DOI QR코드

DOI QR Code

The Effects of Trunk Stability Exercise on Knee function, Balance, Gait in patients after Total Knee Arthroplasty

체간 안정화 운동이 무릎관절 전치환술 환자의 무릎기능, 균형, 보행에 미치는 영향

  • 이재홍 (대구보건대학교 물리치료과) ;
  • 민동기 (대구보건대학교 물리치료과) ;
  • 이상재 (대구 더열린병원)
  • Received : 2017.11.08
  • Accepted : 2018.02.02
  • Published : 2018.02.28

Abstract

This study was conducted to investigate the effects of trunk stability exercise on knee function, balance and gait in patients who underwent total knee arthroplasty. The subjects of this study were recruited from individuals diagnosed with degenerative arthritis who had undergone total knee arthroplasty. Overall, 24 patients were randomly divided into a control groups and an experimental groups (12 each). The trunk stability exercise was conducted for 4 weeks with three exercises developed in a previous study. The measurement tools used were knee function measurements based on the Lysholm knee score, balance ability measured using a test of TUG and OLS, and a walking ability test measured using a 10MWT. Pre and post test results were within groups were compared using the paired t-test, whole differences between groups were compared using the independent t-test. The experimental group showed significantly enhanced results relative to the control group (p<0.05). Based on these results, trunk stability exercise in parallel with knee joint therapy effectively improves the recovery of patients with total knee arthroplasty.

본 연구는 퇴행성 관절염으로 인해 무릎관절 전치환술을 실시한 환자를 대상으로 체간 안정화 운동이 무릎기능, 균형, 보행능력 향상에 어떠한 영향을 미치는지 알아보고자 한다. 본 연구 대상자는 퇴행성 관절염으로 진단 받아 무릎관절 전치환술을 실시한 환자 24명을 선정하여, 무작위 배분으로 일반 물리치료를 실시한 대조군 12명, 체간 안정화 운동을 실시한 실험군 12명으로 구성하였다. 체간 안정화 운동은 선행 연구를 참고하여 구성한 3가지 운동을 총 4주간 실시하였다. 측정도구로는 무릎기능 측정은 무릎관절 주관적 기능 점수 척도를, 균형능력은 일어나 걷기 검사, 한발 서기 검사를 보행능력은 10미터 걷기 검사를 이용하였다. 통계학적 분석은 각 그룹 내 비교는 대응표본 t-검정, 각 그룹 간 비교는 독립표본 t-검정으로 분석하였다. 본 연구 결과 중재 후 실험군이 대조군에 비해 모든 측정 결과가 유의하게 향상되어 나타났다(p<.05). 이와 같은 결과를 바탕으로 무릎관절 전치환술 환자를 대상으로 무릎관절 치료와 함께 체간 안정화 운동을 실시한다면, 환자의 무릎기능, 균형, 보행에 좀 더 효과적이라고 판단된다.

