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Dowell K, Dluzniewski A, Casanova MP, Allred CM, Cady AC, Baker RT. International Knee Documentation Committee Subjective Knee Form Latent Growth Model Analysis: Assessing Recovery Trajectories. Healthcare (Basel) 2024; 12:1021. [PMID: 38786431 PMCID: PMC11121256 DOI: 10.3390/healthcare12101021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
Patient-Reported Outcome Measures (PROMs), such as the six-item International Knee Documentation Committee Subjective Knee Form (IKDC-6), play a crucial role in assessing health conditions and guiding clinical decisions. Latent Growth Modeling (LGM) can be employed to understand recovery trajectories in patients post-operatively. Therefore, the purpose of this study was to assess LGM properties of the IKDC-6 in patients with knee pathologies that require surgical intervention and to assess differences between subgroups (i.e., sex and age). A cross-sectional study was conducted using the Surgical Outcome System (SOS) database with patients who had undergone knee arthroscopy. Our results found that preoperative scores did not influence the rate of change overtime. Perceived knee health improved over time, with varying rates among individuals. The adolescent age subgroup and male subgroup exhibited faster recovery rates compared to the older age subgroup and female subgroup. While initial hypotheses suggested IKDC-6 could serve as a prognostic tool, results did not support this. However, results indicated favorable outcomes irrespective of preoperative perceived knee impairment levels. This study provides valuable insights into recovery dynamics following knee surgery, emphasizing the need for personalized rehabilitation strategies tailored to individual patient characteristics.
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Affiliation(s)
- Katrina Dowell
- WWAMI Medical Education Program, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Alexandra Dluzniewski
- WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA; (A.D.); (M.P.C.); (C.M.A.)
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, Moscow, ID 83844, USA
| | - Madeline P. Casanova
- WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA; (A.D.); (M.P.C.); (C.M.A.)
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, Moscow, ID 83844, USA
| | - Caleb M. Allred
- WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA; (A.D.); (M.P.C.); (C.M.A.)
| | - Adam C. Cady
- Kaiser Permanente, Woodland Hills, CA 91367, USA;
| | - Russell T. Baker
- WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA; (A.D.); (M.P.C.); (C.M.A.)
- Idaho Office of Underserved and Rural Medical Research, University of Idaho, Moscow, ID 83844, USA
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Azimi A, Dizaji SR, Tabatabaei FS, Safari S, Nakhaei Amroodi M, Azimi AF. Effect of Postoperative Kinesio Taping on Knee Edema, Pain, and Range of Motion After Total Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JBJS Rev 2024; 12:01874474-202403000-00011. [PMID: 38489396 DOI: 10.2106/jbjs.rvw.23.00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND Kinesio taping (KT) has been shown to be clinically effective in a wide range of musculoskeletal disorders. Despite evidence supporting KT, there still needs to be more certainty regarding its clinical worthiness in managing postoperative conditions. This study aims to assess the effect of postoperative KT on knee edema, pain, and range of motion (ROM) when added to routine physiotherapy after knee surgery. METHODS In this systematic review and meta-analysis, MEDLINE, Embase, Scopus, Web of Science, and CENTRAL databases were searched from their inception to July 2023. Randomized controlled trials (RCTs) comparing routine physiotherapy with and without KT were included. Random-effect models were used to calculate the standardized mean difference (SMD), confidence interval, and heterogeneity (I2). RESULTS Sixteen RCTs on 842 operated knees were included. KT reduced knee edema in first week (SMD, -0.59, p < 0.001), 14th postoperative day (POD) (SMD, -0.78, p < 0.001), and 28 to 42 days postop (SMD, -0.66, p < 0.001). The KT demonstrated significant pain improvement in second week (SMD, -0.87, p < 0.001) and the fourth week (SMD, -0.53, p < 0.001). The KT groups demonstrated ROM improvement within second week (SMD, 0.69, p = 0.010) and in the 28th POD (SMD, 0.89, p = 0.009). Subgroup analysis demonstrated minimal heterogeneity in anterior cruciate ligament reconstruction (ACLR) cases. However, it did not show significant superiority regarding ankle, calf, or thigh edema and Lysholm scale. CONCLUSION This study suggests that adding KT to routine postoperative physiotherapy reduces pain and knee edema after total knee arthroplasty or ACLR. Low to very low certainty of evidence for all outcomes and the limited number of studies emphasize the need for more high-quality primary studies to explore the optimal method of KT application and its effectiveness in specific knee surgeries. LEVEL OF EVIDENCE Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amirali Azimi
- Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Roshdi Dizaji
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Saeed Safari
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Nakhaei Amroodi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Farbod Azimi
- Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Hodges A, Harmer AR, Dennis S, March L, Crawford R, Parker D. Prevalence and determinants of physical activity, sedentary behaviour and fatigue five years after total knee replacement. Clin Rehabil 2022; 36:1524-1538. [PMID: 35861777 DOI: 10.1177/02692155221113909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence and predictors of physical activity, sedentary behaviour and fatigue five years after total knee replacement surgery. DESIGN A longitudinal cohort study. SETTING Community-dwelling adults who had previously undergone total knee replacement. METHODS Five-year follow-up questionnaire data were obtained from participants previously enrolled in a randomised controlled trial examining rehabilitation after total knee replacement. Main study outcomes at one year did not differ between randomisation groups, hence data were pooled for the present longitudinal analysis. Before and one and five years after surgery, participants completed questionnaires (Active Australia Survey, WOMAC, SF12 v2, demographics and fatigue). RESULTS 272/422 community-dwelling adults (45-74 years) completed the questionnaires at five years. Excessive sedentary behaviour was evident in 91% of the cohort, predicted by excessive sedentary behaviour and lack of energy at one year. Inadequate physical activity at five years was evident for 59% of the cohort, predicted by higher fatigue and comorbidity scores pre-surgery and inadequate physical activity at one year. Just under half (47%) of the cohort experienced clinically-important fatigue at five years, predicted by clinically-important fatigue before and one year after surgery, lack of sleep before surgery and physical activity one year after surgery. CONCLUSION Documenting physical activity, sedentary behaviour and fatigue before and one year after knee replacement is important to identify those at risk of longer-term inadequate physical activity, excessive sedentary behaviour and clinically-important fatigue. Interventions to maintain activity and reduce sedentary behaviour are needed to reap the potential health benefits of total knee replacement surgery.
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Affiliation(s)
- Alison Hodges
- Department of Physiotherapy, 6078Australian Catholic University, North Sydney, New South Wales, Australia
| | - Alison R Harmer
- Faculty of Medicine and Health, 153399University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Dennis
- University of Sydney, Camperdown, New South Wales, Australia.,South Western Sydney Local Health District, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Lyn March
- University of Sydney and North Shore Hospital, Sydney, New South Wales, Australia
| | - Ross Crawford
- Department of Orthopaedic Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
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4
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Le Jeannic A, Maoulida H, Guilmin-Crépon S, Alberti C, Tubiana-Rufi N, Durand-Zaleski I. How to collect non-medical data in a pediatric trial: diaries or interviews. Trials 2020; 21:36. [PMID: 31910885 PMCID: PMC6947947 DOI: 10.1186/s13063-019-3997-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-medical data, such as the amount of time that patients and caregivers spend managing their condition, may be relevant when assessing therapeutic strategies. For chronic pediatric conditions, the time that patients and caregivers spend in seeking and providing care (which are the indirect costs in an economic evaluation) can be significantly different depending on the treatment arm. To explore methods for collecting information on the care burden for caregivers and patients, we investigated whether a patient diary provided additional information compared to retrospective investigator-led interviews and whether a diary that was completed intermittently produced more or less information than a diary completed continually. The main objective of this study was to identify which type of data collection was most effective for measuring the time spent by caregivers and for estimating indirect treatment costs over 9 months. METHODS Start-In! is a randomized controlled trial comparing the efficacy of three strategies of real-time continuous glucose monitoring for 12 months in children and adolescents with type 1 diabetes. We designed an ancillary study to assess methods of collecting information on the time spent by patients and caregivers in managing their condition (indirect costs). Data were entered retrospectively in case report forms (CRFs) by investigators during quarterly follow-up visits, which were supplemented with diaries completed prospectively by children or caregivers either continuously or intermittently. Data about absences from school and work as well as the time that caregivers spent on diabetes care were collected and the three collection methods were compared. RESULTS At the end of the 9-month study, 42% of the study participants failed to return their diary. For the diaries that were received, less than 10% of expected data were collected versus 82% during investigators'interviews. Based on all the information collected, we calculated that over 9 months, caregivers lost on average 3.9 days of working time (€786) and 4 days of personal time, i.e. the equivalent of €526, and spent around 15 min of time on care per day, i.e. the equivalent of €1700. CONCLUSIONS The CRFs completed by investigators during quarterly visits cannot be replaced by a diary. Completing the diaries appeared to represent an important additional burden to children and their caregivers, and the diaries provided little additional information compared to investigators' entries in the CRF. TRIAL REGISTRATION ClinicalTrials.gov, NCT00949221. Registered on 30 July 2009. Registry name: Study of Insulin Therapy Augmented by Real Time Sensor in Type 1 Children and Adolescents (START-IN!).
