in patients with total knee arthroplasty exists. This study aimed to examine the effects of the addition of trunk stability exercise program to standard home exercise programs following total knee arthroplasty on functional performance, balance, and quality of life.
Purpose: Effective treatment strategies for people with pre-arthritic hip disorders (PAHD) are needed to improve function and prevent or delay the onset of hip osteoarthritis. Previously, we completed an exploratory treatment trial to assess the effectiveness of movement pattern training (MPT), a rehabilitation approach to reduce hip adduction during functional tasks, for people with PAHD. To understand better the factors associated with treatment outcomes, we performed a secondary analysis to determine the association among mechanical factors and treatment outcomes among those who participated in MPT. Methods: Participants, 18e40 years old, with chronic PAHD were recruited. Baseline assessment included questionnaires, kinematic assessment, strength testing and magnetic resonance imaging (MRI) for bony morphology. Questionnaires included patient-reported outcome measures to assess hip-specific function, the modified Harris Hip Score (MHHS) and the Hip disability and Osteoarthritis Outcome Score (HOOS). Kinematic data of the single leg squat were captured using an 8camera motion capture system. The independent kinematic variable was hip adduction motion, represented by adduction angle at peak hip flexion. Data from 3 trials were collected and averaged. Hip abductor strength was tested in sidelying with the hip in 15 of abduction. Break tests were performed using a hand-held dynamometer to determine maximum muscle force. Three trials were averaged and multiplied by the moment arm of the external resistance to determine average torque (T). Torque was normalized by body weight and height. Femoral headneck concavity, an indicator of cam impingement, was assessed using MRI. A 1.5T MR system was used to obtain a 3D fat suppressed gradient echo image centered at the pelvis. Radial reformat along the femoral neck axis was performed to obtain alpha angle (AA) measurements at 3, 2, 1 and 12 o’clock. The maximum value of AA was used for analysis. After baseline assessment, participants completed 6 weeks of MPT that included supervised sessions and home program. MPT protocol included 1) task-specific instruction to optimize lower extremity movement patterns during functional tasks and 2) hip muscle strengthening. After treatment, participants returned and completed follow up testing. Paired t-tests were used to assess change in MHHS, HOOS, hip adduction motion and hip abductor strength. Pearson correlation coefficients and Spearman correlation coefficients were used to assess the relationship