Educational Significance of Therapeutic Exercise in the Functional Recovery of Patients with Knee Osteoarthritis: A Multidimensional Perspective
DOI:
https://doi.org/10.18662/rrem/17.2/1001Keywords:
knee osteoarthritis, therapeutic exercise, joint mobility, patient education, physical therapyAbstract
Knee osteoarthritis (OA) is a prevalent degenerative joint disorder significantly affecting mobility, functional independence, and quality of life, particularly in older adults. This study investigated the role of therapeutic physical exercise, integrated with pharmacological treatment, in restoring joint mobility and reducing pain and stiffness in patients diagnosed with knee OA. A two-year intervention involving 52 participants was conducted, comparing a control group undergoing pharmacological treatment alone with an experimental group following a combined rehabilitation program. Functional outcomes were assessed using goniometric measurements and the WOMAC scale. Results demonstrated statistically significant improvements in the experimental group across all indicators-flexion amplitude, extension deficit, pain, stiffness, and functional status-validating the efficacy of therapeutic exercise. Moreover, educational strategies enhanced treatment adherence and outcomes. The study highlights the international relevance of integrating exercise and patient education in OA management and proposes a replicable, evidence-based model for rehabilitation programs.
References
Albu, A., Albu, C., & Vlad, T.L. (2004). Kinetoterapia pasivă. Polirom.
Altman, R. D., & Gold, G. E. (2007). Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis and Cartilage, 15(Suppl A), A1–A56. https://doi.org/10.1016/j.joca.2006.11.009
Altman, R., Asch, E., Bloch, D., Bole, G., Borenstein, D., Brandt, K., Christy, W., Cooke, T. D., Greenwald, R., Hochberg, M., Howell, D., Kaplan, D., Koopman, W., Longley, S., Mankin, H., McShane, D. J., Medsger, T., Meenan, R., Mikkelsen, W., & Wolfe, F. (1986). Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis & Rheumatism, 29(8), 1039–1049. https://doi.org/10.1002/art.1780290816
Ayhan, E., Kesmezacar, H., & Akgun, I. (2014). Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World journal of orthopedics, 5(3), 351–61. https://doi.org/10.5312/wjo.v5.i3.351
Bandy, D.W., & Sanders, B. (2013). Therapeutic Exercise for Physical Therapy Assistants. ((3thed) Philadelphia : Wolters Kluwer/Lippincott Williams & Wilkins Health.
Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., Arden, N. K., Bennell, K., Bierma-Zeinstra, S. M. A., Kraus, V.B., Lohmander, L.S., Abbott, J.H., Bhandari, M., Blanco, F.J., Espinosa, R., Haugen, I.K., Lin, J., Mandl, L.A., Moilanen, E., Nakamura, N., Snyder-Mackler, L., Trojian, T., Underwood, M., McAlindon, T.E., & McAlindon, T. E. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 27(11), 1578–1589. https://doi.org/10.1016/j.joca.2019.06.011
Bartholdy, C., Juhl, C., Christensen, R., Lund, H., Zhang, W., & Henriksen, M. (2017). The role of muscle strengthening in exercise therapy for knee osteoarthritis: A systematic review and meta-regression analysis of randomized trials. Semin Arthritis Rheum. 47(1), 9-21. https://doi.org/10.1016/j.semarthrit.2017.03.007
Bean, J.F, Kiely, D.K., Herman, S., Leveille, S.G., Mizer, K., Frontera, W.R, & Fielding, R. A. (2002). The relationship between leg power and physical performance in mobility-limited older people. Journal of the American Geriatrics Society, 50(3), 461–7. https://doi.org/10.1046/j.1532-5415.2002.50111.x
Berenbaum, F., & Walker, C. (2020). Osteoarthritis and inflammation: a serious disease with overlapping phenotypic patterns. Postgraduate Medicine, 132(4), 377–384. https://doi.org/10.1080/00325481.2020.1730669
Blagojevic, M., Jinks, C., Jeffery, A., & Jordan, K.P. (2010). Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 18(1), 24-33. https://doi.org/10.1016/j.joca.2009.08.010
Bonan, I., & Carson, P. (2009). Rôle de la rééducation dans le traitement de la gonarthrose (Role of physical therapy in the treatment of gonarthrosis). La Revue du praticien, 59(9), 1246–7. French.
