Effect of home exercise program performance in patients with osteoarthritis of the knee or the spine on the visual analog scale after discharge from physical therapy

Abstract Background Knee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence–based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA. Methods This paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development. Results The investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction. Discussion This multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for patients with symptomatic degenerative meniscal tear and concomitant OA. These interventions will be tested as part of the Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial. Trial registration The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 on February 14, 2017. TeMPO was also approved by the Institutional Review Board at Partners HealthCare/Brigham and Women’s Hospital.

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Physical therapy goes App—an innovative at-home exercise program the “Rumpfzirkel” (core circuit) App

Physiotherapy ◽

10.1016/j.physio.2015.03.342 ◽

2015 ◽

Vol 101 ◽

pp. e183-e184

Author(s):

S. Buck ◽

L. Dyer ◽

B. Tessendorf

Keyword(s):

Physical Therapy ◽

Exercise Program ◽

Home Exercise ◽

Home Exercise Program ◽

At Home

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The Management of a Patient with a Cervical Disc Herniation: A Case Report

Clinical Medicine Case Reports ◽

10.4137/ccrep.s727 ◽

2008 ◽

Vol 1 ◽

pp. CCRep.S727 ◽

Cited By ~ 1

Author(s):

Sherry Tsao ◽

Peter Pidcoe

Keyword(s):

Physical Therapy ◽

Disc Herniation ◽

Exercise Program ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Home Exercise ◽

White Female ◽

Home Exercise Program ◽

Patient Reported ◽

Cervical Traction

Purpose To present the management of a patient with a cervical disc herniation and illustrate the efficacy of cervical traction as a main form of treatment for cervical disc herniation in conjunction with a home exercise program. Background A 71-year-old white female diagnosed with cervical disc herniation at the levels of C5-6 and C6-7 presented to physical therapy with neck pain radiating into the left upper extremity down to the 5th digit of the left hand. Treatment The patient reported to outpatient physical therapy for cervical disc herniation and radiculopathy. After initial evaluation she received intermittent cervical traction and was given a home exercise program consisting of cervical lateral flexion stretch, unilateral wall stretch for pectoralis muscles and to continue with her over the door cervical traction. Conclusion Cervical traction and a good home exercise program have been shown to reduce cervical disc herniation and its subsequent symptoms.

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The Effectiveness of Exercise in Treating Patellofemoral-Pain Syndrome

Journal of Sport Rehabilitation ◽

10.1123/jsr.13.4.323 ◽

2004 ◽

Vol 13 (4) ◽

pp. 323-342 ◽

Cited By ~ 18

Author(s):

Janice Kaye Loudon ◽

Byron Gajewski ◽

Heather L. Goist-Foley ◽

Karen Lee Loudon

Keyword(s):

Physical Therapy ◽

Outcome Measures ◽

Statistical Difference ◽

Weight Bearing ◽

Exercise Program ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Home Exercise ◽

Analog Scale

Objective:To determine the effect of exercise on patients with patellofemoral-pain syndrome (PFPS).Patients:29 subjects with unilateral PFPS, assigned to control, home-exercise (HE), or physical therapy (PT) group.Intervention:8-wk exercise program.Main Outcome Measures:A knee survey, visual analog scale (VAS), and 5 weight-bearing tests.Results:MANOVA indicated an overall statistical difference between groups (P< .05). The HE and PT groups experienced less pain than control, and PT experienced less pain than HE (P< .05). In overall knee function and most weight-bearing tests, HE and PT were stronger and more functional than control (P< .05). For anteromedial lunge only PT was stronger and more functional than control (P< .05).Conclusions:Intervention helps PFPS, but there appear to be no differences between home and in-clinic interventions.

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Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program

Physical Therapy ◽

10.1093/ptj/85.12.1301 ◽

2005 ◽

Vol 85 (12) ◽

pp. 1301-1317 ◽

Cited By ~ 226

Author(s):

Gail D Deyle ◽

Stephen C Allison ◽

Robert L Matekel ◽

Michael G Ryder ◽

John M Stang ◽

...

Keyword(s):

Physical Therapy ◽

Treatment Group ◽

Manual Therapy ◽

Exercise Program ◽

Exercise Group ◽

Home Exercise ◽

Home Exercise Program ◽

Therapy Program ◽

Supervised Exercise ◽

Physical Therapy Program

AbstractBackground and Purpose Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteo-arthritis (OA) of the knee. The purpose of this study was tocompare outcomes between a home-based physical therapy program and a clinically based physical therapy program. Subjects. One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinictreatment group (n=66; 61% female, 39% male; mean age [±SD]=64±10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [±SD]=62±9 years). Methods. Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received thesame home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. Both groups showed clinically and statistically significant improvements in 6-minute walkdistances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to betaking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. Discussion and Conclusion Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.

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