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s
:
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-
CS
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p
a
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sig
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K
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w
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s
:
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alth
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x
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cise
Ost
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ar
th
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itis
Pain
R
eh
ab
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T
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is i
s
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p
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c
c
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ss
a
rticle
u
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d
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r th
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CC B
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SA
li
c
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se
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C
o
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s
p
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uth
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r
:
Gr
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Ap
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Dep
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tm
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t o
f
Nu
r
s
in
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,
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tid
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ti Hu
s
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Glen
m
o
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Gen
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p
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Kr
ajan
Ham
let,
T
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alh
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jo
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B
an
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wan
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B
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i Reg
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,
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av
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6
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6
6
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I
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d
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r
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a
2
6
2
@
g
m
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co
m
1.
I
NT
RO
D
UCT
I
O
N
Kn
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o
s
teo
ar
th
r
itis
is
a
d
eg
en
er
ativ
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jo
in
t
d
is
o
r
d
er
th
at
g
r
ad
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tim
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co
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m
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l
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ciate
d
with
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s
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ten
t
p
ain
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d
r
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ce
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p
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ical
f
u
n
ctio
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.
B
ased
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f
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2
0
1
7
Glo
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B
u
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Dis
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s
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t,
th
is
co
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d
itio
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r
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ts
a
s
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n
if
ican
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g
lo
b
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h
ea
lt
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co
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ce
r
n
.
Am
o
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g
in
d
iv
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als
ag
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v
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6
0
y
ea
r
s
,
s
y
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p
to
m
atic
o
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teo
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itis
af
f
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ap
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x
im
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9
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6
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with
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estrictio
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ar
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n
ab
le
to
ca
r
r
y
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ess
en
tial
d
aily
task
s
[
1
]
.
Glo
b
ally
,
an
esti
m
ated
2
5
0
m
illi
o
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p
e
o
p
le
liv
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with
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itis
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with
k
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in
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lv
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b
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th
e
m
o
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t
p
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m
.
I
n
th
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ag
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to
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s
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h
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k
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teo
ar
th
r
itis
r
an
g
es
b
etwe
en
1
6
%
an
d
1
7
%
[
2
]
.
Fu
r
th
er
m
o
r
e,
it
is
r
ec
o
g
n
ized
as
o
n
e
o
f
th
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p
r
im
a
r
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co
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tr
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b
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to
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s
to
d
is
ab
ilit
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am
o
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g
o
ld
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r
a
d
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lts
,
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ig
n
if
ican
tly
im
p
ac
tin
g
b
o
th
in
d
e
p
en
d
e
n
ce
a
n
d
o
v
er
all
q
u
ality
o
f
life
[
3
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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Sci
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N:
2252
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8
8
0
6
E
ffective
n
ess
o
f te
lereh
a
b
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a
t
io
n
ve
r
s
u
s
h
o
me
ex
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in
kn
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s
teo
a
r
th
r
itis
:
… (
Gren
d
a
A
p
r
ilya
w
a
n
)
331
Pain
in
th
e
jo
in
ts
is
th
e
m
ain
f
ac
to
r
co
n
t
r
ib
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tin
g
t
o
r
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u
ce
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f
u
n
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d
d
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in
in
d
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v
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k
n
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s
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a
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t
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r
i
t
is
(
K
OA
)
[
4
]
.
I
n
a
d
d
i
t
i
o
n
t
o
j
o
i
n
t
-
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a
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p
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ts
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x
p
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,
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f
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a
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t
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r
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n
f
u
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c
t
i
o
n
a
l
l
i
m
i
t
a
ti
o
n
s
[
5
]
,
[
6
]
.
T
h
e
s
e
c
o
m
b
i
n
e
d
e
f
f
e
cts
u
l
ti
m
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t
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y
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e
a
d
t
o
a
d
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c
l
i
n
e
i
n
p
a
t
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e
n
t
s
’
o
v
e
r
a
l
l
w
e
ll
-
b
e
i
n
g
a
n
d
l
i
f
e
q
u
a
l
i
t
y
[
7
]
.
T
o
s
l
o
w
d
is
e
a
s
e
p
r
o
g
r
e
s
s
i
o
n
a
n
d
m
a
n
a
g
e
s
y
m
p
t
o
m
s
,
life
s
ty
le
ad
ju
s
tm
en
ts
ar
e
wid
ely
r
ec
o
m
m
en
d
ed
in
clin
ical
g
u
id
elin
es.
T
h
ese
in
clu
d
e
en
g
ag
in
g
in
r
eg
u
la
r
p
h
y
s
ical
ac
tiv
ity
,
ad
o
p
tin
g
s
elf
-
m
an
ag
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e
n
t stra
teg
ies,
an
d
i
m
p
r
o
v
i
n
g
k
n
o
wled
g
e
ab
o
u
t th
e
co
n
d
itio
n
[
8
]
.
E
x
er
cise
h
as
a
cr
u
cial
r
o
le
in
m
ain
tain
in
g
jo
in
t
h
ea
lth
,
p
ar
ti
cu
lar
ly
b
y
r
e
g
u
latin
g
cy
t
o
k
in
e
ac
tiv
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in
s
y
n
o
v
ial
f
l
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id
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n
d
r
ed
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ci
n
g
b
o
th
in
f
la
m
m
atio
n
an
d
o
x
i
d
ativ
e
s
tr
e
ss
[
2
]
.
Ov
er
th
e
p
ast
d
ec
ad
e
an
d
a
h
alf
,
a
g
r
o
win
g
b
o
d
y
o
f
r
esear
ch
h
as
d
em
o
n
s
tr
ated
th
e
ef
f
ec
tiv
en
ess
o
f
e
x
er
cise
in
m
an
a
g
in
g
KOA
[
9
]
,
[
1
0
]
.
