• PNF and Movement
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• 제19권1호
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• pp.9-17
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• 2021

Purpose: This study aims to verify the effectiveness of sit-to-stand training with visual feedback to improve balance ability and knee extensor strength of total knee replacement patients. Methods: In this study, 15 patients with total knee replacement participated in this study. Subjects were assigned to two groups: a feedback group (experimental group)(n = 8) and a control group (n = 7). They all received 30 min of continuous passive motion (CPM) and sit-to-stand training for 15 min five times per week for two weeks. Knee extensor and balance ability were measured. Knee extensor was measured by Biodex system 3; balance ability was measured by Balancia software. Results: After the intervention, there was a significant difference in the strengthening of the knee extensor muscles in the feedback group, area 95%, weight distribution of the affected side, and the sit-to-stand test repeated five times (p < 0.05). Conclusion: The results of this study showed that sit-to-stand training with visual feedback was more effective in increasing knee extensor muscle strength and balance ability than the sit-to-stand training without visual feedback. Therefore, in order to improve the knee extensor muscle and the balance of total knee replacement patients, it is necessary to consider providing visual feedback during sit-to-stand training.

• 대한물리의학회지
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• 제18권2호
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• pp.93-101
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• 2023

PURPOSE: The Western Ontario and McMaster Universities Arthritis (WOMAC) index has been used to measure the outcome of total knee replacement (TKR), but studies on its reliability and validity are limited. The present study examined the reliability and validity of this index for patients with knee osteoarthritis who underwent TKR. METHODS: Seventy-one inpatients and outpatients who underwent bilateral TKR for knee osteoarthritis were included in this study. The pain assessment scale and WOMAC index were used to evaluate the participants every two weeks to examine the test-retest reliability, internal consistency, and construct validity. RESULTS: The test-retest reliability scores for pain, stiffness, and physical function were .75-.92, .85-.90, and .75-.95, respectively. The corresponding intraclass correlation coefficients were .75-.88, .76-.88, and .71-.95, respectively. The internal consistency score in the first and second examinations was .92. Furthermore, the construct validity scores for pain, stiffness, and physical function were .83, .41, and .58, respectively. CONCLUSION: The application of the WOMAC index in patients who underwent TKR showed high test-retest reliability and internal consistency with the use of the WOMAC index and good validity with the use of the pain assessment scale.

• 대한정형도수물리치료학회지
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• 제27권2호
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• pp.69-76
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• 2021

Background: Degenerative arthritis accounts for a large portion of the elderly, causing a lot of inconvenience in daily life. Total knee replacement (TKR) are performed to relieve pain in the knee joint. The purpose of this study was to determine whether knee joint stabilization exercises are effective in improving balance and walking ability in degenerative arthritis patients who have undergone TKR. Methods: A total of 30 TKR patients participated in this study. They were assigned to two groups. The experimental group, the group that underwent knee stabilization exercises, joint mobilization and general physical therapy. On the other hand, and the controlled group, the group that underwent joint mobilization and general physical therapy. All exercises were conducted thrice a week, for four weeks. The main balance outcomes were evaluated using the posture balance training system, while walking ability was assessed using a wireless 3-axis accelerometer. Results: The experimental group had significantly higher scores in postural stability testing (PST), limits stability testing, and waling ability. The post-intervention evaluation, there were significant differences in all variables between the two groups. However, no significant difference was noted in the foam eyes closed test in PST. Conclusion: This study suggests that knee joint stabilization exercises effectively improve the balance and walking ability of TKR patients. Thus, it could be presented as useful in clinical practice.

• 대한통합의학회지
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• 제9권1호
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• pp.101-108
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• 2021

Purpose : The purpose of this study is to verify the effect of selective muscle strengthening of the knee joint extensor muscles using a pressure biofeedback unit to improve knee extensor strength and the balance ability of total knee replacement patients. Through this, we tried to provide clinical information. Methods : In this study, 12 patients with total knee replacement were recruited from a rehabilitation hospital. They were divided into two groups: a feedback group (n=6) and a control group (n=6). All patients received 30 minutes of continuous passive motion and leg-strengthening exercises for 15 minutes five times a week for two weeks. Subjects performed knee extension exercises with or without biofeedback units in the sitting position. The knee extensor strength and balance ability were measured before and after exercise. Knee extensor strength was measured by Biodex system 3 and balance ability was measured by Balancia software. Results : Both the experimental group and the control group showed a significant difference in the muscle strength of the knee joint extensor muscles after intervention (p<.05). In comparison, the experimental group showed a significant difference than the control group (p<.05). Both the experimental group and the control group showed a significant difference in the velocity average, path length, area 95 % center of pressure (COP), weight distribution, five times sit to stand test (FTSST) after intervention. In comparison, the experimental group showed a significant difference in velocity average, area 95 % COP, and FTSST than the control group (p<.05). Conclusion : In order to strengthen the knee extensor muscle and improve the balance ability in total knee replacement patients, it is necessary to consider providing pressure biofeedback unit during leg strengthening exercises.

