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BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA

Year 2023, Volume: 34 Issue: 1, 102 - 114, 20.04.2023
https://doi.org/10.21653/tjpr.1056788

Abstract

Amaç: Bu çalışma ilerleyici kapalı kinetik zincir egzersiz (KKZE) programının, açık kinetik pozisyonda verilen standart egzersiz programına göre bilateral total diz protezi (TDP) hastalarında ağrı şiddeti, ödem, eklem hareket açıklığı ve fonksiyonel durum üzerine kısa dönem etkilerini belirlemek amacıyla yapıldı.
Yöntem: Çalışmaya yaş ortalaması 65,22 ± 6,81 yıl olan ve bilateral TDP uygulanan 36 hasta (72 diz) dahil edildi. Hastalar KKZE grubu (KKZE, n=16) ve standart egzersizlerden oluşan kontrol grubu (KG, n=16) olarak iki gruba ayrıldı. Ameliyat sonrası 1. haftada tüm hastalara aynı fizyoterapi programı uygulandı. Ameliyat sonrası 2. haftada hastalar iki gruba ayrıldı ve gruplarına uygun egzersiz eğitimine başlandı. Haftada 3 gün ve toplamda 6 hafta uygulanan programlarda hastaların ağrı, ödem, eklem hareket açıklığı ölçümleri, başlangıçta ve ameliyat sonrası 4. ve 7. haftada yapıldı. Fonksiyonel durum değerlendirmesi ise sadece son ölçümde yapıldı.
Sonuçlar: Her iki grupta da ağrı, ödem, diz eklemi hareketlerinde 6 hafta sonunda istatistiksel olarak anlamlı iyileşmeler oldu (p<0,05). 4. hafta ölçümlerinde ağrı şiddetindeki değişim KG’de daha fazla idi (p<0,05) ancak tüm diğer parametrelerdeki başlangıca göre olan değişimler her iki grupta da benzerdi (p>0,05).
Tartışma: Post-akut erken dönemde verilen dirençli KKZE programının bilateral TDP hastaları için etkilidir ve programlara eklenebilir. Ancak tek başına KKZE programının standart egzersiz programına kısa dönemde ek bir üstünlüğü yoktur.

Thanks

Çalışmamıza yardımlarından dolayı Op. Dr. Ruşen DEMİR'e teşekkür ederiz.