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Affiliation(s)
- Anaïs Le Jeannic
- AP-HP, Groupe hospitalier Hôtel-Dieu, URC Economie de la Santé Ile de France, Paris, France. .,Inserm, ECEVE UMR-S 1123, Paris, France. .,URC Eco IdF (Paris health economics and health services research unit) and Inserm, ECEVE UMR-S 1123, Paris, France.
| | - Hassani Maoulida
- AP-HP, Groupe hospitalier Hôtel-Dieu, URC Economie de la Santé Ile de France, Paris, France
| | - Sophie Guilmin-Crépon
- Inserm, ECEVE UMR-S 1123, Paris, France.,AP-HP, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie clinique, Paris, France.,Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Robert Debré, Service d'Endocrinologie-Diabétologie pédiatrique et Centre de référence des Maladies Endocriniennes Rares de la Croissance, Paris, France.,CIC-EC 1426, Paris, France
| | - Corinne Alberti
- Inserm, ECEVE UMR-S 1123, Paris, France.,AP-HP, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie clinique, Paris, France.,Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.,CIC-EC 1426, Paris, France
| | - Nadia Tubiana-Rufi
- Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Robert Debré, Service d'Endocrinologie-Diabétologie pédiatrique et Centre de référence des Maladies Endocriniennes Rares de la Croissance, Paris, France
| | - Isabelle Durand-Zaleski
- AP-HP, Groupe hospitalier Hôtel-Dieu, URC Economie de la Santé Ile de France, Paris, France.,AP-HP, Groupe hospitalier Albert Chenevier- Henri Mondor, Service de Santé Publique, Créteil, France.,Inserm METHODS CRESS UMR 1153, Paris, France
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Nelson MJ, Bourke MG, Crossley KM, Russell TG. Outpatient physiotherapy rehabilitation for total hip replacement: comparison of current practice with clinical evidence. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.11.613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark J Nelson
- Physiotherapy Department, QEII Jubilee Hospital, Metro South Health, Brisbane, Australia; Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - Michael G Bourke
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - Kay M Crossley
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia; School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Trevor G Russell
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
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Hodges A, Harmer AR, Dennis S, Nairn L, March L, Crawford R, Parker D, Fransen M. Prevalence and determinants of physical activity and sedentary behaviour before and up to 12 months after total knee replacement: a longitudinal cohort study. Clin Rehabil 2018; 32:1271-1283. [PMID: 29690780 DOI: 10.1177/0269215518769986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to evaluate the prevalence and determinants of inadequate physical activity and excessive sedentary behaviour before and after total knee replacement. DESIGN, SETTING AND SUBJECTS Secondary analysis was performed on data from a cohort of 422 adults (45-74 years), drawn from 12 public or private hospitals, undergoing primary unilateral or bilateral total knee replacement surgery. MAIN MEASURES Questionnaires were used to determine the presence of inadequate physical activity and excessive sedentary behaviour before and 6 and 12 months after total knee replacement surgery. Knee pain, activity limitations, comorbidities, muscle strength, psychological well-being, fatigue, sleep and body mass index were measured/assessed as possible determinants of physical activity or sedentary behaviour. RESULTS Before surgery, 77% ( n = 326) of the cohort participated in inadequate physical activity according to World Health Organization guidelines, and 60% ( n = 253) engaged in excessive sedentary behaviour. Twelve months after surgery, 53% ( n = 185) of the cohort engaged in inadequate physical activity and 45% ( n = 157) in excessive sedentary behaviour. Inadequate physical activity before surgery ( P = 0.02), obesity ( P = 0.07) and comorbidity score >6 ( P = 0.04) predicted inadequate physical activity 12 months after surgery. Excessive sedentary behaviour and activity limitations before surgery predicted excessive sedentary behaviour 12 months after surgery. CONCLUSION Although there were improvements after total knee replacement, 12 months after surgery about half the cohort did not meet World Health Organization recommendations for activity. Pre-surgery assessment of physical activity, activity limitations, sedentary behaviour and body mass index is essential to identify patients at risk for long-term inactivity.