Braun, H. J., & Gold, G. E. (2012). Diagnosis of osteoarthritis: imaging. Bone, 51(2), 278–88. https://doi.org/10.1016/j.bone.2011.11.019
Brosseau, L., Taki, J., Desjardins, B., Thevenot, O., Fransen, M., Wells, G.A., Mizusaki, Imoto, A., Toupin-April, K., Westby, M., Álvarez, Gallardo, I.C., Gifford, W., Laferrière, L., Rahman, P., Loew, L., De Angelis, G., Cavallo, S., Shallwani, S.M., Aburub, A., Bennell, K.L., Van der Esch, M., Simic, M., McConnell, S., Harmer, A., Kenny, G.P., Paterson, G., Regnaux, J.P., Lefevre-Colau, M.M., & McLean, L. (2017). The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clinical Rehabilitation, 31(5), 596–611. https://doi.org/10.1177/0269215517691084
Bruyère, O., Honvo, G., Veronese, N., Arden, N.K., Branco, J., Curtis, E.M., Al-Daghri, N.M., Herrero-Beaumont, G., Martel-Pelletier, J., Pelletier, J.P., Rannou, F., Rizzoli, R., Roth, R., Uebelhart, D., Cooper, C., & Reginster, J.Y. (2019). An updated algorithm recommendation for the management of knee osteoarthritis from the European society for clinical and economic aspects of osteoporosis. osteoarthritis and musculoskeletal diseases (ESCEO). Semin Arthritis Rheum, 49(3), 337-350. https://doi.org/10.1016/j.semarthrit.2019.04.008
Dulay, G. S., Cooper, C., & Dennison, E. M. (2015). Knee pain, knee injury, knee osteoarthritis & work. Best Practice & Research Clinical Rheumatology, 29(3), 454-61. https://doi.org/10.1016/j.berh.2015.05.005
Dunleavy, K., & Slowik, K. A. (2018). Therapeutic exercise prescription. (1thed) Elsevier.
Fitzgerald, G. K., & Oatis, C. (2004). Role of physical therapy in management of knee osteoarthritis. Current opinion in rheumatology, 16(2), 143–7. https://doi.org/10.1097/00002281-200403000-00013.
Fransen, M., McConnell, S., Harmer, A. R., van der Esch, M., Simic, M., & Bennell, K. L. (2015a). Exercise for osteoarthritis of the knee: a Cochrane systematic review. British journal of sports medicine, 49(24), 1554-1557. https://doi.org/10.1136/bjsports-2015-095424
Fransen, M., McConnell, S., Harmer, A. R., van der Esch, M., Simic, M., & Bennell, K. L. (2015b). Exercise for osteoarthritis of the knee. The Cochrane Database of Systematic Reviews, 1(1), CD004376. https://doi.org/10.1002/14651858.CD004376.pub3
GBD 2021 Osteoarthritis Collaborators. (2023). Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021, The Lancet Rheumatology, 5,(9),e508-e522, https://doi.org/10.1016/S2665-9913(23)00163-7
Germain-Calais, B. & Germain, F. (2024). Anatomie pentru miscare. Introducere în analiza tehnicilor corporale. Volumul I, Ediția a III-a revizuită. Polirom.
Herbert, R. D., de Noronha, M., & Kamper, S. J. (2011). Stretching to prevent or reduce muscle soreness after exercise. Cochrane database of systematic reviews, 6(7), CD004577. https://doi.org/10.1002/14651858.CD004577.pub3
Hunter, D.J., & Bierma - Zeinstra, S. (2019). Osteoarthritis. Lancet, 393(10182), 1745-1759. https://doi.org/10.1016/s0140-6736(19)30417-9
Kalu, M.E., Dal Bello-Hass, V., Griffin, M., Boamah, A.S., Harris, E. J., Zaide, M., Rayner, G.D., Khattab, N., Bhatt, V., Goodin, C., Song, (Beth) J.W., Smal, J., & Budd, N. (2022). Physical mobility determinants among adults:a scoping review of self-reported and performance-based measures. European Journal of Physiotherapy, 25(9), 1-18. https://doi.org/10.1080/21679169.2022.2153303
Kellgren, J.H., & Lawrence, J.S. (1957). Radiological assessment of osteo-arthrosis. Annals of the rheumatic diseases, 16(4), 494–502. https://doi.org/10.1136/ard.16.4.494.
Kisner, C., Borstad, J., & Colby, L., (Eds.). (2023). Therapeutic exercise: Foundations and techniques. (8th ed.) F. A. Davis Company - PT Collection
Kisner, C., Colby, L. A., Borstad, J. (2018). Therapeutic Exercise: Foundations and Techniques (7thed) F. A. Davis Company – PT Collection
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W.F., Hawker, G., Herzig, E., Kwoh, C.K., Nelson, A.E., Samuels, J., Scanzello, C., White, D., Wise, B., Altman. R.D., DiRenzo, D., Fontanarosa, J., Giradi, G., Ishimori, M., Misra, D., Shah, A.A., Shmagel, A.K., Thoma, L.M., Turgunbaev, M., Turner, A.S., & Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology, 72(2), 220–233. https://doi.org/10.1002/art.41142
Kroon, F. P., van der Burg, L. R., Buchbinder, R., Osborne, R. H., Johnston, R. V., & Pitt, V. (2014). Self-management education programmes for osteoarthritis. The Cochrane Database of Systematic Reviews, 2014(1), CD008963. https://doi.org/10.1002/14651858.CD008963.pub2
La Grow, S., Yeung, P., Towers, A., Alpass, F., & Stephens, C. (2013). The impact of mobility on quality of life among older persons. Journal of Aging and Health, 25(5), 723-736. https://doi.org/10.1177/0898264313490198
Levangie, P.K., & Norchin, C.C. (2011). Joint structure and function: A comprehensive analysis. (5thed.) F. A. Davis Company.