References

  • 1. Han AS, Nairn L, Harmer AR, Crosbie J ve ark. Early rehabilitation after total knee replacement surgery: a multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care. Arthritis Care Res (Hoboken). 2015 Feb;67(2):196-202.
  • 2. Lisi C, Caspani P, Bruggi M, Carlisi E, Scolè D, Benazzo F, Dalla Toffola E. Early rehabilitation after elective total knee arthroplasty. Acta Biomed. 2017 Oct 18;88(4S):56-61. doi: 10.23750/abm.v88i4-S.5154.
  • 3. Bade MJ, Struessel T, Dayton M, Foran J, Kim RH, Miner T, Wolfe P, Kohrt WM, Dennis D, Stevens-Lapsley JE. Early High-Intensity Versus Low-Intensity Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2017 Sep;69(9):1360-1368. doi: 10.1002/acr.23139. Epub 2017 Aug 13.
  • 4. Masaracchio M, Hanney WJ, Liu X, Kolber M et al. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS ONE 2017;12(6):e0178295 doi.org/10.137/journal.pone.0178295.
  • 5. Iwakiri K, Ohta Y, Shibata Y, Minoda Y, Kobayashi A, Nakamura H Initiating range of motion exercises within 24 hours following total knee arthroplasty affects the reduction of postoperative pain: A randomized controlled trial..Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Apr 28;21:11-16. doi: 10.1016/j.asmart.2020.03.003. eCollection 2020 Jul.
  • 6. Makimoto K, Fujita K, Konno R. Review and synthesis of the experience of patients following total hip or knee arthroplasty in the era of rapidly decreasing hospital length of stay. Jpn J Nurs Sci. 2020 Oct;17(4):e12361. doi: 10.1111/jjns.12361. Epub 2020 Aug 24.
  • 7. Henderson KG, Wallis JA, Snowdon DA.Physiotherapy. Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis. 2018 Mar;104(1):25-35. doi: 10.1016/j.physio.2017.01.002. Epub 2017 Feb 1.
  • 8. Sattler LN, Hing WA, Vertullo CJ. What is the evidence to support early supervised exercise therapy after primary total knee replacement? A systematic review and meta-analysis. BMC Musculoskelet Disord. 2019 Jan 29;20(1):42. doi: 10.1186/s12891-019-2415-5.
  • 9. Florez-García M, García-Pérez F, Curbelo R, Pérez-Porta I, Nishishinya B, Rosario Lozano MP, Carmona L. Efficacy and safety of home-based exercises versus individualized supervised outpatient physical therapy programs after total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3340-3353. doi: 10.1007/s00167-016-4231-x.
  • 10. Li D, Yang Z, Kang P, Xie X. Home-Based Compared with Hospital-Based Rehabilitation Program for Patients Undergoing Total Knee Arthroplasty for Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Jun;96(6):440-447. doi: 10.1097/PHM.0000000000000621.
  • 11. Morelli I, Maffulli N, Brambilla L, Agnoletto M, Peretti GM, Mangiavini L. Quadriceps muscle group function and after total knee arthroplasty-asystematic narrative update. .Br Med Bull. 2021 Mar 25;137(1):51-69. doi: 10.1093/bmb/ldaa041.
  • 12. Fitz W, Shukla P, Li L, Scott RD. Early Regain of Function and Proprioceptive Improvement Following Knee Arthroplasty. Arch Bone Jt Surg. 2018; 6(6): 523-531.
  • 13. Jewiss D, Ostman C, Smart N. Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Journal of Sports Medicine Volume 2017, Article ID 4721548, 10 pages.
  • 14. Husby VS, Helgreud J, Bjorgen S, Husby OS, Hoff J. Early maximal strength training an efficient treatment for patients undergoing total hip arthroplasty. Arch Phys Med rehabil.2009;90:1658-67.
  • 15. HusbyVS, Foss OA, Husby OS,Winther SB. Randomized controlled trial of maximal strangth training vs standart rehabilitation following total knee arthroplasty.Eur J Phys Reh Med.2018;53(3):371-79.
  • 16. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage 2005;13(1):28–33.
  • 17. Jakobsen TL, Hustel H, Petersen J, Bandholm T. Early progressive strength training to enhance recovery after fast-track total knee arthroplasty: A rondomized controlled trial. Arthritis Care Res. 2014; 66:1856-66.
  • 18. Fransen BL, Hoozemans MJM, Argelo KDS, Keijser LCM ve ark. Fast-track total knee arthroplasty improved clinical and functionaloutcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up. Arch of Orthop and Trauma Surg. 2018;138:1305-1316.
  • 19. Piva SR, Gil AB, Almeida GJ, DiGioia AM 3rd, Levison TJ, Fitzgerald GK. A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial. 2010 Jun;90(6):880-94. doi: 10.2522/ptj.20090150. Epub 2010 Apr 8.
  • 20. Hsu WH, Hsu WB, Shen WJ, Lin ZR ve ark. Twenty-four-week hospital-based progressive resistance training on functional recovery in female patients post total knee arthroplasty. Knee. 2019 Mar 19. pii: S0968-0160(18)30625-2.
  • 21. Suh MJ, Kim BR, Kim SR, Han EY, Lee SY.Effects of Early Combined Eccentric-Concentric Versus Concentric Resistance Training Following Total Knee Arthroplasty. Ann Rehabil Med. 2017 Oct;41(5):816-827.
  • 22. Moffet H, Collet J-P, Shapiro SH, Paradis G et al. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: a single-blind randomized controlled trial. Arch Phys Med Rehab 2004;85:546–56.
  • 23. Jogi P, Overend TJ, Spaulding SJ, Zecevic A ve ark. Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial. SAGE Open Med. 2015 Feb 11;3:2050312115570769.
  • 24. Vincent KR, Vincent HK, Lee LW, Alfano AP. Outcomes in total knee arthroplasty patients after inpatient rehabilitation: influence of age and gender. Am J Phys Med Rehabil. 2006;85(6):482-9.
  • 25. Fortier LM, Rockov ZA, Chen AF, Rajaee SS Activity Recommendations After Total Hip and Total Knee Arthroplasty..J Bone Joint Surg Am. 2021 Mar 3;103(5):446-455. doi: 10.2106/JBJS.20.00983.
  • 26. Pinsornsak P, Kanitnate S, Boontanapibul K The effect of immediate post-operative knee range of motion photographs on post-operative range of motion after total knee arthroplasty : An assessor-blinded randomized controlled clinical trial in sixty patients. .Int Orthop. 2021 Jan;45(1):101-107. doi: 10.1007/s00264-020-04877-3. Epub 2020 Nov 24.
  • 27. Hasebe Y, Akasaka K, Yamamoto M. Factors affecting early knee-flexion range of motion after total knee arthroplasty. J Phys Ther Sci. 2021 Sep;33(9):672-675. doi: 10.1589/jpts.33.672. Epub 2021 Sep 1.

