{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:19:12Z","timestamp":1780391952787,"version":"3.54.1"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":53,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"the Ministry of Education, Science, and Technology","award":["2017R1A6A1A03015562"],"award-info":[{"award-number":["2017R1A6A1A03015562"]}]},{"name":"he Ministry of Trade, Industry, and Energy","award":["P0025775"],"award-info":[{"award-number":["P0025775"]}]},{"name":"the Gachon University research fund","award":["GCU-202410300001"],"award-info":[{"award-number":["GCU-202410300001"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-026-38892-y","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T16:04:56Z","timestamp":1775837096000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of closed and open kinetic chain exercises following total knee arthroplasty in elderly women: a randomized controlled trial"],"prefix":"10.1038","volume":"16","author":[{"given":"Jae Ang","family":"Sim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyeong-Sik","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moon Hee","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Jin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Hoon","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"38892_CR1","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1097\/01.blo.0000188066.01833.4f","volume":"443","author":"RD Crowninshield","year":"2006","unstructured":"Crowninshield, R. D., Rosenberg, A. G. & Sporer, S. M. Changing demographics of patients with total joint replacement. Clin. Orthop. Relat. Res. 443, 266\u2013272 (2006).","journal-title":"Clin. Orthop. Relat. Res."},{"key":"38892_CR2","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1007\/s00167-010-1325-8","volume":"19","author":"P Levinger","year":"2011","unstructured":"Levinger, P. et al. Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery. Knee Surg. Sports Traumatol. Arthrosc. 19, 1082\u20131089 (2011).","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"38892_CR3","doi-asserted-by":"publisher","first-page":"246","DOI":"10.2519\/jospt.2008.2715","volume":"38","author":"W Meier","year":"2008","unstructured":"Meier, W. et al. Total knee arthroplasty: muscle impairments, functional limitations, and recommended rehabilitation approaches. J. Orthop. Sports Phys. Ther. 38, 246\u2013256 (2008).","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"38892_CR4","doi-asserted-by":"publisher","first-page":"559","DOI":"10.2519\/jospt.2010.3317","volume":"40","author":"MJ Bade","year":"2010","unstructured":"Bade, M. J., Kohrt, W. M. & Stevens-Lapsley, J. E. Outcomes before and after total knee arthroplasty compared to healthy adults. J. Orthop. Sports Phys. Ther. 40, 559\u2013567 (2010).","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"38892_CR5","doi-asserted-by":"publisher","first-page":"823","DOI":"10.4040\/jkan.2015.45.6.823","volume":"45","author":"JY Yun","year":"2015","unstructured":"Yun, J. Y. & Lee, J. K. Effects of a Thera-Band exercise program on pain, knee flexion ROM, and psychological parameters following total knee arthroplasty. J. Korean Acad. Nurs. 45, 823\u2013833 (2015).","journal-title":"J. Korean Acad. Nurs."},{"key":"38892_CR6","first-page":"877","volume":"49","author":"F Pozzi","year":"2013","unstructured":"Pozzi, F., Snyder-Mackler, L. & Zeni, J. Physical exercise after knee arthroplasty: a systematic review of controlled trials. Eur. J. Phys. Rehabil. Med. 49, 877\u2013892 (2013).","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"38892_CR7","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1589\/jpts.25.671","volume":"25","author":"YJ Kwon","year":"2013","unstructured":"Kwon, Y. J., Park, S. J., Jefferson, J. & Kim, K. The effect of open and closed kinetic chain exercises on dynamic balance ability of normal healthy adults. J. Phys. Ther. Sci. 25, 671\u2013674 (2013).","journal-title":"J. Phys. Ther. Sci."},{"key":"38892_CR8","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.jbmt.2017.01.009","volume":"21","author":"C Abbas","year":"2017","unstructured":"Abbas, C. & Daher, J. Pilot study: post-operative rehabilitation pathway changes and implementation of functional closed kinetic chain exercise in total hip and total knee replacement patient. J. Bodyw. Mov. Ther. 21, 823\u2013829 (2017).","journal-title":"J. Bodyw. Mov. Ther."},{"key":"38892_CR9","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s40945-017-0036-6","volume":"7","author":"OM Olagbegi","year":"2017","unstructured":"Olagbegi, O. M., Adegoke, B. O. & Odole, A. C. Effectiveness of three modes of kinetic-chain exercises on quadriceps muscle strength and thigh girth among individuals with knee osteoarthritis. Arch. Physiother. 7, 9 (2017).","journal-title":"Arch. Physiother."