A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis*,*,**,***

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Abstract

Objective: To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis (OA). Methods: One hundred thirty-two patients with bilateral knee OA (Altman Grade II) were sequentially divided into 4 random groups (GI to GIV). The patients in group I received isokinetic muscle-strengthening exercise, group II received isotonic muscle-strengthening exercise, group III received isometric muscle-strengthening exercise, and group IV acted as controls. The changes of muscle power of leg flexion and extension were measured with a Kinetic Communicator dynamometer, and patients' functional status was evaluated by visual analogue scale, ambulation speed, and Lequesne index before and after treatment, and at the follow-up 1 year later. Results: The results showed that the patients with OA in each treated group had significant improvement in pain reduction, disability reduction, and in walking speed after treatment and at follow-up when compared with their initial status. Isotonic exercise had the greatest effect on pain reduction after treatment, and fewer participants discontinued the treatment because of exercise knee pain. Isokinetic exercise caused the greatest increase of walking speed and decrease of disability after treatment and at follow-up. The greatest muscle-strength gain in 60°/second angular velocity peak torques was found in the isokinetic and isotonic exercise groups. A significant muscle-strength gain in 180°/second angular velocity peak torques was found only in the isokinetic group after treatment. Conclusion and Relevance: Isotonic exercise is suggested for initial strengthening in patients with OA with exercise knee pain, and isokinetic exercise is suggested for improving joint stability or walking endurance at a later time. Semin Arthritis Rheum 32:398-406. © 2003 Elsevier Inc. All rights reserved.

Section snippets

Subjects

On hundred thirty-two patients with moderate bilateral knee OA (Altman grade II; Table 1) (18) were selected by clinicians from outpatients attending the department of rehabilitation.

Table 1: The Criteria of Stages of Knee OA

StageKnee PainRadiographic OsteophytesAge (yr)Morning StiffnessCrepitusBony Enlargement on Physical Examination
I<40---
II>40<30 min-
III>40>30 min-
IV>40>30 min

Modified from Altman (18).

-, findings absent.

Patients with respiratory or cardiac dysfunction, or

Subjects

The ages of the 132 patients ranged from 45 to 77 years (mean, 62 ± 4.5) with a female to male ratio of 93:39. The duration of knee pain ranged from 4 months to 9 years.

Changes in knee pain

The changes in average scores of knee pain for each subgroup are shown in Table 3.

Table 3: The VAS Score of Knee Pain in Each Group Before and After Treatment

Empty CellI (Isokinetic)II (Isotonic)III (Isometric)IV (Control)
Before4.8 ± 1.4 (66)4.6 ± 1.7 (66)4.7 ± 1.4 (66)4.6 ± 1.3 (66)
After3.1 ± 1.2 (58)*2.6 ± 0.7 (62)*†‡3.6 ± 0.6 (62)*4.4 ± 0.4 (66)
Follow-up2.5 ± 1.8 (56)*2.0 ± 1.4 (58)*†‡3.2 ± 1.6 (60)*6.1 ± 1.3 (54)*
*Significant difference of VAS score after treatment or follow-up in each group (P <

Discussion

Pain and functional disability are the most common symptoms of patients with OA. Because curative therapy is not available, treatment is aimed primarily at the alleviation of these symptoms and the prevention of further joint deterioration. Knee pain and disability in patients with knee OA are associated with cartilage and bone degeneration (articular level); with muscular weakness and limitation of joint motion (kinesiologic level); and with anxiety, obsession with symptoms, and possibly

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    *

    Mao-Hsiung Huang, MD, PhD: Associate Professor, Department of Medicine, Kaohsiung Medical University Hospital, Taiwan; Physiatrist, Research Fellow; Yueh-Shuang Lin, MS: Lecturer, Department of Biomechanism, Kuan-San University of Technology, Taiwan; Research Fellow; Rei-Cheng Yang, MD, PhD: Professor of Medicine, Chairman of Department of Physiology, Kaohsiung Medical University Hospital, Taiwan; Research Director; Chia-Ling Lee, MD: Physiatrist, Kaohsiung Medical University Hospital, Taiwan; Research Fellow.

    *

    Supported by a project grant from the National Science Council of Taiwan.

    **

    Address reprint requests to: Mao-Hsiung Huang, Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan. E-mail: [email protected].

    ***

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