The Effect of Strengthening and Balance Exercises on Static Stability Indices in Women With Knee Osteoarthritis; A Randomized Clinical Trial

Abstract

Knee osteoarthritis is one of the most common musculoskeletal problems that is associated with impaired balance. This study was conducted to determine the result of balance and strengthening training in static stability indices in females with knee osteoarthritis. Methods: In this single-blind randomized controlled study, 13 patients were determined through the available sampling method and randomly assigned to strengthening exercises and balance exercises groups. Strengthening exercises were based on quadriceps strengthening and in the balance exercises group, it included balance exercises. Anteriorposterior, overall, and medial-lateral stability measures were performed by Biodex before and after the treatment in the static situation at the status of open and close eyes on one and two feet. The treatment was performed 15 sessions for 3 weeks. The data were analyzed by paired t-test and independent t-test. Results: In strengthening exercises group, at the static status, overall and anterior-posterior stability index on two feet at the status of open eyes reduced from 1.26±0.82 to 0.76±0.48 (P=0.02) and from 0.87±0.53 to 0.56±0.37 (P=0.02), respectively. In the balance exercise group, in the static status, overall lateral stability index on the involved foot at the status of close eyes reduced from 9.15±3.18 to 7.53±2.81 (P=0.00) and from 8.27±3.32 to 6.77±2.95 (P=0.00), respectively. There was no significant difference between the groups (P>0.05). Discussion: There was no difference between them regarding the impact on static stability indices. However, strengthening exercises caused improvement in the greater number of stability indices compared to those in the balance exercises group.

The Effect of Balance Training on Functional Outcomes in Patients with Knee Osteoarthritis: A Systematic Review

“…The results of most included studies showed that the implementation of balance training or sensorimotor or perturbation training improved self-reported functionality or performance-based functional outcomes in knee OA patients, although they did not have superiority over to control group ( 3 , 14 , 21 , 23 - 26 , 29 , 31 ). However, some studies showed experimental group attained superior improvement in comparison with the control group ( 13 , 20 , 22 , 27 , 28 , 30 ).…”

“…Of the 862 participants with a mean age of 60.76 years which included, 411 participants received balance exercise training or sensorimotor or perturbation training. Interventions of control groups contained strengthening exercise ( 13 , 14 , 20 - 26 ) or routine physiotherapy ( 3 , 27 - 29 ) or no specific training ( 30 ).…”

“…Most studies used patient-reported outcome measures for the evaluation of functional outcomes, including WOMAC, KOOS, and SF-36 ( 3 , 13 , 20 - 26 , 28 - 31 ).Some studies used performance-based functional outcome measures such as the Timed Up and Go test (TUG), Get Up and Go test (GUG), functional reach test, stair climb test, 30s chair stand test, and 10 or 60m walking ( 3 , 13 , 21 - 29 ).There are few studies that have measured quadriceps and hamstring muscle strength and used sophisticated equipment (Biodex stability system, sway-meter) for measuring postural sway and fall risk score ( 14 , 22 , 24 , 28 ).…”

“…Recent works, however, have used exercises that intensify the sensory systems to improve balance and reported improved patients' balance and functional performance. These studies compared the experimental groups (i.e., with balance exercises) for several weeks and the control groups (i.e., with no particular emphasis on balance training) ( 3 , 11 - 14 ). Overall, the results have shown that rehabilitation programs for patients with knee OA, including balance exercises or programs emphasizing the sensory-motor system training, will improve functional performance and specific balance outcomes.…”

“…The main differences identified in the methodological designs include the type of outcome measures, statistical design, and duration of the exercise program ( 3 , 11 - 14 ). A new meta-analysis study has examined the effect of proprioception training on pain, joint stiffness, and functional outcomes in knee OA patients ( 15 ), but so far, no systematic review has been conducted on the effect of balance training in subjects with knee OA.…”