},{"key":"38892_CR10","volume":"13","author":"T Thonga","year":"2021","unstructured":"Thonga, T., Stasi, S. & Papathanasiou, G. The effect of intensive close-kinetic-chain exercises on functionality and balance confidence after total knee arthroplasty. Cureus 13, e18965 (2021).","journal-title":"Cureus"},{"key":"38892_CR11","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1093\/ptj\/66.2.206","volume":"66","author":"RW Bohannon","year":"1986","unstructured":"Bohannon, R. W. Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Phys. Ther. 66, 206\u2013209 (1986).","journal-title":"Phys. Ther."},{"key":"38892_CR12","doi-asserted-by":"publisher","first-page":"701","DOI":"10.5535\/arm.2011.35.5.701","volume":"35","author":"HS Kim","year":"2011","unstructured":"Kim, H. S. et al. Balance control and knee osteoarthritis severity. Ann. Rehabil. Med. 35, 701\u2013709 (2011).","journal-title":"Ann. Rehabil. Med."},{"key":"38892_CR13","doi-asserted-by":"publisher","first-page":"2914","DOI":"10.1109\/TNSRE.2020.3030847","volume":"28","author":"M Ghislieri","year":"2020","unstructured":"Ghislieri, M. et al. Muscle synergy assessment during single-leg stance. IEEE Trans. Neural Syst. Rehabil. Eng. 28, 2914\u20132922 (2020).","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"38892_CR14","doi-asserted-by":"crossref","unstructured":"Boonstra, M. C., De Waal Malefijt, M. C. & Verdonschot, N. How to quantify knee function after total knee arthroplasty? Knee 15, 390\u2013395 (2008).","DOI":"10.1016\/j.knee.2008.05.006"},{"key":"38892_CR15","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1002\/pri.394","volume":"13","author":"P Botolfsen","year":"2008","unstructured":"Botolfsen, P. et al. Reliability and concurrent validity of the Expanded Timed Up-and-Go test in older people with impaired mobility. Physiother. Res. Int. 13, 94\u2013106 (2008).","journal-title":"Physiother. Res. Int."},{"key":"38892_CR16","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1093\/ptj\/86.5.646","volume":"86","author":"E Nordin","year":"2006","unstructured":"Nordin, E., Rosendahl, E. & Lundin-Olsson, L. Timed, \u201cUp & Go\u201d test: reliability in older people dependent in activities of daily living\u2014focus on cognitive state. Phys. Ther. 86, 646\u2013655 (2006).","journal-title":"Phys. Ther."},{"key":"38892_CR17","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1002\/pri.453","volume":"15","author":"J Crosbie","year":"2010","unstructured":"Crosbie, J., Naylor, J. M. & Harmer, A. R. Six minute walk distance or stair negotiation? Choice of activity assessment following total knee replacement. Physiother. Res. Int. 15, 35\u201341 (2010).","journal-title":"Physiother. Res. Int."},{"key":"38892_CR18","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.1519\/JSC.0000000000003104","volume":"35","author":"PL Valenzuela","year":"2021","unstructured":"Valenzuela, P. L. et al. Ischemic preconditioning and muscle force capabilities. J. Strength Cond. Res. 35, 2187\u20132192 (2021).","journal-title":"J. Strength Cond. Res."},{"key":"38892_CR19","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.jos.2015.10.002","volume":"21","author":"M Furu","year":"2016","unstructured":"Furu, M. et al. Quadriceps strength affects patient satisfaction after total knee arthroplasty. J. Orthop. Sci. 21, 38\u201343 (2016).","journal-title":"J. Orthop. Sci."},{"key":"38892_CR20","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.arth.2017.09.014","volume":"33","author":"BA Basques","year":"2018","unstructured":"Basques, B. A. et al. The influence of patient gender on morbidity following total hip or total knee arthroplasty. J. Arthroplasty 33, 345\u2013349 (2018).","journal-title":"J. Arthroplasty"},{"key":"38892_CR21","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1186\/s12891-021-04600-2","volume":"22","author":"H Jacobs","year":"2021","unstructured":"Jacobs, H., Seeber, G. H., Allers, K. & Hoffmann, F. Utilisation of outpatient physiotherapy in patients following total knee arthroplasty\u2014a systematic review. BMC Musculoskelet. Disord. 22, 711 (2021).","journal-title":"BMC Musculoskelet. Disord."},{"key":"38892_CR22","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1177\/0269215510393759","volume":"25","author":"NS Labraca","year":"2011","unstructured":"Labraca, N. S. et al. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial. Clin. Rehabil. 25, 557\u2013566 (2011).","journal-title":"Clin. Rehabil."},{"key":"38892_CR23","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.knee.2019.02.008","volume":"26","author":"WH Hsu","year":"2019","unstructured":"Hsu, W. H. et al. Twenty-four-week hospital-based progressive resistance training on functional recovery in female patients post total knee arthroplasty. Knee 26, 729\u2013736 (2019).","journal-title":"Knee"},{"key":"38892_CR24","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1302\/0301-620X.94B7.28219","volume":"94","author":"CE Scott","year":"2012","unstructured":"Scott, C. E. et al. Patient expectations of arthroplasty of the hip and knee. J. Bone Joint Surg. Br. 94, 974\u2013981 (2012).","journal-title":"J. Bone Joint Surg. Br."