E
v
id
en
ce
f
r
o
m
r
an
d
o
m
ize
d
co
n
tr
o
lled
tr
ials
in
d
icate
s
th
at
s
tr
en
g
th
en
in
g
ex
e
r
cises
an
d
r
a
n
g
e
-
of
-
m
o
tio
n
tr
ain
i
n
g
ca
n
allev
iate
p
ain
an
d
en
h
an
ce
f
u
n
ctio
n
al
ab
ilit
y
,
ev
en
wh
en
ad
h
er
en
ce
is
n
o
t o
p
ti
m
al
[
1
1
]
,
[
1
2
]
.
As a
r
esu
lt,
ex
er
cise
is
co
n
s
id
er
ed
a
k
ey
n
o
n
-
p
h
ar
m
ac
o
l
o
g
ical
a
p
p
r
o
ac
h
an
d
a
ce
n
tr
al
co
m
p
o
n
en
t
o
f
co
n
s
er
v
ativ
e
tr
ea
tm
en
t f
o
r
t
h
is
ch
r
o
n
ic
co
n
d
itio
n
[
1
0
]
.
Desp
ite
th
ese
b
en
ef
its
,
s
u
s
tai
n
in
g
life
s
ty
le
ch
an
g
es
af
ter
h
o
s
p
ital
d
is
ch
ar
g
e
r
em
ai
n
s
d
if
f
icu
lt
f
o
r
m
a
n
y
p
a
t
i
e
n
ts
[
1
3
]
.
L
i
m
i
t
e
d
s
u
p
e
r
v
i
s
i
o
n
a
n
d
l
a
c
k
o
f
f
e
e
d
b
a
c
k
f
r
o
m
h
e
a
l
t
h
c
a
r
e
p
r
o
f
e
s
s
io
n
a
l
s
o
f
t
e
n
l
e
a
d
t
o
r
e
d
u
c
e
d
e
n
g
a
g
e
m
e
n
t
i
n
r
e
h
a
b
i
l
i
t
at
i
o
n
p
r
o
g
r
a
m
s
,
t
h
e
r
e
b
y
d
e
c
r
e
a
s
i
n
g
t
r
e
a
t
m
e
n
t
e
f
f
e
c
t
i
v
e
n
es
s
[
1
4
]
.
M
o
r
e
o
v
e
r
,
a
c
c
e
s
s
t
o
h
e
a
l
t
h
c
a
r
e
s
e
r
v
i
c
e
s
i
s
o
f
t
e
n
r
e
s
t
r
ic
t
e
d
i
n
r
u
r
a
l
a
r
e
a
s
,
w
h
e
r
e
o
l
d
e
r
p
o
p
u
l
a
t
i
o
n
s
te
n
d
t
o
h
a
v
e
p
o
o
r
e
r
h
e
a
l
t
h
-
r
e
l
a
te
d
q
u
a
l
it
y
o
f
li
f
e
[
1
5
]
.
B
as
e
d
o
n
t
h
e
s
e
c
h
a
l
le
n
g
e
s
,
t
h
i
s
s
t
u
d
y
w
a
s
c
o
n
d
u
c
t
e
d
t
o
e
v
a
l
u
a
t
e
a
n
d
c
o
m
p
a
r
e
t
h
e
e
f
f
e
c
t
i
v
e
n
es
s
o
f
t
e
l
e
r
e
h
a
b
il
it
a
t
i
o
n
a
n
d
h
o
m
e
-
b
a
s
e
d
e
x
e
r
c
is
e
p
r
o
g
r
a
m
s
i
n
i
n
d
i
v
i
d
u
a
l
s
w
i
t
h
k
n
e
e
o
s
t
e
o
a
r
t
h
r
it
is
.
2.
M
E
T
H
O
D
T
h
is
r
esear
ch
ad
o
p
te
d
a
q
u
asi
-
ex
p
er
im
en
tal
d
esig
n
u
tili
zin
g
b
o
th
p
r
e
-
i
n
ter
v
en
tio
n
an
d
p
o
s
t
-
in
ter
v
en
tio
n
ass
ess
m
en
ts
with
a
co
n
tr
o
l
g
r
o
u
p
f
o
r
co
m
p
ar
is
o
n
.
T
h
e
s
tu
d
y
was
co
n
d
u
cted
with
in
th
e
s
er
v
ice
ar
ea
o
f
th
e
T
ap
an
r
ej
o
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
in
B
a
n
y
u
wan
g
i
R
eg
e
n
cy
.
A
to
tal
o
f
1
2
0
in
d
i
v
id
u
als
d
iag
n
o
s
ed
with
o
s
teo
ar
t
h
r
itis
wer
e
r
ec
r
u
ited
b
ased
o
n
s
p
ec
if
ic
elig
ib
ilit
y
cr
iter
ia.
Par
ticip
an
ts
wer
e
r
eq
u
ir
ed
t
o
v
o
lu
n
tar
ily
ag
r
ee
to
jo
in
th
e
s
tu
d
y
,
liv
e
in
d
ep
e
n
d
en
tly
,
am
b
u
late
with
o
u
t
ass
i
s
tiv
e
d
ev
ices,
an
d
p
o
s
s
ess
an
d
o
p
er
ate
a
s
m
ar
tp
h
o
n
e,
tab
let,
o
r
co
m
p
u
te
r
with
in
ter
n
et
ac
ce
s
s
.
E
x
clu
s
io
n
cr
iter
ia
in
clu
d
ed
th
e
p
r
esen
ce
o
f
o
th
er
s
y
s
tem
ic
r
h
eu
m
atic
co
n
d
itio
n
s
,
p
ar
ticip
atio
n
in
p
h
y
s
io
th
er
ap
y
o
r
r
eh
ab
ilit
atio
n
with
in
th
e
p
r
ev
io
u
s
s
ix
m
o
n
th
s
,
a
h
is
to
r
y
o
f
k
n
ee
s
u
r
g
er
y
,
r
ec
en
t
lig
am
e
n
t
o
r
m
en
is
c
al
in
ju
r
ies,
f
r
eq
u
en
t
f
alls
(
m
o
r
e
th
an
twice
in
s
ix
m
o
n
th
s
)
,
r
ec
en
t
o
r
p
lan
n
ed
k
n
ee
in
jectio
n
s
,
illi
ter
ac
y
,
c
o
g
n
itiv
e
im
p
air
m
e
n
t,
v
is
u
al
d
is
tu
r
b
an
ce
s
,
o
r
h
ea
r
i
n
g
d
if
f
icu
lties
.