THE EFFECTS OF EARLY PROGRESSIVE CLOSED KINETIC CHAIN EXERCISES IN COMPARISON WITH STANDARD EXERCISE PROGRAM AFTER BILATERAL TOTAL KNEE ARTHROPLASTY - RANDOMIZED CONTROLLED STUDY

Year 2023, Volume: 34 Issue: 1, 102 - 114, 20.04.2023
https://doi.org/10.21653/tjpr.1056788

Abstract

Purpose: This study was conducted to determine the short-term effects of a progressive closed kinetic chain exercise (CKCE) program on pain severity, edema, range of motion and functional status in patients with bilateral total knee arthroplasty (TKA) compared to standard exercise program given in open kinetic position.
Methods: 36 patients (72 knees) with a mean age of 65.22 ± 6.81 years and bilateral TKA were included in the study. The patients were divided into the CKCE group (CKCE, n=16) and the control group (CG, n=16) consisting of standard exercises. The same physiotherapy program was applied to all patients in the first postoperative week. In 2nd post-operative week, the patients were divided into two groups and started exercise training appropriate for their groups. Pain, edema, range of motion measurements of the patients were evaluated at the beginning and at post-operative 4th and 7th weeks in the programs applied 3 days a week and for 6 weeks in total. The functional status assessment was performed only in the last measurement.
Results: There were statistically significant improvements in pain, edema and knee range of motions at the end of the 6 weeks in both groups (p<0.05). In the 4th week measurements, the change in pain was more distinctive in CG (p<0.05), but the changes from baseline in all other measured parameters were similar in both groups (p>0.05).
Conclusion: The study reveals that the progressive CKCE program in the early post-acute period seems effective for bilateral TKA patients and can be embedded in the postoperative exercise programs. However, more than the CKCE program is needed to have an additional advantage over the standard exercise program in the short term.