• 근관절건강학회지
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• 제25권2호
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• pp.61-74
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• 2018

Purpose: The purpose of this study was to examine the factors affecting changes in Korean Knee Score (KKS) and ranges of motion (ROM) of the knee after the structured exercise programs for the patients with total knee arthroplasty. Methods: This was a retrospective study using electronic medical records from January 2015 to February 2017, and the subject of this study was a total of 124 out of 434 patients underwent total knee replacement operation. They took part in a structured step-by-step exercise program conducted by orthopedic nurses, and then were evaluated for KKS and Knee ROM for 12 weeks after operation. Results: Post-intervention scores increased significantly in the KKS subdomains including pain and symptoms (t=-22.31, p<.001), function (t=-20.68, p<.001), evaluation of floor life (t=-14.18, p<.001), socioemotional function (t=-28.94, p<.001) over time. As for the change in the ROM, knee extension (t=9.23, p<.001) and knee flexion (t=4.04, p<.001) showed a statistically significant changes over time. Conclusion: This study illuminated the factors affecting the changes in pain and symptom, physical function, evaluation of floor life, socioemotional function and range of motion after structured exercise training programs for knee arthritis patients.

• 대한정형도수물리치료학회지
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• 제28권3호
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• pp.79-87
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• 2022

Background: The purpose of this study was to examine the effect of transcranial direct current stimulation (tDCS) on the pain and balance of patients who receive total knee arthroplasty (TKA). Methods: This study subjects were 24 patients in Hospital T, located in Daegu, South Korea who received TKA after being diagnosed with degenerative arthritis. The subjects were randomly divided into and experimental group and a control group, with each group including 12 patients. Both group received superfical thermal therapy, interferential current therapy (ICT), and continue passive motion (CPM), which are conventional knee therapy on the knee joint. The experimental group received the tDCS treatment three times a week for three weeks, from October 1st to October 20th. The visual analogue scale and Wii Balance Board system were used to measure the pain and balancing ability, respectively, of both groups. In the statistical result analysis, to compare about pre and post test difference in each groups was accomplished. Statistical analysis of independent t-test and paired t-test were conducted using SPSS version 23.0. Results: After three weeks of intervation, there were significantly difference in balance ability in pre and post test in the tDCS group. VAS decreased significantly in both groups(p<.05), There was a significantly difference in pain, balance ability in the tDCS group compared to the sham group. Conclusion: These results indicate that applying tDCS together with conventional knee joint therapy for TKA patients is effective in promoting the patients' recovery.

• 대한통합의학회지
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• 제11권2호
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• pp.159-168
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• 2023

Purpose : This study aimed to investigate how neuromuscular electrical stimulation (NMES) affects the balance ability of patients who have undergone total knee arthroplasty owing to osteoarthritis. Methods : Thirty patients who had undergone total knee arthroplasty were randomized to an experimental group (n=15) and a control group (n=15). The experimental group received conventional physical therapy for 50 minutes and NMES treatment for 30 minutes, whereas the control group received conventional physical therapy for 50 minutes and active range of motion (AROM) exercises for 30 minutes. Within-group and between-group changes in static and dynamic balance ability before and after the 4-week intervention were analyzed. Results : In the within-group comparison, sway velocity in the center of gravity and total distance were significantly improved in both the experimental and control groups (p<.05), with no significant differences between the groups (p>.05). In the within-group comparison, both the experimental and control groups showed significant improvement in the functional reach test and movement velosity (p<.05). In the between-group comparison, the experimental group showed a significantly better improvement than the control group in the functional reach test (p<.05), but there was no significant difference in the movement velosity test (p>.05). Conclusion : In this study, NMES improved the static and dynamic balance in patients who had undergone total knee arthroplasty. Compared with AROM exercises, there was a greater effect on dynamic balance partially; however, the overall effect was similar. Therefore, NMES may be one option among various interventions to improve the balance ability in patients who have undergone total knee arthroplasty. In particular, this method may be effective when it is difficult to apply balance training for patients with total knee arthroplasty in a clinical setting.