E
lig
ib
le
p
ar
ticip
a
n
ts
wer
e
a
s
s
ig
n
ed
to
eith
e
r
an
in
ter
v
e
n
tio
n
g
r
o
u
p
o
r
a
co
n
tr
o
l
g
r
o
u
p
.
T
h
e
in
ter
v
en
tio
n
g
r
o
u
p
r
ec
eiv
ed
t
eler
eh
ab
ilit
atio
n
s
ess
io
n
s
co
n
d
u
cted
v
ia
v
id
eo
co
n
f
er
e
n
cin
g
u
s
in
g
th
e
Z
o
o
m
p
latf
o
r
m
u
n
d
er
th
e
s
u
p
er
v
is
io
n
o
f
a
p
h
y
s
io
th
er
a
p
is
t.
Me
an
wh
ile,
in
d
iv
id
u
als
in
th
e
co
n
tr
o
l
g
r
o
u
p
wer
e
p
r
o
v
id
e
d
wit
h
p
r
i
n
ted
in
s
tr
u
ct
io
n
al
m
ater
ials
o
u
tlin
in
g
t
h
e
e
x
er
cises
an
d
th
eir
p
r
o
p
er
ex
ec
u
tio
n
.
Par
ticip
an
ts
wer
e
also
in
f
o
r
m
ed
a
b
o
u
t
ac
c
ess
in
g
o
n
lin
e
s
ess
io
n
s
th
r
o
u
g
h
Go
o
g
le
Meet
,
an
d
m
ee
tin
g
lin
k
s
wer
e
s
h
ar
ed
v
ia
m
ess
ag
in
g
.
T
h
e
teler
eh
ab
ilit
atio
n
p
r
o
g
r
am
co
n
s
is
ted
o
f
2
4
s
ess
io
n
s
,
an
d
ad
d
itio
n
al
ed
u
ca
tio
n
was
d
eliv
er
ed
f
o
llo
win
g
ev
al
u
atio
n
s
th
r
o
u
g
h
o
n
lin
e
m
ee
tin
g
s
.
T
h
e
ex
er
cise
r
eg
im
en
in
clu
d
e
d
m
o
v
em
en
ts
s
u
ch
as
s
ea
ted
k
n
ee
ex
ten
s
io
n
an
d
f
le
x
io
n
,
h
ip
f
lex
io
n
,
ch
air
s
it
-
u
p
s
,
is
o
m
etr
ic
s
tr
en
g
th
en
in
g
o
f
th
e
q
u
ad
r
icep
s
an
d
h
ip
a
d
d
u
ct
o
r
s
,
s
tr
aig
h
t
le
g
r
aises
in
a
s
u
p
in
e
p
o
s
itio
n
,
h
ip
ab
d
u
ctio
n
an
d
ad
d
u
ctio
n
i
n
a
s
id
e
-
l
y
in
g
p
o
s
itio
n
,
s
q
u
ats
with
v
a
r
y
in
g
s
tan
ce
wid
th
s
,
an
d
s
in
g
le
-
leg
s
tan
d
in
g
ex
er
cises
.
Stre
tch
in
g
r
o
u
tin
es
tar
g
etin
g
th
e
h
am
s
tr
in
g
s
an
d
q
u
ad
r
icep
s
wer
e
p
er
f
o
r
m
ed
af
ter
co
m
p
letin
g
th
e
m
ain
ex
er
cise
s
.
E
x
er
cise
in
ten
s
ity
an
d
r
ep
e
titi
o
n
s
wer
e
p
r
o
g
r
ess
iv
ely
in
c
r
ea
s
ed
ea
ch
wee
k
.
T
h
e
i
n
t
e
r
v
en
ti
o
n
w
as
ca
r
r
ie
d
o
u
t
t
h
r
ee
ti
m
es
p
er
w
ee
k
,
wi
th
ea
c
h
s
ess
i
o
n
l
asti
n
g
4
5
–
6
0
m
i
n
u
tes
o
v
er
a
p
e
r
i
o
d
o
f
e
ig
h
t
w
ee
k
s
.
I
n
c
o
n
t
r
as
t,
t
h
e
c
o
n
tr
o
l
g
r
o
u
p
p
e
r
f
o
r
m
e
d
t
h
e
s
am
e
e
x
er
cises
i
n
d
e
p
e
n
d
e
n
t
ly
wit
h
o
u
t
s
u
p
er
v
is
io
n
.
Sev
er
al
o
u
tco
m
e
m
ea
s
u
r
es
w
er
e
u
s
ed
in
th
is
s
tu
d
y
.
T
h
e
3
0
-
s
ec
o
n
d
ch
ai
r
s
tan
d
test
(
3
0
-
C
ST)
was
em
p
lo
y
ed
to
ass
ess
lo
wer
lim
b
s
tr
en
g
th
an
d
d
y
n
am
ic
b
alan
ce
.
Par
ticip
an
ts
wer
e
s
ea
t
ed
o
n
a
s
tan
d
ar
d
ch
air
(
ap
p
r
o
x
im
ately
4
4
cm
h
i
g
h
)
w
ith
o
u
t a
r
m
r
ests
,
with
th
e
ch
air
s
tab
ilized
ag
ain
s
t a
wall.
W
ith
ar
m
s
cr
o
s
s
ed
o
v
er
t
h
e
c
h
e
s
t
,
p
a
r
t
i
ci
p
a
n
t
s
w
e
r
e
i
n
s
t
r
u
c
t
e
d
t
o
s
t
a
n
d
a
n
d
s
i
t
r
e
p
e
at
ed
l
y
f
o
r
3
0
s
e
c
o
n
d
s
,
a
n
d
p
e
r
f
o
r
m
a
n
c
e
w
as
r
e
c
o
r
d
e
d
[
1
6
]
.