Keywords

References

  1. Badley E. E., Wang P. P., "Arthritis and the aging population: Projection of arthritis prevalence in Canada 1991 to 2031", The Journal of rheumatology, vol. 25, no. 1, pp. 138-144, 1998.
  2. Brooks P. M., "Impact of osteoarthritis on individual and society: how much disability? Social consequences and health economic implication", CURRENT OPINION IN RHEUMATOLOGY, vol. 14, no. 5, pp. 573-577, 2002. DOI: https://doi.org/10.1097/00002281-200209000-00017
  3. Creamer P, Lethbridge-Cejku M, Hochberg M. C, "Factors associated with functional impairment in symptomatic knee osteoarthritis", Rheumatology, vol. 39, no. 5, pp. 490-496, 2000. DOI: https://doi.org/10.1093/rheumatology/39.5.490
  4. H. J. Cho, C. B. Chang, J. W. Jung, S. C. Seong, T. K. Kim, "Prevalence of radiographic knee osteoarthritis in elderly kreans", Korean Knee Society, vol. 21, no. 4, pp. 223-231, 2009.
  5. Kramer J. F, Speechley M, Bourne R, Rorabeck C, Vaz M, "Comparison of clinic and home-based rehabilitation programs after total knee arthroplasty", Clinical orthopaedics and related research, vol. -no. 410, pp. 225-234, 2003.
  6. K. O. Hwang, "The effects of isometric exercise and active stretching on joint function in patient with osteoarthritis", Daegu University Dissertation of Master Degree, 2005
  7. Brill P. W, Couzen G. S, "The core program", 1-231, Bantam Book, 2002.
  8. Akuthota V, Nadler S. F, "Core strengthening", Archives of physical medicine and rehabilitation, vol. 85, pp. 86-92, 2004. DOI: https://doi.org/10.1053/j.apmr.2003.12.005
  9. Marshall P. W, Murphy B. A, "Core stability exercises on and off a swiss ball", Archives of physical medicine and rehabilitation, vol. 86, no. 2, pp. 242-249, 2005. DOI: https://doi.org/10.1053/j.apmr.2003.12.005
  10. O'Sullivan P. B, Twomey L. T, Allison G. T, "Evaluation of specific stabilizing exercise in the treatment of chronin low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis", Spine, vol. 22, no. 24, pp. 2959-2967, 1997. DOI: https://doi.org/10.1097/00007632-199712150-00020
  11. M. S. Jung, H. S. Kwak, "The effects of a muscle strengthening exercise program on pain, straight leg raising ability, passive range of motion, independent walking time and satisfaction with total knee arthroplasty(TKA)", The journal of Korean Academic Society of Nursing Education, vol. 14, no. 1, pp. 20-29, 2008. DOI: http://dx.doi.org/10.5977/JKASNE.2008.14.1.020
  12. H. S. Min, "Effects of muscle strengthening exercise program on pain, fatigue, physical function in elderly women with total knee arthroplasty", Journal of Muscle and Joint Health, vol. 18, no. 2, pp. 203-214, 2011. DOI: https://doi.org/10.5953/JMJH.2011.18.2.203
  13. Maniar R. N, Baviskar J. V, Singhi T, Rathi S. S, "To use or not to use continuous passive motion post-total knee arthroplasty", The Journal of arthroplasty, vol. 27, no. 2, pp. 193-200, 2012. DOI: https://doi.org/10.1016/j.arth.2011.04.009
  14. Synder M, Kozlwski P, Drobniewski M, Grzegorzewski A, Glowacka A, "The use of continuous passive motion(CPM) in the rehabilitation of patients after total knee arthroplasty", Journal of Orthopaedics and Traumatology, vol. 6, no. 3, pp. 336-41, 2004
  15. Sara R, Piva, Alexandra B, Gil, Gustabo J, Almeida M, Antony M, DGgioia III, Iimothy J, Levison G, Kelley Fitzgerald, "A balance exercise program appears to improve function for patiens with total knee arthroplasty : a randomized clinical trial", Journal of the american physical therapy association, vol. 90, no. 6, pp. 880-894, 2010.
  16. J. Y. Youn, "Effect of thera band exercise program following total knee replacement", Dankook University Dissertation of Master Degree, 2013.
  17. Liebenson, C. Spinal stabilization training: the transverse abdominis. Journal of Bodywork and Movement Therapies, vol. 2, no. 4, pp. 218-223. 1998. DOI: https://doi.org/10.1016/S1360-8592(98)80018-1
