Investigation of the Effects of Modified Otago and Neuromuscular Exercise Programs on Falling, Gait, Physical Function and Quality of Life in Geriatric Knee Osteoarthritis
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 88
- 试验地点
- 2
- 主要终点
- Functional Status Assessment
研究概览
简要总结
. This study was carried out to examine the effects on walking, physical function and quality of life. There were 88 individuals in the study and they were divided into three groups as Modified Otago, Neuromuscular and Control groups. Traditional physiotherapy applications (Hotpack + Ultrasound (US) + Transcutaneous Electrical Nerve Stimulation (TENS) were applied to all groups. In addition to these applications, Modified Otago and Neuromuscular exercises were performed 2 days a week in a clinical setting, accompanied by a physiotherapist for 12 weeks. The control group was only followed up. Patients were evaluated for basic parameters before and after treatment: Berg Balance Scale (BBS) and Timed Up Go Test (TUG) for balance and fall risk, International Fall Efficiency Scale (FES-I) for fear of falling, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for symptoms and function, Tampa Kinesiophobia Scale (TKS) for kinesiophobia, 6-minute walk test for functional capacity (6MWT), Nottingham Health Profile (NHP) for quality of life, McGill Short Form (MSF) questionnaire for pain, an android-based smartphone application called "Gait Analyzer" were used for spatio-temporal variables in gait. Joint position sense (JPS) was measured with a goniometer and knee flexion was determined as 30° and 60° target angles. The exercise experiences of the groups who exercised after the treatment were evaluated by asking three questions with answers ranging from 0 to 10. It was observed that modified Otago and Neuromuscular exercises reduced the risk of falling and fear of falling, increased balance, decreased clinical symptoms and pain, increased function and quality of life, provided positive changes in the spatio-temporal parameters of walking and partially improved the sense of joint position compared to the control group (p<0,05). When the exercise groups were compared, the Modified Otago group had more positive quality of life and pain than the Neuromuscular exercise group (p<0.05). In addition, individuals in this group evaluated the exercises as less boring and less tiring (p<0.001). Modified Otago and Neuromuscular exercises can be included in the treatment programs of individuals with geriatric knee osteoarthritis as exercises aimed at reducing possible falls. It was concluded that Modified Otago exercises are superior and therefore more preferable in terms of compliance and satisfaction of individuals.
详细描述
This study was conducted to geriatric individuals diagnosed with knee osteoarthritis who applied to T.R. Ministry of Health Kilis Prof. Dr. Alaeddin Yavaşca State Hospital Department of the Physical Therapy and Rehabilitation. 88 individuals who volunteered to participate in the study were included in the study. Individuals were evaluated in terms of basic parameters and 3 randomized groups were formed: Modified Otago exercise group (29), neuromuscular exercise group (29) and control group (30).
The study protocol was approved by Hasan Kalyoncu University Ethics Committee (No: 2021/073, 31.05.2021). Individuals were informed about the scope, duration, treatment and evaluations of the study.
The study was planned as prospective, single-blind and randomized controlled. Patients underwent a preliminary evaluation by a physiotherapist to determine compliance with the inclusion criteria. The numbers were randomly distributed on the website www.random.org, which offers random numbers for many purposes. Patients whose eligibility was determined were then assigned to one of these groups in the order of arrival. The groups were determined as Group-1 Modified Otago Exercise Group (MOEG), Group-2 Neuromuscular Exercise Group (NEG) and Group-3 Control Group (CG).
Initially, traditional physiotherapy applications (Hotpack + US (Ultrasound) + TENS (Transcutaneous Electrical Stimulation) were applied to each group, and after these applications, each group was evaluated in terms of basic parameters.
In addition to these practices, the exercise groups were given modified otago and neuromuscular exercises in the clinic, 2 days a week, under the supervision of a physiotherapist, for 12 weeks. KG was not intervened.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 65 Years 至 80 Years（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Diagnosed with knee OA
- •65 years and above - 80 years and below
- •BMI <30 kg/m2
- •3 < VAS score < 8
- •Berg Balance Scale scores between 21-40
- •Have a score of 24 or above on the Standardized Mini Mental State Test
- •Not having received physiotherapy treatment in the last year.