P
a
i
n
i
n
te
n
s
it
y
w
as
m
ea
s
u
r
e
d
u
s
i
n
g
t
h
e
n
u
m
e
r
i
c
r
a
ti
n
g
s
c
a
l
e
(
NR
S
)
,
r
a
n
g
i
n
g
f
r
o
m
0
(
n
o
p
a
i
n
)
t
o
1
0
(
w
o
r
s
t
i
m
a
g
i
n
a
b
l
e
p
a
i
n
)
[
1
7
]
.
P
h
y
s
i
c
a
l
a
c
t
i
v
it
y
l
e
v
e
l
s
w
e
r
e
e
v
a
lu
a
t
e
d
u
s
i
n
g
t
h
e
I
n
t
e
r
n
a
t
i
o
n
a
l
P
h
y
s
i
c
a
l
Activ
ity
Qu
esti
o
n
n
air
e
(
I
PAQ)
,
wh
ich
co
n
s
is
ts
o
f
n
i
n
e
item
s
[
1
8
]
.
Fear
o
f
m
o
v
e
m
en
t
was
ass
ess
ed
with
th
e
1
7
-
item
T
am
p
a
Kin
esio
p
h
o
b
ia
Scale
(
T
KS)
[
1
9
]
.
E
x
er
cise
ad
h
e
r
en
ce
was
m
ea
s
u
r
ed
u
s
in
g
th
e
1
6
-
item
e
x
e
r
cis
e
ad
h
e
r
e
n
ce
r
ati
n
g
s
c
ale
(
E
AR
S
)
[
2
0
]
,
w
h
il
e
f
a
ti
g
u
e
w
as
ass
e
s
s
ed
wit
h
th
e
f
a
ti
g
u
e
s
ev
er
it
y
s
ca
l
e
(
FS
S)
,
wh
ic
h
r
e
f
le
cts
f
ati
g
u
e
e
x
p
er
ie
n
c
ed
o
v
er
th
e
p
as
t
m
o
n
t
h
[
2
1
]
.
P
ati
en
t
s
atis
f
a
cti
o
n
w
as
ev
al
u
at
e
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3.
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r
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I
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8
8
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E
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.
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ec
eiv
in
g
teler
eh
ab
ilit
atio
n
.
Pre
v
io
u
s
r
esear
ch
h
as
in
d
icat
ed
th
at
KOA
o
cc
u
r
s
m
o
r
e
f
r
eq
u
en
tly
in
wo
m
en
th
an
i
n
m
en
[
2
4
]
.
C
o
n
s
is
ten
t
w
ith
th
is
,
f
em
ale
p
ar
ticip
an
ts
co
n
s
titu
ted
th
e
m
ajo
r
ity
in
b
o
th
g
r
o
u
p
s
in
th
is
s
tu
d
y
.
T
h
is
g
en
d
er
d
is
tr
ib
u
tio
n
alig
n
s
with
ea
r
lie
r
s
tu
d
ies
[
2
5
]
–
[
2
7
]
.
Ad
d
itio
n
ally
,
KOA
is
r
ec
o
g
n
ized
as
o
n
e
o
f
t
h
e
lead
i
n
g
ca
u
s
es
o
f
d
is
ab
ilit
y
am
o
n
g
i
n
d
iv
id
u
als
o
v
e
r
th
e
ag
e
o
f
5
0
,
s
i
g
n
if
ican
tly
af
f
ec
tin
g
in
d
ep
en
d
en
ce
an
d
q
u
ality
o
f
life
.
T
h
e
av
er
a
g
e
ag
e
o
f
p
ar
ticip
an
ts
in
b
o
th
g
r
o
u
p
s
in
th
is
s
t
u
d
y
was
also
ab
o
v
e
5
0
y
ea
r
s
,
wh
ich
is
co
n
s
is
ten
t
with
ex
is
tin
g
liter
atu
r
e
[
2
8
]
–
[
3
0
]
.
E
x
ce
s
s
b
o
d
y
weig
h
t
is
wid
ely
ac
k
n
o
wled
g
ed
as
a
m
ajo
r
r
is
k
f
ac
to
r
f
o
r
KOA.
I
n
cr
ea
s
ed
b
o
d
y
m
ass
p
lace
s
ex
ce
s
s
iv
e
m
ec
h
an
ical
l
o
ad
o
n
th
e
k
n
ee
jo
i
n
t,
wh
ich
m
ay
alter
ca
r
tilag
e
s
tr
u
ctu
r
e
an
d
co
n
tr
ib
u
te
to
its
d
eg
en
er
atio
n
.
I
n
t
h
is
s
tu
d
y
,
p
ar
ticip
an
ts
in
b
o
th
g
r
o
u
p
s
h
a
d
av
er
ag
e
B
MI
v
al
u
es
in
d
ica
tin
g
o
b
esit
y
.
T
h
ese
f
in
d
in
g
s
ar
e
c
o
n
s
is
ten
t
with
p
r
io
r
s
tu
d
ies
r
ep
o
r
tin
g
B
MI
v
a
lu
es
ab
o
v
e
3
0
in
s
im
ilar
p
o
p
u
latio
n
s
[
2
9
]
,
[
3
1
]
,
f
u
r
th
er
s
u
p
p
o
r
tin
g
th
e
r
elatio
n
s
h
ip
b
etwe
en
o
b
esit
y
a
n
d
KO
A
d
ev
elo
p
m
e
n
t.
Pain
is
o
n
e
o
f
th
e
m
o
s
t
p
r
o
m
in
en
t
s
y
m
p
to
m
s
ex
p
er
ien
ce
d
b
y
in
d
iv
id
u
als
with
KOA
[
3
2
]
.
I
n
th
is
s
tu
d
y
,
p
ain
in
ten
s
ity
was
m
ea
s
u
r
ed
u
s
in
g
th
e
NR
S.
B
aselin
e
p
ain
lev
els
wer
e
co
m
p
ar
ab
l
e
b
etwe
en
th
e
two
g
r
o
u
p
s
.