• PNF and Movement
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• 제16권1호
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• pp.75-83
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• 2018

Purpose: This study investigated the effects of proprioceptive neuromuscular facilitation (PNF) exercise on the range of motion (ROM), pain, and functional activity of patients who received total knee arthroplasty (TKA). The purpose of this study was to provide fundamental data regarding the use of PNF exercise among patients with musculoskeletal disease. Methods: Fourteen patients who received TKA were randomly divided into an experimental group (n=7) that took part in PNF exercise and a control group (n=7) that performed general rehabilitation exercise. Both groups performed the respective exercises for 30 minutes, five times a week for 2 weeks. For the measurement of ROM, the range of knee flexion was measured using a clinometer smartphone application. A visual analogue scale (VAS) was used for the measurement of the level of pain. The timed up and go test (TUG) was conducted to measure functional activity. A paired t-test was performed to compare within-group changes before and after the PNF exercise. Differences between the experimental group and control group were analyzed by an independent t-test. For all tests, the level of statistical significance was set at ${\alpha}=0.05$. Results: After the exercise, there was a significant within-group change in VAS and TUG scores in the experimental group and control group (p<0.01). There was also a significant between-group difference in VAS and TUG scores after the intervention (p<0.05). Conclusion: General rehabilitation exercise is commonly applied as a treatment for TKA patients and is relatively effective. The application of PNF exercise may be useful in such patients, considering its effects on ROM improvement, pain reduction, and functional enhancement.

• 대한정형외과학회지
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• 제54권3호
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• pp.254-260
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• 2019

목적: 슬관절 전 치환술 시, 90° 굴곡과 신전 시의 간격(gap) 차이와 술 후 1년째의 슬관절 기능과의 관계를 알아보고자 하였다. 대상 및 방법: 2017년 3월부터 6월까지 골관절염 환자를 대상으로 하여 시행된 내비게이션을 이용한 전치환술의 연속된 82예를 대상으로 시행된 전향적 연구이다. 간격 측정은 내비게이션을 이용하였으며, 슬개골을 towel clip을 이용하여 정복한 이후 간격을 측정하였다. 신전 시의 내측과 외측 간격의 평균과 90° 굴곡 시의 내측과 외측 간격의 평균값을 구한 이후 간격 차이(90° 굴곡 시의 간격-신전 간격)를 계산하였다. 간격 차이<0 mm, 0 mm≤간격 차이<2 mm, 2 mm≤간격 차이를 각각 1군, 2군, 3군으로 나누었다. 술 후 1년째, Knee Society score (KSS)와 함께 무릎의 최대 굴곡 각도를 측정한 이후, 각 군 간의 값을 비교하였다. 결과: 간격 차이의 값에 따라 나눈 군의 수는 1군이 37예, 2군이 29예, 3군이 16예였다. 술 후 1년째의 KSS knee는 평균 81.21±8.31, KSS function은 71.34±9.84, 그리고 무릎의 최대 굴곡 각도는 126.48°±7.28°였다. 간격 차이에 따른 1년 후의 KSS의 값은 통계적으로 유의한 차이가 없었다. Mann-Whitney test를 이용한 두 군 간의 비교에서 2 mm≤간격 차이를 보이는 3군이 1군과 2군에 비하여 통계적으로 유의하게 큰 최대 무릎 굴곡 각도를 보였다. 결론: 슬관절 전 치환술 시, 90° 굴곡 시의 간격이 신전 시의 간격보다 2 mm 이상 큰 경우에서 다른 군에 비하여 술 후 1년째의 최대 무릎 굴곡 각도가 통계적으로 유의하게 높았다.

• 대한의용생체공학회:의공학회지
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• 제19권5호
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• pp.503-511
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• 1998

본 연구에서는 동적충격하중 하에서 다양한 tibial component system의 하중전달현상 및 발생 가능한 실패기전을 관찰하기 위해 서로 다른 tibial component들에 대한 수치해석을 통한 응력분포를 관찰하고 또한 접합 상태에 따른 임플란트 시스템이 받는 영향을 비교 분석하였다. 따라서, 해석에 고려되는 모델은 정상 경골과 현재 가장 많이 적용되는 시스템인 시멘트형과 무시멘트형 metal-backed tibial component, 폴리에틸렌으로 된 시멘트형 tibial component, 그리고 골과 slew사이의 비접합상태를 가정한 metal-backed tibial component을 포함한다. 해석 결과 metal-backed tibial component의 stem 끝 부분에서는 시멘트형이 무시멘트형 보다 약간 더 놀은 최대 응력을 보였다. 반면, 폴리에틸렌으로 된 tibial component의 경우 stem 글 부분에서의 최대 응력은 metal-backed tibial component에 비해 차 반 정도로 줄었고, 전체적으로 정상 경골에 유사한 응답 특성을 보여주었다. 골과 stem 사이의 비접합을 가정한 경우 금속 tray 밑 부된에서의 응력은 완전히 접합된 경우 보다 3배 더 높았고, stem 끝부분에서는 시간에 따른 불안정한 응력이 관찰되어 이 현상은 임플란트 해리현상과 불완전한 골접합을 가중시키는 원인으로 사료된다. 따라서, 수직충격하중을 고려한 경우 골에 안정하게 고정되는 폴리에틸렌 tibial component가 가장 바람직하다.