Effects of closed and open kinetic chain exercises on pain, muscle strength, function, and quality of life in patients with knee osteoarthritis

Özüdoğru, Anıl; Gelecek, Nihal

doi:10.1590/1806-9282.20230164

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Revista da Associação Médica Brasileira

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ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 69 (7) • 2023 • https://doi.org/10.1590/1806-9282.20230164 copy

Effects of closed and open kinetic chain exercises on pain, muscle strength, function, and quality of life in patients with knee osteoarthritis

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Therapeutic exercises are well documented for the treatment of osteoarthritis; there is less evidence on what the effect of closed kinetic chain exercises is for knee osteoarthritis. The aim of this study was to investigate the effects of open kinetic chain exercises and closed kinetic chain exercises on pain, muscle strength, functional status, and quality of life in patients with knee osteoarthritis.

METHODS:

The study included a total of 60 patients with primary unilateral knee osteoarthritis grade I and II. The patients were categorized into three groups as open kinetic chain exercises (n=20), closed kinetic chain exercises (n=20), and control group (n=20). The outcome measures, including pain, isokinetic muscle strength, functional status, and quality of life, were collected at baseline and at the end of 6 and 12 weeks.

RESULTS:

Closed kinetic chain exercises and open kinetic chain exercises had significant improvement in pain, muscle strength, WOMAC, and SF-36 scores after the treatment and at their 6th and 12th week follow-ups compared to their baseline values and compared to the control group (p<0.05).

CONCLUSION:

The changes in all outcome measures were similar between closed kinetic chain exercises and open kinetic chain exercises (p>0.05). Closed kinetic chain exercises and open kinetic chain exercises were similar for knee osteoarthritis grade I and II. Closed kinetic chain exercises could be safely added to the exercise programs of patients with low-grade knee osteoarthritis.

Keywords
Knee osteoarthritis; Weight bearing exercise program; Joint pain; Muscle strength; Functional status

	OKCE (n=20) X±SD	CKCE (n=20) X±SD	Control (n=20) X±SD	p-value
Age (years)	53.05±10.88	54.40±7.92	56.10±12.73	0.667**
Height (cm)	163.00±9.85	162.55±7.04	160.25±12.03	0.641**
Body weight (kg)	79.40±13.35	75.85±13.49	76.40±12.98	0.410**
BMI (kg/m²)	30.05±5.55	28.93±6.27	29.45±6.28	0.854**

		n (%)	n (%)	n (%)	p-value
Gender	Female	11 (55)	10 (50)	9 (45)	0.819*
Gender	Male	9 (45)	10 (50)	11 (55)	0.819*
Affected leg	Left	10 (50)	10 (50)	9 (45)	0.935*
Affected leg	Right	10 (50)	10 (50)	11 (55)	0.935*
Radiological assessment	Grade I	3 (15)	10 (50)	8 (40)	0.057*
Radiological assessment	Grade II	17 (85)	10 (50)	12 (60)	0.057*