Alth
o
u
g
h
b
o
th
g
r
o
u
p
s
s
h
o
wed
r
ed
u
ctio
n
s
in
p
ain
af
ter
th
e
in
ter
v
en
tio
n
,
th
e
d
ec
r
ea
s
e
in
th
e
c
o
n
tr
o
l
g
r
o
u
p
was
n
o
t
s
tatis
tically
s
ig
n
if
ican
t.
I
n
co
n
tr
ast,
th
e
r
ed
u
c
tio
n
o
b
s
er
v
ed
in
th
e
teler
eh
a
b
ilit
atio
n
g
r
o
u
p
was
s
ig
n
if
ican
tly
g
r
ea
ter
.
T
h
is
o
u
t
co
m
e
m
ay
b
e
ex
p
lain
e
d
b
y
th
e
f
ac
t
th
at
p
ar
ticip
an
ts
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
p
er
f
o
r
m
ed
th
ei
r
ex
e
r
cises
u
n
d
er
p
r
o
f
ess
io
n
al
s
u
p
er
v
is
io
n
v
i
a
v
id
eo
s
ess
io
n
s
,
en
s
u
r
in
g
c
o
r
r
ec
t
tech
n
iq
u
e
an
d
co
n
s
is
te
n
cy
.
Me
an
wh
ile,
p
ar
t
icip
an
ts
in
th
e
co
n
tr
o
l
g
r
o
u
p
r
elied
s
o
lely
o
n
wr
itten
in
s
tr
u
ctio
n
s
with
o
u
t
m
o
n
ito
r
in
g
o
r
r
e
m
in
d
er
s
,
m
ak
in
g
it
u
n
ce
r
tain
wh
eth
er
ex
er
c
is
es
wer
e
p
er
f
o
r
m
ed
c
o
r
r
ec
tly
o
r
r
e
g
u
lar
ly
.
T
h
ese
f
in
d
in
g
s
ar
e
i
n
lin
e
with
p
r
ev
i
o
u
s
s
tu
d
ies
r
ep
o
r
tin
g
th
at
teler
eh
ab
ilit
atio
n
-
b
ased
ex
e
r
cise
p
r
o
g
r
am
s
ef
f
ec
tiv
el
y
r
ed
u
ce
p
ai
n
in
KOA
p
atien
ts
[
2
5
]
,
[
2
7
]
,
[
2
8
]
,
[
3
0
]
,
[
3
1
]
,
[
3
3
]
–
[
3
5
]
.
Fu
n
ctio
n
al
ab
ilit
y
is
o
f
ten
co
m
p
r
o
m
is
ed
in
in
d
iv
id
u
als
with
KOA
d
u
e
to
p
ain
an
d
o
th
er
s
y
m
p
to
m
s
.
I
n
th
is
s
tu
d
y
,
p
h
y
s
ical
p
er
f
o
r
m
an
ce
was
ass
e
s
s
ed
u
s
in
g
th
e
3
0
-
s
ec
o
n
d
c
h
ai
r
s
tan
d
test
(
3
0
-
C
ST)
.
B
o
th
g
r
o
u
p
s
h
ad
s
im
ilar
b
aselin
e
s
co
r
es,
an
d
im
p
r
o
v
em
en
ts
wer
e
o
b
s
er
v
ed
a
f
ter
th
e
in
ter
v
e
n
ti
o
n
.
Ho
we
v
er
,
th
e
im
p
r
o
v
em
e
n
t
in
th
e
co
n
tr
o
l
g
r
o
u
p
d
id
n
o
t
r
ea
ch
clin
ical
s
i
g
n
if
ican
ce
,
w
h
er
ea
s
th
e
teler
eh
ab
ilit
atio
n
g
r
o
u
p
s
h
o
wed
a
s
ig
n
i
f
ican
tly
g
r
ea
t
er
in
cr
ea
s
e.
T
h
is
d
if
f
e
r
en
ce
m
ay
ag
ai
n
b
e
attr
ib
u
te
d
to
s
u
p
er
v
is
ed
ex
er
cise
s
ess
io
n
s
,
wh
ich
en
s
u
r
ed
p
r
o
p
er
ex
ec
u
tio
n
an
d
ad
h
er
en
ce
.
Pro
g
r
ess
iv
e
s
tr
en
g
th
en
i
n
g
e
x
e
r
cises
ar
e
k
n
o
wn
to
en
h
an
ce
m
u
s
cle
s
tr
en
g
t
h
,
wh
i
ch
is
r
ef
lecte
d
in
im
p
r
o
v
ed
3
0
-
CS
T
s
co
r
es
[
3
6
]
.
W
h
ile
s
o
m
e
p
r
e
v
io
u
s
s
tu
d
ies
h
av
e
r
ep
o
r
te
d
m
i
x
ed
r
esu
lts
r
eg
ar
d
in
g
f
u
n
ctio
n
al
im
p
r
o
v
e
m
en
t
with
teler
e
h
ab
ilit
atio
n
,
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
ar
e
co
n
s
is
ten
t w
ith
th
o
s
e
o
f
Ner
o
et
a
l
.
[
2
7
]
a
n
d
Go
h
ir
et
a
l
.
[
3
1
]
.
Kin
esio
p
h
o
b
ia,
o
r
f
ea
r
o
f
m
o
v
em
en
t,
h
as
b
ee
n
ass
o
ciate
d
with
in
cr
ea
s
ed
p
ain
,
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
,
an
d
d
is
ab
ilit
y
[
3
7
]
.
I
t
is
also
c
o
m
m
o
n
ly
o
b
s
er
v
ed
in
in
d
i
v
id
u
als
with
KO
A.
I
n
th
is
s
tu
d
y
,
k
in
esio
p
h
o
b
ia
was
m
ea
s
u
r
ed
u
s
in
g
T
KS.
I
n
itial
s
co
r
es
in
d
i
ca
ted
s
ev
er
e
lev
els
o
f
f
ea
r
i
n
b
o
th
g
r
o
u
p
s
.
