Clinical trial of step-up exercise therapy using DVD for patients with hip osteoarthritis

Abstract

Purpose: Efficacy of exercise treatment for osteoarthritis (OA) has been reported controversially. We developed a new exercise program designed as several step-up stages in accordance with patient disease activity, using a digital video disc (DVD). In this study, we analyzed the efficacy of this step-up exercise therapy program using DVD for the hip OA patients. Methods: We prospectively recruited 45 patients (male1, female44) with symptomatic hip OA were included. All participants provided informed consent to the study which was approved by the Institutional Review Board. They were assigned into 2 groups; (1) DVD group in which the patient was instructed to perform exercise by watching specially-developed DVD program, (2) control group in which the patient was instructed to perform exercise by referring to the home exercise instruction documents. The original DVD was developed among the community of the orthopaedic surgeons, physical therapists and the orthopaedic research nurse. On the DVD, the step-up program had 6 stages consisting of 3 OKC (Open kinetic chain) exercise programs and 3 CKC (Closed kinetic chain) exercise programs. Patients were instructed to perform exercise daily for 30-40 minutes by watching DVD, with completing each stage for 2 weeks. All patients received the following assessments at the entry to the study and 3 months later; (1) muscle volume in the lower limb estimated by impedance of living body instrument, (2) muscle strength by dynamometer, (3) gait speed by time up and go test, (4) stability of lower limb by one-legged standing time (up to 120 seconds), and (5) the objective evaluations by Oxford hip score, Health related Quality of life by SF-8 and Self-efficacy (Self-efficacy is defined as people's beliefs about their capabilities to produce designated levels of performance) by General Selfefficacy scale. If the patient had OA in both hips, only one hip with more painful side was included. Results: There were 12 patients (mean age 54.0 years) in the DVD group and 33 patients (51.7) in the control group. At 3 months, time up and go test was significantly improved from 7.4 seconds to 6.9 seconds (p1⁄40.015) in the DVD group and from 7.6 seconds to 7.2 seconds in the control group (p1⁄40.024). The effect size of this improvement was superior in the DVD group. The stability of lower limb by one-legged standing time was significantly improved only in the DVD group from 81.6 seconds to 103.8 seconds (p1⁄40.02). The muscle volume of the lower limbwas not changed significantly in both groups. The muscle strength of hip abduction was significantly improved from 114.2 to 133.2 newton (p1⁄40.031) only in the control group. SF-8(physical), General Self-efficacy, and Oxford hip score showed tendency of improvement in both groups. However, statistically significant improvement was only seen for pain score of Oxford hip score from 11.9 to 9.6 (p1⁄40.002) in the control group. In hearing of impression regarding DVD program, patients had feeling of better understating of program content by movie, or of accelerating effect by synchronization with the instructor's action in the DVD. Conclusions: Physical function and pain of the patients were significantly improved in both DVD and control groups. Although muscle volume and muscle strength were not improved apparently, physical function including the time up and go test and one-legged standing time was improved better in DVD group than control group. The body balance might be improved more by visual education of DVD movie. The patients’ comments were also related with encouragement of correct understanding of exercise using DVD.