Lorig, K. R., Ritter, P., Stewart, A. L., Sobel, D. S., Brown, B. W., Jr., Bandura, A., Gonzalez, V. M., Laurent, D. D., & Holman, H. R. (2001). Chronic disease self-management program: 2-year health status and health care utilization outcomes. Medical care, 39(11), 1217–23. https://doi.org/10.1097/00005650-200111000-00008
Magnusson K, Turkiewicz, A., & Englund, M. (2019). Nature vs nurture in knee osteoarthritis - the importance of age, sex and body mass index. Osteoarthritis Cartilage, 27(4), 586–592. https://doi.org/10.1016/j.joca.2018.12.018
Mahir, L., Belhaj, K., Zahi, S., Azanmasso, H., Lmidmani, F., & El Fatimi, A. (2016). Impact of knee osteoarthritis on the quality of life. Annals of physical and rehabilitation medicine, 59, e159. https://doi.org/10.1016/j.rehab.2016.07.355
McGregor, R. A., Cameron-Smith, D., & Poppitt, S. D. (2014). It is not just muscle mass: a review of muscle quality, composition and metabolism during ageing as determinants of muscle function and mobility in later life. Longev & healthspan, 3(1), 9. https://doi.org/10.1186/2046-2395-3-9
McWilliams, D. F., Leeb, B. F., Muthuri, S. G., Doherty, M., & Zhang, W. (2011). Occupational risk factors for osteoarthritis of the knee: a meta-analysis. Osteoarthritis Cartilage, 19(7), 829–39. https://doi.org/10.1016/j.joca.2011.02.016
Messier, S. P., Gutekunst, D. J., Davis, C., & DeVita, P. (2005). Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis and rheumatism, 52(7), 2026–32. https://doi.org/10.1002/art.21139
Nelson, G.A., & Kokkonen, J. (2022). Anatomia stretchingului (3nd ed., translation). Lifestyle Publishing.
Raposo. F., Ramos, M., & Lúcia Cruz, A. (2021). Effects of exercise on knee osteoarthritis: A systematic review. Musculoskeletal Care. 19(4), 399-435. https://doi.org/10.1002/msc.1538
Rayahin, J. E., Chmiel, J. S., Hayes, K. W., Almagor, O., Belisle, L., Chang, A. H., Moisio, K., Zhang, Y., & Sharma, L. (2014). Factors associated with pain experience outcome in knee osteoarthritis. Arthritis care & research, 66(12), 1828–35. https://doi.org/10.1002/acr.22402
Rosadi, R., Jankaew, A., Wu, P. T., Kuo, L. C., & Lin, C. F. (2022). Factors associated with falls in patients with knee osteoarthritis: A cross-sectional study. Medicine (Baltimore), 101(48), e32146. https://doi.org/10.1097/MD.0000000000032146
Segal, N. A., Glass, N. A., Felson, D. T., Hurley, M., Yang, M., Nevitt, M., Lewis, C.E., & Torner, J. C. (2010). Effect of quadriceps strength and proprioception on risk for knee osteoarthritis. Medicine and science in sports and exercise, 42(11), 2081-8. https://doi.org/10.1249/MSS.0b013e3181dd902e
Shumway- Cook, A., Woollacott, H. M., Rachwani, J., & Santamaria, V. (2023). Motor control: translating research into clinical practice (6th ed.). Lippincott Williams & Wilkins, a Wolters Kluwer business. https://pt.lwwhealthlibrary.com/book.aspx?bookid=3185§ionid=0
Si, J., Sun, L., Li, Z., Zhu, W., Yin, W., & Peng, L. (2023). Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 18(1), 503. https://doi.org/10.1186/s13018-023-04004-z
Skou, S. T., & Roos, E. M. (2017). Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskeletal Disorders, 18, (1), 72. https://doi.org/10.1186/s12891-017-1439-y
Skou, S.T., & Roos, E.M. (2019). Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice. Clin Exp Rheumatol. 37 Suppl 120(5), 112-117.
Sowers, M. R., & Karvonen-Gutierrez, C. A. (2010). The evolving role of obesity in knee osteoarthritis. Current opinion in rheumatology, 22(5), 533–537. https://doi.org/10.1097/BOR.0b013e32833b4682
Uivaraseanu, B., Vesa, C. M., Tit, D. M., Abid, A., Maghiar, O., Maghiar, T. A., Hozan, C., Nechifor, A. C., Behl, T., Patrascu, J. M., & Bungau, S. (2022). Therapeutic approaches in the management of knee osteoarthritis (Review). Experimental and therapeutic medicine, 23(5), 328. https://doi.org/10.3892/etm.2022.11257
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