References

  • 1. Han AS, Nairn L, Harmer AR, Crosbie J ve ark. Early rehabilitation after total knee replacement surgery: a multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care. Arthritis Care Res (Hoboken). 2015 Feb;67(2):196-202.
  • 2. Lisi C, Caspani P, Bruggi M, Carlisi E, Scolè D, Benazzo F, Dalla Toffola E. Early rehabilitation after elective total knee arthroplasty. Acta Biomed. 2017 Oct 18;88(4S):56-61. doi: 10.23750/abm.v88i4-S.5154.
  • 3. Bade MJ, Struessel T, Dayton M, Foran J, Kim RH, Miner T, Wolfe P, Kohrt WM, Dennis D, Stevens-Lapsley JE. Early High-Intensity Versus Low-Intensity Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2017 Sep;69(9):1360-1368. doi: 10.1002/acr.23139. Epub 2017 Aug 13.
  • 4. Masaracchio M, Hanney WJ, Liu X, Kolber M et al. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS ONE 2017;12(6):e0178295 doi.org/10.137/journal.pone.0178295.
  • 5. Iwakiri K, Ohta Y, Shibata Y, Minoda Y, Kobayashi A, Nakamura H Initiating range of motion exercises within 24 hours following total knee arthroplasty affects the reduction of postoperative pain: A randomized controlled trial..Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Apr 28;21:11-16. doi: 10.1016/j.asmart.2020.03.003. eCollection 2020 Jul.
  • 6. Makimoto K, Fujita K, Konno R. Review and synthesis of the experience of patients following total hip or knee arthroplasty in the era of rapidly decreasing hospital length of stay. Jpn J Nurs Sci. 2020 Oct;17(4):e12361. doi: 10.1111/jjns.12361. Epub 2020 Aug 24.
  • 7. Henderson KG, Wallis JA, Snowdon DA.Physiotherapy. Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis. 2018 Mar;104(1):25-35. doi: 10.1016/j.physio.2017.01.002. Epub 2017 Feb 1.
  • 8. Sattler LN, Hing WA, Vertullo CJ. What is the evidence to support early supervised exercise therapy after primary total knee replacement? A systematic review and meta-analysis. BMC Musculoskelet Disord. 2019 Jan 29;20(1):42. doi: 10.1186/s12891-019-2415-5.
  • 9. Florez-García M, García-Pérez F, Curbelo R, Pérez-Porta I, Nishishinya B, Rosario Lozano MP, Carmona L. Efficacy and safety of home-based exercises versus individualized supervised outpatient physical therapy programs after total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3340-3353. doi: 10.1007/s00167-016-4231-x.
  • 10. Li D, Yang Z, Kang P, Xie X. Home-Based Compared with Hospital-Based Rehabilitation Program for Patients Undergoing Total Knee Arthroplasty for Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Jun;96(6):440-447. doi: 10.1097/PHM.0000000000000621.
  • 11. Morelli I, Maffulli N, Brambilla L, Agnoletto M, Peretti GM, Mangiavini L. Quadriceps muscle group function and after total knee arthroplasty-asystematic narrative update. .Br Med Bull. 2021 Mar 25;137(1):51-69. doi: 10.1093/bmb/ldaa041.
  • 12. Fitz W, Shukla P, Li L, Scott RD. Early Regain of Function and Proprioceptive Improvement Following Knee Arthroplasty. Arch Bone Jt Surg. 2018; 6(6): 523-531.
  • 13. Jewiss D, Ostman C, Smart N. Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Journal of Sports Medicine Volume 2017, Article ID 4721548, 10 pages.
  • 14. Husby VS, Helgreud J, Bjorgen S, Husby OS, Hoff J. Early maximal strength training an efficient treatment for patients undergoing total hip arthroplasty. Arch Phys Med rehabil.2009;90:1658-67.
  • 15. HusbyVS, Foss OA, Husby OS,Winther SB. Randomized controlled trial of maximal strangth training vs standart rehabilitation following total knee arthroplasty.Eur J Phys Reh Med.2018;53(3):371-79.
  • 16. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage 2005;13(1):28–33.
  • 17. Jakobsen TL, Hustel H, Petersen J, Bandholm T. Early progressive strength training to enhance recovery after fast-track total knee arthroplasty: A rondomized controlled trial. Arthritis Care Res. 2014; 66:1856-66.
  • 18. Fransen BL, Hoozemans MJM, Argelo KDS, Keijser LCM ve ark. Fast-track total knee arthroplasty improved clinical and functionaloutcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up. Arch of Orthop and Trauma Surg. 2018;138:1305-1316.
  • 19. Piva SR, Gil AB, Almeida GJ, DiGioia AM 3rd, Levison TJ, Fitzgerald GK. A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial. 2010 Jun;90(6):880-94. doi: 10.2522/ptj.20090150. Epub 2010 Apr 8.
  • 20. Hsu WH, Hsu WB, Shen WJ, Lin ZR ve ark. Twenty-four-week hospital-based progressive resistance training on functional recovery in female patients post total knee arthroplasty. Knee. 2019 Mar 19. pii: S0968-0160(18)30625-2.
  • 21. Suh MJ, Kim BR, Kim SR, Han EY, Lee SY.Effects of Early Combined Eccentric-Concentric Versus Concentric Resistance Training Following Total Knee Arthroplasty. Ann Rehabil Med. 2017 Oct;41(5):816-827.
  • 22. Moffet H, Collet J-P, Shapiro SH, Paradis G et al. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: a single-blind randomized controlled trial. Arch Phys Med Rehab 2004;85:546–56.
  • 23. Jogi P, Overend TJ, Spaulding SJ, Zecevic A ve ark. Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial. SAGE Open Med. 2015 Feb 11;3:2050312115570769.
  • 24. Vincent KR, Vincent HK, Lee LW, Alfano AP. Outcomes in total knee arthroplasty patients after inpatient rehabilitation: influence of age and gender. Am J Phys Med Rehabil. 2006;85(6):482-9.
  • 25. Fortier LM, Rockov ZA, Chen AF, Rajaee SS Activity Recommendations After Total Hip and Total Knee Arthroplasty..J Bone Joint Surg Am. 2021 Mar 3;103(5):446-455. doi: 10.2106/JBJS.20.00983.
  • 26. Pinsornsak P, Kanitnate S, Boontanapibul K The effect of immediate post-operative knee range of motion photographs on post-operative range of motion after total knee arthroplasty : An assessor-blinded randomized controlled clinical trial in sixty patients. .Int Orthop. 2021 Jan;45(1):101-107. doi: 10.1007/s00264-020-04877-3. Epub 2020 Nov 24.
  • 27. Hasebe Y, Akasaka K, Yamamoto M. Factors affecting early knee-flexion range of motion after total knee arthroplasty. J Phys Ther Sci. 2021 Sep;33(9):672-675. doi: 10.1589/jpts.33.672. Epub 2021 Sep 1.
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Araştırma Makaleleri
Authors

