Comparative Effects of Rehabilitation Programs After Total Knee Arthroplasty: A Modified GLA:D® Program and a Lower-Limb Strengthening Program

TL;DR

This study compares two modified rehabilitation programs for patients after knee replacement surgery in Korea, finding that supervised training leads to better recovery than home-based exercises.

Contribution

The study evaluates modified GLA:D® programs adapted for post-TKA patients in Korea, highlighting the importance of supervised rehabilitation for better outcomes.

Findings

GLA:D-M showed statistically significant and clinically meaningful improvements in functional and psychosocial outcomes.

GLA:D-C improved lower-limb strength but did not consistently lead to functional recovery.

Supervised neuromuscular training may offer more comprehensive recovery than home-based strengthening.

Abstract

Background: The GLA:D® program is an evidence-based intervention widely used in Western countries to improve knee function and exercise adherence among individuals with osteoarthritis. However, its application in postoperative total knee arthroplasty (TKA) populations is limited, particularly in Asia. This study evaluated two modified GLA:D® interventions tailored to the Korean clinical environment. Methods: Patients who underwent TKA participated in one of two programs. The GLA:D-M group received therapist-supervised neuromuscular training with structured progression. The GLA:D-C group received a modified GLA:D® program with additional lower-limb strengthening, primarily conducted as home-based exercise. Outcomes at 3 and 6 months included functional performance, isokinetic strength, gait speed, and psychosocial measures. Statistical significance, minimal clinically important difference (MCID), and effect sizes were used to assess clinical relevance. Results: Both groups improved; however, recovery patterns differed. GLA:D-M demonstrated statistically significant (p < 0.05) and clinically meaningful improvements in functional and psychosocial outcomes, exceeding MCID thresholds with large effect sizes. GLA:D-C showed significant gains in lower-limb strength, but many changes did not meet the MCID and did not consistently translate into higher-level functional recovery. These findings suggest that supervised neuromuscular training may facilitate more comprehensive recovery than home-based strengthening alone. Conclusions: Adapting the GLA:D® program for TKA patients in a Korean clinical setting was feasible and beneficial. Additionally, the delivery method, particularly therapist supervision, played a vital role in maximizing outcomes. Both program content and delivery format should be considered in rehabilitation models. Larger, long-term studies are warranted to confirm these findings and explore broader clinical applications.

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