Af
ter
th
e
in
ter
v
e
n
tio
n
,
b
o
th
g
r
o
u
p
s
s
h
o
wed
im
p
r
o
v
em
e
n
t;
h
o
we
v
er
,
th
e
r
ed
u
ctio
n
was
s
ig
n
if
ic
an
tly
g
r
ea
te
r
in
th
e
teler
eh
ab
ilit
atio
n
g
r
o
u
p
.
T
h
is
im
p
r
o
v
em
en
t
m
ay
b
e
lin
k
e
d
to
d
ec
r
ea
s
ed
p
ai
n
an
d
en
h
an
ce
d
p
h
y
s
ical
an
d
em
o
tio
n
al
f
u
n
ctio
n
in
g
.
No
t
ab
ly
,
lim
ited
r
esear
ch
h
as
ex
p
lo
r
ed
th
e
ef
f
ec
t
o
f
t
eler
eh
ab
ilit
atio
n
o
n
k
in
esio
p
h
o
b
ia
in
KOA,
m
ak
in
g
th
is
s
tu
d
y
a
v
al
u
ab
le
co
n
tr
ib
u
tio
n
to
th
e
f
ield
.
Fatig
u
e
is
an
o
th
er
f
r
eq
u
en
t
c
o
m
p
lain
t
am
o
n
g
in
d
iv
id
u
als
with
o
s
teo
ar
th
r
itis
an
d
is
in
f
lu
en
ce
d
b
y
f
ac
to
r
s
s
u
ch
as
p
ain
,
r
ed
u
ce
d
ac
tiv
ity
,
an
d
p
s
y
ch
o
l
o
g
ical
co
n
d
itio
n
s
.
I
n
th
is
s
tu
d
y
,
f
atig
u
e
wa
s
as
s
es
s
ed
u
s
in
g
th
e
FS
S.
B
aselin
e
f
atig
u
e
le
v
els
wer
e
s
im
ilar
b
etwe
en
g
r
o
u
p
s
.
Fo
llo
win
g
th
e
i
n
ter
v
e
n
tio
n
,
a
s
ig
n
if
ican
t
r
ed
u
ctio
n
i
n
f
atig
u
e
was
o
b
s
er
v
ed
o
n
ly
in
th
e
teler
eh
ab
ilit
atio
n
g
r
o
u
p
.
T
h
is
im
p
r
o
v
em
e
n
t m
ay
b
e
attr
ib
u
ted
to
b
etter
p
ain
m
an
ag
em
e
n
t
an
d
en
h
an
ce
d
p
h
y
s
ical
an
d
f
u
n
c
tio
n
al
ca
p
ac
ity
in
th
is
g
r
o
u
p
.
T
h
e
f
in
d
in
g
s
ar
e
co
n
s
is
ten
t w
ith
p
r
ev
io
u
s
s
tu
d
i
es th
at
h
av
e
ev
alu
ate
d
f
atig
u
e
u
s
in
g
s
im
ilar
m
ea
s
u
r
es
[
2
5
]
,
[
3
0
]
.
L
ev
els
o
f
p
h
y
s
ical
ac
tiv
ity
in
i
n
d
iv
id
u
als
with
KOA
ar
e
o
f
te
n
in
f
lu
en
ce
d
b
y
p
ain
,
f
ea
r
o
f
m
o
v
em
en
t,
an
d
f
atig
u
e.
I
n
th
is
s
tu
d
y
,
p
h
y
s
ical
ac
tiv
ity
was
m
ea
s
u
r
e
d
u
s
in
g
th
e
I
PAQ
-
SF
.
W
h
ile
b
aselin
e
lev
els
wer
e
co
m
p
ar
ab
le,
o
n
ly
th
e
teler
eh
a
b
ilit
atio
n
g
r
o
u
p
d
em
o
n
s
tr
ated
a
s
ig
n
if
ican
t
in
c
r
ea
s
e
af
ter
t
h
e
in
ter
v
en
tio
n
.
T
h
is
im
p
r
o
v
em
e
n
t
m
ay
b
e
ex
p
lain
ed
b
y
r
ed
u
ce
d
s
y
m
p
to
m
s
an
d
in
cr
ea
s
ed
m
o
tiv
atio
n
,
s
u
p
p
o
r
ted
b
y
co
n
tin
u
o
u
s
in
ter
ac
tio
n
with
a
p
h
y
s
io
th
e
r
a
p
is
t.
T
h
e
r
esu
lts
alig
n
with
lo
n
g
-
ter
m
f
in
d
in
g
s
f
r
o
m
p
r
ev
io
u
s
s
tu
d
ies
[
2
5
]
,
[
3
8
]
,
alth
o
u
g
h
s
o
m
e
s
tu
d
ies
h
av
e
r
ep
o
r
ted
n
o
s
ig
n
if
ican
t
ch
a
n
g
e
s
in
ac
tiv
ity
lev
el
s
[
2
6
]
.
Dif
f
er
en
ce
s
in
o
u
tco
m
es
m
ay
b
e
r
elate
d
to
p
a
tien
t e
d
u
c
atio
n
an
d
t
h
e
lev
el
o
f
p
r
o
f
ess
io
n
al
g
u
i
d
an
ce
p
r
o
v
id
e
d
d
u
r
in
g
th
e
in
ter
v
en
tio
n
.
E
x
er
cise
ad
h
er
e
n
ce
,
ass
ess
ed
u
s
in
g
th
e
E
AR
S,
was
s
ig
n
if
ican
tly
h
ig
h
e
r
in
th
e
teler
e
h
ab
ilit
atio
n
g
r
o
u
p
co
m
p
ar
ed
to
t
h
e
co
n
tr
o
l
g
r
o
u
p
.
T
h
is
is
ex
p
ec
ted
,
as
s
u
p
er
v
is
ed
p
r
o
g
r
am
s
ten
d
to
im
p
r
o
v
e
co
m
p
lian
ce
.
