Fear of movement and other associated factors in older patients with total knee arthroplasty

The effect of preoperative education on fear of first mobilization experienced after total knee arthroplasty in individuals

OBJECTIVE

Total knee arthroplasty is a surgical intervention performed to reduce pain and movement restriction resulting from advanced joint deformity in individuals diagnosed with osteoarthritis, and to improve their quality of life and functionality. Meeting the preoperative educational needs of individuals undergoing total knee arthroplasty positively impacts postoperative recovery, mobilization, and rehabilitation. In this context, this study was conducted to determine the effect of preoperative education on fear of mobilization experienced after surgery in individuals who have undergone total knee arthroplasty.

MATERIALS AND METHODS

This study, was conducted using a single-group pre-test-post-test model, included 36 individuals who underwent total knee arthroplasty. Data were collected preoperatively and postoperatively using a questionnaire, a fear of falling and fall history assessment form, a Visual Analog Scale-10 (VAS-10), and a fall information exchange form.

RESULTS

The average age of the 36 participants (27 women [75 %]; 9 men [25 %]) was 65.56 ± 4.39 years. The pre-education level of fear was 5.09 ± 1.57, the post-education level of fear was 3.73 ± 0.68, and the level of fear of pre-mobilization was 4.08 ± 0.81. A statistically significant difference was found between the pre-education and post-education level of fear of mobilization (t = 8.324, p = 0.000), between the post-education level and the level of fear before the first mobilization (t = -22.293, p = 0.000). However, it should be noted that fear of mobilization slightly increased during the postoperative first mobilization compared to after education; this may be related to patients' fear of mobilization, pain or anxiety.

CONCLUSION

The results of this study show that preoperative education provided to individuals undergoing total knee arthroplasty has positive effects on reducing fear of first mobilization experienced after surgery.

Prevalence and influencing factors of kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis is a common degenerative disease in the elderly, and total knee arthroplasty is an effective treatment for end-stage knee joint diseases. However, kinesiophobia after surgery can impede patients' rehabilitation and affect the recovery of knee joint function. There are differences in the research on its related influencing factors.

OBJECTIVES

This meta-analysis examined the prevalence and risk factors of kinesiophobia after TKA.

METHODS

Pubmed, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, Web of Science on the prevalence and risk factors of kinesiophobia after TKA was searched in science, MEDLINE and other databases. Duplicate literature, low quality literature, literature with inconsistent observation indicators, and literature without full text were excluded. Two independent researchers used Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included literature. After data extraction, Meta-analysis was performed using Stata17.0.

RESULTS

A total of 11 articles involving 4039 cases were included in this meta-analysis to assess the prevalence of kinesiophobia after TKA. The overall prevalence was found to be 35% (95% CI: 27-44%). Subgroup analyses revealed varying prevalence rates based on age, education, income, and residence, with the highest prevalence observed in individuals under 65 years and those with lower levels of education and income. Key factors influencing the prevalence of kinesiophobia included pain (OR = 2.313, 95% CI: 1.556-3.07), low social support (OR = 1.681, 95% CI: 1.000-2.361), and negative coping strategies (OR = 1.344, 95% CI: 1.165-1.523).

CONCLUSION

The prevalence of kinesiophobia after TKA is high. There are differences in the prevalence of kinesiophobia among people with different places of residence, different education levels, and different monthly incomes. At the same time, it is affected by many factors such as postoperative pain, low social support, low self-efficacy, negative coping, old age, and low education level.

Kinesophobia in patients with osteoporotic vertebral compression fractures: a latent profile analysis

ObjectiveTo explore the status of kinesophobia in patients with osteoporotic vertebral compression fractures and analyze the influencing factors of different kinesophobia profiles.DesignCross-sectional survey studyParticipantsA total of 245 patients with osteoporotic vertebral compression fractures who underwent surgical treatment at our Department of Orthopedics between January 2023 and March 2024 were selectedMain MeasureA general data questionnaire and Tampa Scale for Kinesiophobia were used in the investigation. Latent profile analysis was conducted to categorise kinesophobia in patients with osteoporotic vertebral compression fractures, while univariate logistic regression was performed to identify the factors influencing the latent profiles of kinesophobia.ResultsThe average kinesophobia score of the patients with osteoporotic vertebral compression fractures was 45.38 ± 7.12 points. The patients were divided into three latent profile categories, namely high, medium, and low kinesophobia, with mean probabilities of 0.958, 0.966, and 0.970, respectively. Furthermore, age, gender, pain score, injury cause, and other injuries were significant influencing factors in the kinesophobia groups (P < 0.05).ConclusionKinesophobia in patients with osteoporotic vertebral compression fractures is heterogeneous and affected by age, gender, pain score, injury cause, and other injuries. Clinical staff should recognise the characteristics of patients in different kinesophobia categories and actively adopt appropriate measures for those in the high kinesophobia group to enhance the alleviation of their fear status and mitigate the occurrence of fear-induced adverse outcomes, such as disability and weakness.