  18. Liebenson, C. Functional abdominal training. Journal of Bodywork and Movement Therapies, vol. 7, no. 2, pp. 101-103. 2003. DOI: https://doi.org/10.1016/S1360-8592(02)00112-2
  19. C. B. Jeon, "Effects of Trunk Stabilization Exercise on the Thickness of the Deep Abdominal Muscles and Balance in Hemiplegic Patients", Daegu University Dissertation of Master Degree, 2012.
  20. C. Y. Kim, "The Effects of Trunk Stability Exercise on Trunk Strengthening, Dynamic Balance and Walking in the Persons with Chronic Stroke", Sahmyook University Dissertation of Master Degree, 2008.
  21. Lysholm, J., & J. Gillquist. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale, Am J Sports Med, 10, pp. 150-154. 1982. DOI: https://doi.org/10.1177/036354658201000306
  22. Posiadlo D, Richardson S. The Timed "Up & Go": a test of basic functional mobility for frail elderly persons, J Am Geriatr Soc, 39: pp. 142-148, 1991. DOI: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  23. Man-Roung Lin, Hei-Fen Hwang, et al., Psychometric Comparisons of the Timed Up and Go, One-Leg Stand, Functional Reach, and Tinetti Balance Measures in Community-Dwelling Older People. 2004.
  24. Wirz M, Van Hedel HJ, et al., Muscle force and gait performance : relationships after spinalcord injury. 2006.
  25. Urquhart D. M, Hodges P. W., Allen T. J., Story I. H.., "Abdominal muscle recruitment during a range of voluntary exercises", Man Ther, 10, 2, pp. pp. 144-153, 2005. DOI: https://doi.org/10.1016/j.math.2004.08.011
  26. Stevens V. K, Coorevits P. L., Bouche K. G., Mahieu N. N., Vanderstraeten G. G., Danneels L. A., "The influence of specific training on trunk muscle recruitment patterns in healthy subjects during stabilization exercises", Man Ther, 12, 3, pp. pp. 271-279, 2007. DOI: https://doi.org/10.1016/j.math.2006.07.009
  27. O'sullivan P. B, "Lumbar segmental 'instability': clinical presentation and specific stabilizing exercise management", Man Ther, 5, 1, pp. 2-12, 2000. DOI: https://doi.org/10.1016/j.math.2006.07.009
  28. Ryerson S, Byl N. N., Brown D. A., Wong R. A., Hidler J. M., "Altered trunk position sense and its relation to balance functions in people post-stroke", Journal Neurol Phys Ther, 32, 1, pp. pp. 14-20, 2008. DOI: https://doi.org/10.1097/NPT.0b013e3181660f0c
  29. M. Piirtola and P. Era, "Force platform measurement as predictors of falls among older people-a review", Gerontology, vol. 52, pp. 1-16, 2006. DOI: https://doi.org/10.1159/000089820
  30. B. J. Park, "Effects of Core Stability Combined Rehabilitation on Muscle Strenght, Stability of Knee Joint after ACL Reconstruction", Korea University Dissertation of Master Degree, 2011.
  31. I. Y. Oh, "The Effects of 12wk Accelerated Rehabilitation Exercise on Knee Strengthening, Balance, Thigh Circumference and Lysholm Score After ACL Reconstruction", Kookmin University Dissertation of Master Degree, 2011.
  32. Hodges P. W, Richardson, C. A. "Contraction of the abdominal muscle associated with movement of the lower limb", Physical Therapy, 77, pp. pp. 132-142, 1997. DOI: https://doi.org/10.1093/ptj/77.2.132
  33. Akuthota, V., Nadler, S. F. "Core strengthening", Archives of Physical Medicine and Rehabilitation, vol. 85, no. 3, 92, 586, 2004.
  34. Dennis, D.A., Evaluation of painful total knee arthroplasty, J Arthroplasty, 19(4 Suppl 1): p. pp. 35-40, 2004. DOI: https://doi.org/10.1016/j.arth.2004.03.003
  35. Y. H. Kim, "The Effects of Trunk Stability Exercise on the Balance and Gait in the Patients with Stroke", Daegu University Dissertation of Master Degree, 2010.
  36. Kane K, Bell A, "A core stability group program for children with developmental coordination disorder: 3 clinical case reports", Pediatric Phys Ther, 21, 4, pp. pp. 375-382, 2009. DOI: https://doi.org/10.1097/PEP.0b013e3181beff38