Similar
f
in
d
in
g
s
h
a
v
e
b
ee
n
r
e
p
o
r
ted
in
p
r
e
v
io
u
s
s
tu
d
ies
u
s
in
g
b
o
th
E
AR
S
an
d
o
th
er
ad
h
e
r
en
ce
m
ea
s
u
r
es
[
3
5
]
,
[
3
9
]
.
Patien
t sati
s
f
ac
tio
n
was a
ls
o
h
ig
h
er
in
th
e
teler
eh
a
b
ilit
atio
n
g
r
o
u
p
.
All p
ar
ticip
an
ts
in
t
h
is
g
r
o
u
p
r
ep
o
r
te
d
b
ein
g
s
atis
f
ied
o
r
v
e
r
y
s
atis
f
ied
with
th
eir
tr
ea
tm
en
t,
co
m
p
ar
ed
to
a
lo
wer
p
r
o
p
o
r
tio
n
in
th
e
co
n
tr
o
l
g
r
o
u
p
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
3
3
0
-
3
3
6
334
T
h
is
r
esu
lt
i
s
co
n
s
is
ten
t
with
f
in
d
in
g
s
f
r
o
m
B
r
o
o
k
s
et
a
l
.
[
4
0
]
,
alth
o
u
g
h
it
d
if
f
er
s
f
r
o
m
B
en
n
ell
et
a
l
.
[
3
9
]
,
p
o
s
s
ib
ly
d
u
e
to
d
if
f
e
r
en
ce
s
in
in
ter
v
en
t
io
n
d
u
r
atio
n
,
with
th
e
p
r
esen
t
s
tu
d
y
last
in
g
8
wee
k
s
co
m
p
ar
ed
to
s
h
o
r
ter
d
u
r
atio
n
s
in
o
t
h
er
r
ese
ar
ch
.
4.
CO
NCLU
SI
O
N
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
in
d
icate
th
at
teler
eh
ab
ilit
atio
n
is
m
o
r
e
ef
f
ec
tiv
e
th
an
s
elf
-
d
ir
ec
ted
m
an
ag
em
en
t
ap
p
r
o
ac
h
es.
No
ad
v
er
s
e
ef
f
ec
ts
wer
e
o
b
s
er
v
ed
in
eith
er
g
r
o
u
p
th
r
o
u
g
h
o
u
t
th
e
s
tu
d
y
p
er
io
d
.
T
h
e
ev
id
en
ce
s
u
g
g
ests
th
at
teler
eh
ab
ilit
atio
n
is
a
v
alu
ab
le
a
n
d
r
eliab
le
in
ter
v
e
n
tio
n
ca
p
ab
le
o
f
allev
iatin
g
s
y
m
p
to
m
s
in
in
d
i
v
id
u
als
with
th
is
co
n
d
itio
n
.
C
o
n
s
eq
u
en
tly
,
th
ese
f
in
d
in
g
s
ar
e
ex
p
ec
ted
to
n
o
t
o
n
ly
e
n
r
ich
ex
is
tin
g
s
cien
tific
k
n
o
wled
g
e
b
u
t
also
o
f
f
er
p
r
ac
tical
in
s
ig
h
t
s
f
o
r
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als.
Fu
tu
r
e
r
esear
ch
is
r
ec
o
m
m
en
d
ed
to
f
u
r
th
er
i
n
v
esti
g
ate
th
e
co
s
t
-
ef
f
ec
tiv
en
es
s
an
d
o
v
er
all
im
p
ac
t
o
f
p
h
y
s
io
th
er
ap
is
t
-
g
u
id
ed
teler
eh
ab
ilit
a
tio
n
o
n
h
ea
lth
ca
r
e
s
y
s
tem
s
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
r
esear
ch
e
r
wo
u
ld
lik
e
to
th
an
k
all
r
esp
o
n
d
en
ts
w
h
o
h
av
e
p
ar
ticip
ated
in
th
is
s
tu
d
y
an
d
th
e
Min
is
tr
y
o
f
Hig
h
er
E
d
u
ca
tio
n
,
Scien
ce
an
d
T
ec
h
n
o
lo
g
y
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
e
ar
ticle
was f
u
n
d
e
d
b
y
th
e
Min
is
tr
y
o
f
Hig
h
er
E
d
u
ca
tio
n
,
Scien
ce
an
d
T
ec
h
n
o
lo
g
y
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Gr
en
d
a
Ap
r
ily
awa
n
✓
✓
✓
✓
✓
✓
✓
✓
I
n
ay
ah
A
g
en
g
I
zz
a
✓
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✓
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✓
L
an
en
d
o
R
au
f
b
ar
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am
d
an
Su
wan
d
a
✓
✓
✓
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✓
Ma
d
e
Ma
h
ag
u
n
a
Pu
tr
a
✓
✓
✓
✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
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:
Va
l
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
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y
s
i
s
I
:
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n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
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E
:
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r
i
t
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n
g
-
R
e
v
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e
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&
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d
i
t
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n
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:
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su
a
l
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a
t
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:
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p
e
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v
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s
i
o
n
P
:
P
r
o
j
e
c
t
a
d
mi
n
i
st
r
a
t
i
o
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Fu
:
Fu
n
d
i
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g
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c
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t
i
o
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NF
L
I
C
T
O
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I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est.
E
T
H
I
CAL AP
P
RO
V
AL
E
th
ical
clea
r
an
ce
f
o
r
t
h
is
s
tu
d
y
was
o
b
tain
ed
f
r
o
m
th
e
Hea
lt
h
R
esear
ch
E
th
ics
C
o
m
m
ittee
o
f
STI
Kes
R
u
s
tid
a
(
Ap
p
r
o
v
al
No
:
0
0
0
1
/EC/KEPK/I
X
/2
0
2
5
)
.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
ata
th
at
s
u
p
p
o
r
t
th
e
f
i
n
d
in
g
s
o
f
th
is
s
tu
d
y
ar
e
av
aila
b
le
o
n
r
eq
u
est
f
r
o
m
th
e
co
r
r
esp
o
n
d
in
g
au
th
o
r
,
[
GA]
.