Influencing factors of kinesiophobia in knee arthroplasty patients under the social cognitive theory: A structural equation model

OBJECTIVE

To analyze the path relationships among influencing factors for kinesiophobia in knee arthroplasty patients through a structural equation model.

BACKGROUND

The occurrence of kinesiophobia significantly impacts the rehabilitation process of knee arthroplasty patients. However, there is still a need to determine factors that contribute to reducing kinesiophobia.

DESIGN

A cross-sectional study was conducted and reported following the STROBE guideline.

METHODS

Between February 2022 to October 2022, 162 total knee arthroplasty (TKA) patients and 81 unicompartmental knee arthroplasty (UKA) patients completed a survey. A structural equation modeling (SEM) approach was utilized to analyze the relationships between kinesiophobia and influencing factors (social support, pain resilience, and rehabilitation self-efficacy). Furthermore, multi-group SEM analysis was conducted to examine whether the model equally fitted patients in different types of knee arthroplasty.

RESULTS

The direct negative effects of rehabilitation self-efficacy (β = -0.535) and pain resilience (β = -0.293) on kinesiophobia were observed. The mediating effect (β = -0.183) of pain resilience and rehabilitation self-efficacy between social support and kinesiophobia was also significant. The SEM model achieved an acceptable model fit (χ2 = 35.656, RMSEA = 0.031, χ2/df = 1.230, GFI = 0.972, NFI = 0.982, IFI = 0.997, CFI = 0.996). In multicohort analysis, no significant differences were observed among knee arthroplasties (TKA, UKA) (Δχ2 = 4.213, p = 0.648).

CONCLUSIONS

Satisfactory social support enhances pain resilience and rehabilitation self-efficacy, so as to reduce kinesiophobia. Future interventions that directly target the assessment and management of kinesiophobia, available social support may help reduce kinesiophobia, and pain resilience and rehabilitation self-efficacy may be critical factors in managing kinesiophobia.

RELEVANCE TO CLINICAL PRACTICE

Reducing kinesiophobia in knee arthroplasty patients requires satisfactory social support, pain resilience, and rehabilitation self-efficacy. Therefore, healthcare organizations may implement initiatives to reduce kinesiophobia by taking these factors into account.

The acute cross-education effect of foam rolling on the thigh muscles in patients after total knee arthroplasty

INTRODUCTION

In the early postoperative period after total knee arthroplasty (TKA), joint range of motion (ROM) limitation and increased stiffness due to pain are commonly observed. Previous studies have reported that a single bout of foam rolling (FR) can acutely increase ROM and pain threshold on the contralateral (non-intervention) side in healthy participants. In this study, we aimed to expand this knowledge for TKA rehabilitation and investigated the acute effects of FR intervention on the non-operative side on ROM, stiffness, and pain of the operative side in postoperative patients within the first week after TKA.

MATERIALS AND METHODS

The study employed a randomized crossover design: 20 patients (mean age 75.0 ± 7.8 years) in the first postoperative week after TKA were divided alternately into Roll_Break and Break_Roll groups in the order of prescription. In the Roll_Break group, after the initial evaluation, a 180-s (60-s × three sets) FR intervention using a roller massager by a physiotherapist for the knee extensors was performed on the contralateral side (non-operative side), followed by the measurement. Afterwards, after 180-s of supine at rest, the measurement was performed again (i.e., control phase). In the Break_Roll group, after the initial evaluation, each patient was placed in a seated resting position for 180-s, and then another measurement was performed (i.e., control phase). After this, the FR intervention was performed for 180-s, and then the measurement was performed again. The intensity of the FR intervention was set to the maximum intensity that did not cause pain. We measured pain using the visual analogue scale at rest and during the knee joint ROM measurements, knee joint active movement ROM, knee joint passive ROM, and stiffness during the knee joint active movement.