},{"key":"38892_CR25","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/j.joca.2011.01.003","volume":"19","author":"J Knoop","year":"2011","unstructured":"Knoop, J. et al. Proprioception in knee osteoarthritis: a narrative review. Osteoarthr. Cartil. 19, 381\u2013388 (2011).","journal-title":"Osteoarthr. Cartil."},{"key":"38892_CR26","first-page":"347","volume":"49","author":"M R\u00e4tsepsoo","year":"2013","unstructured":"R\u00e4tsepsoo, M. et al. Leg extensor muscle strength, postural stability, and fear of falling after a 2-month home exercise program in women with severe knee joint osteoarthritis. Medicina (Kaunas) 49, 347\u2013353 (2013).","journal-title":"Medicina (Kaunas)"},{"key":"38892_CR27","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1093\/rheumatology\/39.9.955","volume":"39","author":"MP Steultjens","year":"2000","unstructured":"Steultjens, M. P. et al. Range of joint motion and disability in patients with osteoarthritis of the knee or hip. Rheumatology (Oxford) 39, 955\u2013961 (2000).","journal-title":"Rheumatology (Oxford)"},{"key":"38892_CR28","doi-asserted-by":"publisher","first-page":"117","DOI":"10.4055\/cios.2014.6.2.117","volume":"6","author":"TQ Lee","year":"2014","unstructured":"Lee, T. Q. Biomechanics of hyperflexion and kneeling before and after total knee arthroplasty. Clin. Orthop. Surg. 6, 117\u2013126 (2014).","journal-title":"Clin. Orthop. Surg."},{"key":"38892_CR29","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1002\/jor.20496","volume":"26","author":"JL Astephen","year":"2008","unstructured":"Astephen, J. L., Deluzio, K. J., Caldwell, G. E. & Dunbar, M. J. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J. Orthop. Res. 26, 332\u2013341 (2008).","journal-title":"J. Orthop. Res."},{"key":"38892_CR30","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1016\/S0021-9290(01)00036-7","volume":"34","author":"KR Kaufman","year":"2001","unstructured":"Kaufman, K. R. et al. Gait characteristics of patients with knee osteoarthritis. J. Biomech. 34, 907\u2013915 (2001).","journal-title":"J. Biomech."},{"key":"38892_CR31","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/S0966-6362(02)00096-6","volume":"17","author":"S Fantozzi","year":"2003","unstructured":"Fantozzi, S. et al. Fluoroscopic and gait analysis of the functional performance in stair ascent of two total knee replacement designs. Gait Posture 17, 225\u2013234 (2003).","journal-title":"Gait Posture"},{"key":"38892_CR32","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1046\/j.1532-5415.2001.49178.x","volume":"49","author":"K Jadelis","year":"2001","unstructured":"Jadelis, K., Miller, M. E., Ettinger, W. H. Jr. & Messier, S. P. Strength, balance, and the modifying effects of obesity and knee pain: results from the Observational Arthritis Study in Seniors (OASIS). J. Am. Geriatr. Soc. 49, 884\u2013891 (2001).","journal-title":"J. Am. Geriatr. Soc."},{"key":"38892_CR33","first-page":"136","volume":"102","author":"M Moutzouri","year":"2016","unstructured":"Moutzouri, M., Gleeson, N., Billis, E., Panoutsopoulou, I. & Gliatis, J. What is the effect of sensori-motor training on functional outcome and balance performance of patients undergoing TKR?. A systematic review. Physiotherapy 102, 136\u2013144 (2016).","journal-title":"A systematic review. Physiotherapy"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-38892-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-38892-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-38892-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T08:51:06Z","timestamp":1780390266000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-38892-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["38892"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-38892-y","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]},"assertion":[{"value":"23 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors affirm that we have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed and cited in the manuscript. Any other conflict of interest (i.e., personal associations or involvement as a director, officer, or expert witness) is also disclosed and cited in the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study protocol was approved by Institutional Review Board (IRB) of Gachon University Hospital (IRB No: GDIRB2022-095). This trial was registered in the Clinical Research Information Service (CRiS) (Registration No. KCT0009533) on 14\/06\/2024.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent has been obtained from the patient(s) to publish this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"16936"}}