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

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.