T
h
e
d
ata,
wh
ich
co
n
tain
in
f
o
r
m
atio
n
th
at
co
u
ld
co
m
p
r
o
m
is
e
th
e
p
r
iv
ac
y
o
f
r
esear
c
h
p
ar
ticip
an
ts
,
ar
e
n
o
t p
u
b
licly
a
v
ailab
le
d
u
e
to
ce
r
tain
r
estrictio
n
s
.
RE
F
E
R
E
NC
E
S
[
1
]
M
.
Z.
H
a
i
d
e
r
e
t
a
l
.
,
“
R
i
s
k
f
a
c
t
o
r
s
o
f
k
n
e
e
o
st
e
o
a
r
t
h
r
i
t
i
s
i
n
B
a
n
g
l
a
d
e
s
h
i
a
d
u
l
t
s
:
a
n
a
t
i
o
n
a
l
s
u
r
v
e
y
,
”
BM
C
Mu
sc
u
l
o
sk
e
l
e
t
a
l
D
i
so
r
d
e
rs
,
v
o
l
.
2
3
,
n
o
.
1
,
p
.
3
3
3
,
A
p
r
.
2
0
2
2
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
8
9
1
-
0
2
2
-
0
5
2
5
3
-
5.
[
2
]
S.
-
H
.
X
i
e
,
Q
.
W
a
n
g
,
L
.
-
Q
.
W
a
n
g
,
S
.
-
Y
.
Z
h
u
,
Y
.
L
i
,
a
n
d
C
.
-
Q
.
H
e
,
“
T
h
e
f
e
a
s
i
b
i
l
i
t
y
a
n
d
e
f
f
e
c
t
i
v
e
n
e
s
s
o
f
i
n
t
e
r
n
e
t
-
b
a
s
e
d
r
e
h
a
b
i
l
i
t
a
t
i
o
n
f
o
r
p
a
t
i
e
n
t
s
w
i
t
h
k
n
e
e
o
st
e
o
a
r
t
h
r
i
t
i
s,”
Me
d
i
c
i
n
e
,
v
o
l
.
9
9
,
n
o
.
4
4
,
p
.
e
2
2
9
6
1
,
O
c
t
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
9
7
/
M
D
.
0
0
0
0
0
0
0
0
0
0
0
2
2
9
6
1
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
E
ffective
n
ess
o
f te
lereh
a
b
ilit
a
t
io
n
ve
r
s
u
s
h
o
me
ex
ercis
e
in
kn
ee
o
s
teo
a
r
th
r
itis
:
… (
Gren
d
a
A
p
r
ilya
w
a
n
)
335
[
3
]
D
.
D
.
D
u
n
l
o
p
,
L.
M
.
M
a
n
h
e
i
m,
E
.
H
.
Y
e
l
i
n
,
J.
S
o
n
g
,
a
n
d
R
.
W
.
C
h
a
n
g
,
“
T
h
e
c
o
st
s
o
f
a
r
t
h
r
i
t
i
s,”
Ar
t
h
ri
t
i
s
C
a
re
&
Re
se
a
rc
h
,
v
o
l
.
4
9
,
n
o
.
1
,
p
p
.
1
0
1
–
1
1
3
,
F
e
b
.
2
0
0
3
,
d
o
i
:
1
0
.
1
0
0
2
/
a
r
t
.
1
0
9
1
3
.
[
4
]
S
.
G
l
y
n
-
J
o
n
e
s
e
t
a
l
.
,
“
O
st
e
o
a
r
t
h
r
i
t
i
s,”
T
h
e
L
a
n
c
e
t
,
v
o
l
.
3
8
6
,
n
o
.
9
9
9
1
,
p
p
.
3
7
6
–
3
8
7
,
J
u
l
.
2
0
1
5
,
d
o
i
:
1
0
.
1
0
1
6
/
S
0
1
4
0
-
6
7
3
6
(
1
4
)
6
0
8
0
2
-
3.
[
5
]
C
.
B
a
r
t
h
o
l
d
y
,
S
.
T.
S
k
o
u
,
H
.
B
l
i
d
d
a
l
,
a
n
d
M
.
H
e
n
r
i
k
se
n
,
“
C
h
a
n
g
e
s
i
n
p
h
y
s
i
c
a
l
i
n
a
c
t
i
v
i
t
y
d
u
r
i
n
g
s
u
p
e
r
v
i
se
d
e
d
u
c
a
t
i
o
n
a
l
a
n
d
e
x
e
r
c
i
s
e
t
h
e
r
a
p
y
i
n
p
a
t
i
e
n
t
s
w
i
t
h
k
n
e
e
o
st
e
o
a
r
t
h
r
i
t
i
s
:
a
p
r
o
s
p
e
c
t
i
v
e
c
o
h
o
r
t
st
u
d
y
,
”
T
h
e
K
n
e
e
,
v
o
l
.
2
7
,
n
o
.
6
,
p
p
.
1
8
4
8
–
1
8
5
6
,
D
e
c
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
k
n
e
e
.
2
0
2
0
.
0
9
.
0
0
7
.
[
6
]
Y
.
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[
7
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M
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[
8
]
S
.
L.
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[
9
]
S.
-
L.
G
o
h
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.
,
“
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A
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met
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1
0
]
C
.
J
.
J
.
K
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k
,
D
.
B
o
sse
n
,
P
.
M
.
S
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V
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[
1
1
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S
.
F
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M
.
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[
1
2
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B
.
J
.
L
a
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1
3
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.
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[
1
4
]
B
.
A
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,
E.
E
n
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se
n
,
D
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a
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.
M
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M
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h
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.
[
1
5
]
A
.
A
.
N
o
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l
,
Y
.
H
e
,
A
.
R
o
se
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M
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b
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m,
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B
.
C
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g
,
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R
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.
[
1
6
]
S
.
A
.
R
i
c
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d
,
R
.
K
.
F
u
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C
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A
.
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e
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.
[
1
7
]
M
.
E.
G
ü
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r
,
“
A
ğ
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ğ
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[
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