Elif Kıraç Can 0000-0002-8636-8046

Murat Tomruk 0000-0002-3941-816X

Nihal Gelecek 0000-0003-1780-2520

Publication Date April 20, 2023
Published in Issue Year 2023 Volume: 34 Issue: 1

Cite

APA Kıraç Can, E., Tomruk, M., & Gelecek, N. (2023). BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, 34(1), 102-114. https://doi.org/10.21653/tjpr.1056788
AMA Kıraç Can E, Tomruk M, Gelecek N. BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA. Turk J Physiother Rehabil. April 2023;34(1):102-114. doi:10.21653/tjpr.1056788
Chicago Kıraç Can, Elif, Murat Tomruk, and Nihal Gelecek. “BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi 34, no. 1 (April 2023): 102-14. https://doi.org/10.21653/tjpr.1056788.
EndNote Kıraç Can E, Tomruk M, Gelecek N (April 1, 2023) BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA. Türk Fizyoterapi ve Rehabilitasyon Dergisi 34 1 102–114.
IEEE E. Kıraç Can, M. Tomruk, and N. Gelecek, “BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA”, Turk J Physiother Rehabil, vol. 34, no. 1, pp. 102–114, 2023, doi: 10.21653/tjpr.1056788.
ISNAD Kıraç Can, Elif et al. “BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA”. Türk Fizyoterapi ve Rehabilitasyon Dergisi 34/1 (April 2023), 102-114. https://doi.org/10.21653/tjpr.1056788.
JAMA Kıraç Can E, Tomruk M, Gelecek N. BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA. Turk J Physiother Rehabil. 2023;34:102–114.
MLA Kıraç Can, Elif et al. “BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, vol. 34, no. 1, 2023, pp. 102-14, doi:10.21653/tjpr.1056788.
Vancouver Kıraç Can E, Tomruk M, Gelecek N. BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA. Turk J Physiother Rehabil. 2023;34(1):102-14.