Variable	Time frame	OKCE (n=20) Mean±SD	CKCE (n=20) Mean±SD	Control (n=20) Mean±SD	Time		Group × time
Variable	Time frame	OKCE (n=20) Mean±SD	CKCE (n=20) Mean±SD	Control (n=20) Mean±SD	F	p-value	F	p-value
Pain (VAS) 0–10	Baseline	5.31±0.86	4.87±1.24	5.26±1.13	81.075	<0.001*	18.248	<0.001*^#
	6th week	2.07±1.22	2.55±1.61	5.10±1.75
	12th week	2.01±1.14	1.76±1.07	5.08±1.37
90°/s Extension (Nm)	Baseline	62.02±14.31	57.59±14.83	63.46±10.94	189.817	<0.001*	597.661	<0.001*
	6th week	76.57±15.59	69.67±16.56	64.06±11.03
	12th week	76.79±15.24	70.17±16.39	64.48±11.72
120°/s Extension (Nm)	Baseline	51.19±8.31	54.65±10.13	51.52±7.95	70.693	<0.001*	21.546	<0.001*^x
	6th week	59.08±9.99	61.14±11.19	51.21±8.25
	12th week	58.34±10.76	60.72±11.75	50.98±8.56
180°/s Extension (Nm)	Baseline	36.08±16.02	37.08±13.04	36.83±12.02	120.811	<0.001*	28.964	<0.001*
	6th week	48.24±16.42	46.73±13.95	36.90±11.75
	12th week	48.47±17.12	47.23±13.86	37.32±12.64
90°/s Flexion (Nm)	Baseline	46.47±10.60	43.35±12.13	43.64±11.21	28.105	<0.001*	13.522	<0.001*
	6th week	52.78±11.54	47.87±12.40	42.49±11.37
	12th week	51.98±11.40	47.79±12.64	42.58±11.52
120°/s Flexion (Nm)	Baseline	56.67±11.40	53.50±9.39	53.86±8.89	33.361	<0.001*	17.209	<0.001*^x
	6th week	64.61±12.90	57.83±10.06	53.26±9.16
	12th week	63.92±11.54	56.72±10.58	57.62±11.44
180°/s Flexion (Nm)	Baseline	61.44±13.68	58.82±15.26	57.57±12.66	2.080	N.S.	5.416	<0.001*
	6th week	64.24±17.16	60.59±16.86	56.18±13.05
	12th week	64.74±18.00	59.89±17.24	55.21±14.63

Variable	Time frame	OKCE (n=20) Mean±SD	CKCE (n=20) Mean±SD	Control (n=20) Mean±SD	Time		Group × time
Variable	Time frame	OKCE (n=20) Mean±SD	CKCE (n=20) Mean±SD	Control (n=20) Mean±SD	F	p-value	F	p-value
WOMAC Pain	Baseline	9.70±4.15	8.90±4.27	10.15±3.66	27.984	<0.001*	10.519	<0.001*^#
	6th week	6.65±3.66	5.80±5.27	10.80±4.26
	12th week	6.65±4.35	6.00±5.43	10.30±4.49
WOMAC Stiffness	Baseline	3.95±1.35	4.15±1.08	3.90±1.11	51.510	<0.001*	12.275	<0.001*^#
	6th week	2.30±1.08	2.50±1.31	3.85±1.42
	12th week	2.35±1.38	2.55±1.27	3.90±1.88
WOMAC Physical function	Baseline	33.20±9.32	33.55±10.31	32.90±8.76	115.030	<0.001*	24.471	<0.001*
	6th week	23.65±9.61	24.05±9.94	32.60±8.42
	12th week	23.00±9.59	24.15±10.58	32.65±8.59
SF-36 Physical Functioning	Baseline	44.00±4.75	44.30±4.56	45.25±5.25	13.639	<0.001*	5.377	<0.001*^#
	6th week	52.75±11.41	54.80±12.57	44.50±9.58
	12th week	52.00±14.81	55.05±15.71	43.25±11.72
SF-36 Role Limitations (Physical)	Baseline	11.50±11.36	16.00±11.42	13.00±9.23	56.00	<0.001*	114.00	<0.033*^#
	6th week	26.00±9.94	22.50±11.18	14.00±10.46
	12th week	28.00±10.05	24.00±12.73	13.50±12.25
SF-36 Pain	Baseline	30.75±16.74	30.25±13.76	31.12±17.61	14.057	<0.001*	4.313	<0.003*^#
	6th week	49.50±25.75	49.00±19.62	30.05±20.04
	12th week	48.25±23.84	49.62±27.91	29.25±21.38
SF-36 General Health Perception	Baseline	53.50±22.48	51.75±22.95	51.75±19.68	54.891	<0.001*	14.932	<0.001*
	6th week	71.25±20.25	69.25±21.23	51.00±20.65
	12th week	70.75±20.14	68.75±22.64	51.00±22.10
SF-36 Mental Health	Baseline	56.40±13.35	58.80±13.11	59.00±15.94	10.211	<0.001*	3.310	<0.001*^#
	6th week	73.20±9.97	69.40±9.20	59.20±6.43
	12th week	68.80±11.50	62.20±14.76	58.80±7.00

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[1] *Corresponding author: aozudogru@hotmail.com