- •Able to adapt to the training program,
- •Those who want to participate in volunteer work,
- •Individuals with informed consent
排除标准
- •Patients with positive Romberg Test
- •Patients with absolute angular error value more than 20˚ in the evaluation of joint position sense
- •Patients with B12 deficiency
- •Patients using antidepressant, anxiolytic and myorelaxant derivative drugs
- •Patients diagnosed with diabetes
- •Patients with discopathy
- •Those who have had lower extremity surgery, traumatic injury within the last six months, or are currently involved in a rehabilitation program
- •Refusing to participate in the study
- •Patients who cannot adapt to the training program.
结局指标
主要结局
Functional Status Assessment
时间窗: 3 months
WOMAC is a self-reported health status measure developed to assess pain, joint stiffness, and function that is widely used in patients with hip and knee osteoarthritis.
Spatio-Temporal Variables of Gait
时间窗: 3 months
For gait, a smartphone-based application called "Gait Analyzer" for gait (version 0.9.95.0 (Control One LLC, NM, USA)), offered as a paid application by the Android platform, whose reliability and validity have been tested-retested, was used. As a result of the measurement made with this application, kinematic data of walking such as walking speed, cadence, step time, step length, step length symmetry and step time symmetry can be obtained. After the program was installed on the smartphone (Huawei Mate 10 Lite, RNE-L01), some demographic data of the patient was entered. Afterwards, the smartphone was fixed to the area corresponding to the patient's L3 proccesus spinosus with a suitable waist belt with a velcro bandage. The measurement was then performed by asking the patients to walk a distance of 20 meters in their natural walking style and speed, without walking aid. The results were recorded on the form.
Fall Risk Assessment
时间窗: 3 months
Berg Balance Scale (BBS): BBS is used to evaluate an adult's balance abilities while performing functional tasks. Some functional activities such as standing up from a sitting position, standing without support, standing on one leg, various turning activities, standing with eyes closed, and chair transfers are evaluated. The scale consists of 14 items in Likert format and performances are scored as five different points (0-4), ranging from 0 "cannot do" to 4 "does independently and safely". The total score is between 0 and 56 points. The closer this value is to 0, the higher the risk of falling.
Balance Assessment
时间窗: 3 months
Timed Up and Go Test (TUG) :Recommended by the American Geriatrics Society and the British Geriatrics Society to screen for fall risk. This test was used to determine functional mobility and fall risk. For the test, patients were asked to sit on a chair. A target point was determined 3 meters away from the chair.
Assessment of Fear of Falling
时间窗: 3 months
Falls Efficacy Scale - International FES-I :International Falls Efficacy Scale is a 16-question self-reported scale that aims to obtain information about individuals' anxiety levels regarding falls while performing daily life activities. The questions are in Likert format and are scored as 4 points (1-4), from 1 "I am not worried at all" to 4 "I am very worried". The total score varies between 16-64 points, and the closer this score is to 64, the higher the fear of falling.
Evaluation Quality of Life
时间窗: 3 months
The Turkish version of the Nottingham Health Profile (NHP) was used to evaluate individuals' perceptions of quality of life. NHP is a quality of life scale used to measure individuals' perceived health status. It has been found to be extremely safe for use in OA populations. Turkish adaptation and psychometric properties study of the questionnaire was conducted by Küçükdeveci et al. It was conducted by in individuals with OA. The survey essentially consists of two parts. The first part deals with 6 health-related dimensions (pain-8, physical activity-8, energy level-3, sleep-5, social isolation-5 and emotional reactions-9) and consists of a total of 38 items. The second part consists of 7 items. Individuals are asked to evaluate the situations as "yes" or "no". Each section is scored between 0-100 points and the total score is scored between 0-600 points, thus obtaining a health profile score. Low scores indicate a good health profile, high scores indicate a poor health profile.
次要结局
- Pain Assessment(3 months)
- Functional Capacity Evaluation(3 months)
- Assessment of Kinesiophobia(3 months)
- Joint Position Sense(3 months)
- Assessing Exercise Satisfaction(3 months)
研究者
Mehmet Ercan ODABAŞIOĞLU
PhD
Hasan Kalyoncu University