RESULTS

All outcome variables showed significant improvements after the FR intervention (intervention phase) when compared pre- to post-intervention, and significantly favourable effects were found compared to the control condition.

CONCLUSION

The results showed significant improvements in ROM, pain, and stiffness of the operative side after the FR intervention on the non-operative side. For future therapy approaches for TKA patients, FR treatment of the non-operative side should be employed in the first weeks after surgery.

Heterogeneity of social participation in patients three months after total knee arthroplasty: a latent profile analysis

BACKGROUND

Social participation is an important index of rehabilitation and social reintegration in patients after total knee arthroplasty (TKA). However, most existing studies focus on improving patients' functioning and activities, with only a few examining the social participation among patients after TKA. Therefore, the study aims to investigate the heterogeneity of social participation in patients three months after TKA and analyze subgroup influencing factors, to promote functional exercise and postoperative follow-up in specific patients.

METHODS

This cross-sectional study recruited 255 patients who underwent TKA in a Tertiary Hospital in Jinan City, China, from March to July 2022. Three months after having undergone TKA, participants' data were collected using the Numeric Pain Rating Scale, the Chinese version of the Tampa Scale of Kinesiophobia, the 10-item Kessler Psychological Distress Scale, Hospital for Special Surgery Knee-rating Scale, and Impact on Participation and Autonomy Questionnaire. Latent profile analysis was used to identify categories of patients' social participation. Multiple logistic regression analysis was used to analyze the influencing factors of the different subgroups.

RESULTS

Three months after TKA, the patients were divided into three subgroups: low social participation group (17.9%), moderate social participation group (40.8%), and high social participation group (41.3%). The vast majority of patients who underwent TKA exhibited moderate-to-high level of social participation. The multiple logistic regression analysis results showed that age, degree of pain, knee function, and kinesiophobia were the influencing factors of the potential profiles of social participation in patients three months after TKA (p < 0.05).

CONCLUSION

These results support a distinct categorical feature of social participation among patients three months after undergoing TKA. Medical staff need to provide targeted guidance according to the potential classification characteristics of social participation to improve the level of social participation and promote rehabilitation of patients.

The Effect of Foot Reflexology on Pain and Kinesiophobia in Patients Following Total Knee Arthroplasty: A Double-Blind Randomized Controlled Study

Nonpharmacological methods are used in the management of pain and kinesiophobia following total knee arthroplasty. The aim of this double-blind randomized controlled trial was to examine the effect of foot reflexology on pain and kinesiophobia in patients following total knee arthroplasty. A total of 40 patients (20 in the control group and 20 in the intervention group) were randomly assigned to either of two groups for the study. The intervention group was exposed to foot reflexology. Postoperative Visual Analog Scale scores decreased faster in the intervention group compared to the control group (F = 80.417; p < .001; η2 = 0.685). The Western Ontario and McMaster Universities Osteoarthritis Index scores decreased in the intervention group over time, while they increased in the control group (p < .05). While a gradual increase was observed in the Tampa Scale for Kinesiophobia scores in the control group, there was a decrease in the intervention group (F = 84.860; p < .001; η2 = 0.696). The amount of analgesics used was lower in the intervention group (p < .05). Foot reflexology can be applied as an effective and safe method to manage pain and kinesiophobia in total knee arthroplasty patients.

Effects of amino acid supplementation on muscle mass, muscle performance and functional capacity in subjects undergoing total knee arthroplasty: a systematic review of randomized clinical trials

The aim of the present study was to summarize the effectiveness of amino acid supplementation on muscle strength, muscle volume, and functional capacity in patients undergoing total knee arthroplasty. For this, in November 2022, a search was carried out in the PubMed, Cochrane Library, and EMBASE databases, identifying a total of 2182 documents, of which only 4 were included in the present review. The included studies had 148 participants (47 men and 101 women), with a minimum age of 53 and a maximum of 92 years, and supplementation times of 13 to 30 days (1 to 3 times a day). For the results, in relation to muscle performance, when comparing the control and experimental groups, greater muscle atrophy was observed in the pre- and post-moments of the control group, in relation to the experimental group. In addition, studies suggest a good tendency for muscle mass gain, and improvement in the functional capacities of patients who used supplementation. Therefore, the use of amino acids after TKA surgery reduces muscle atrophy, which preserves muscle mass and leads to better performance in tests of strength and functional capacity, when compared to the use of a placebo.