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Affiliation(s)
- Alison Hodges
- 1 Musculoskeletal Health Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Alison R Harmer
- 1 Musculoskeletal Health Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Sarah Dennis
- 1 Musculoskeletal Health Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.,2 South Western Sydney Local Health District, Warwick Farm, NSW, Australia.,3 Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Lillias Nairn
- 4 Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Lyn March
- 5 Royal North Shore Hospital, St Leonard's; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Ross Crawford
- 6 Queensland University of Technology, Brisbane, QLD, Australia
| | - David Parker
- 7 Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia
| | - Marlene Fransen
- 1 Musculoskeletal Health Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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7
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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; 69:1360-1368. [PMID: 27813347 DOI: 10.1002/acr.23139] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/20/2016] [Accepted: 11/01/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the safety and efficacy of a high-intensity (HI) progressive rehabilitation protocol beginning 4 days after total knee arthroplasty (TKA) compared to a low-intensity (LI) rehabilitation protocol. METHODS A total of 162 participants (mean ± SD ages 63 ± 7 years; 89 women) were randomized to either the HI group or LI group after TKA. Key components of the HI intervention were the use of progressive resistance exercises and a rapid progression to weight-bearing exercises and activities. Both groups were treated in an outpatient setting 2 to 3 times per week for 11 weeks (26 total sessions). Outcomes included the stair climbing test (SCT; primary outcome), timed-up-and-go (TUG) test, 6-minute walk (6MW) test, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-item Short Form health survey (SF-12), knee range of motion (ROM), quadriceps and hamstring strength, and quadriceps activation. Outcomes were assessed preoperatively and at 1, 2, 3 (primary end point), 6, and 12 months postoperatively. RESULTS There were no significant differences between groups at 3 or 12 months in SCT, TUG, 6MW, WOMAC scores, knee ROM, quadriceps and hamstrings strength, quadriceps activation, or adverse event rates. By 12 months, outcomes on the 6MW, TUG, WOMAC, SF-12, quadriceps and hamstring strength, and quadriceps activation had improved beyond baseline performance in both groups. CONCLUSION Both the HI and LI interventions were effective in improving strength and function after TKA. HI progressive rehabilitation is safe for individuals after TKA. However, its effectiveness may be limited by arthrogenic muscular inhibition in the early postoperative period.
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Affiliation(s)
| | | | | | - Jared Foran
- The Steadman Clinic and The Steadman Philippon Research Institute, Vail, Colorado
| | - Raymond H Kim
- The Steadman Clinic and The Steadman Philippon Research Institute, Vail, Colorado
| | - Todd Miner
- Colorado Joint Replacement, Denver, Colorado
| | - Pamela Wolfe
- University of Colorado Anschutz Medical Campus, Aurora
| | - Wendy M Kohrt
- University of Colorado Anschutz Medical Campus, Aurora, and Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado
| | | | - Jennifer E Stevens-Lapsley
- University of Colorado Anschutz Medical Campus, Aurora, and Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado
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Fransen M, Nairn L, Bridgett L, Crosbie J, March L, Parker D, Crawford R, Harmer AR. Post-Acute Rehabilitation After Total Knee Replacement: A Multicenter Randomized Clinical Trial Comparing Long-Term Outcomes. Arthritis Care Res (Hoboken) 2017; 69:192-200. [PMID: 27868384 DOI: 10.1002/acr.23117] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 09/20/2016] [Accepted: 10/04/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the long-term benefit of providing a post-acute, outpatient group exercise program for patients following primary total knee replacement (TKR) surgery for osteoarthritis. METHODS A multicenter randomized clinical trial was conducted in 12 Australian public and private hospital centers. A total of 422 participants, ages 45-75 years, were randomly allocated prior to hospital discharge to the post-acute group exercise program or to usual care and were assessed at 6 weeks, 6 months, and 12 months after surgery. The main outcomes were operated knee pain and activity limitations at 12 months using the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Secondary outcomes included health-related quality of life (Short Form 12 health survey), knee extension and flexion strength, stair-climb power, 50-foot walk speed, and active knee range of motion. RESULTS While both allocation groups achieved significant improvements in knee pain and activity limitations over the 12-month followup period, there were no significant differences in these main outcomes, or in the secondary physical performance measures, between the 2 treatment allocations. Twelve months after TKR, 69% and 72% of participants allocated to post-acute exercise and usual acute care, respectively, were considered to be treatment-responders. While population normative values for self-report measures of pain, activity limitation, and health-related quality of life were attained 12 months after TKR, marked deficits in physical performance measures remained. CONCLUSION Providing access to a post-acute group exercise program did not result in greater reductions in long-term knee pain or activity limitations than usual care. Patients undergoing primary TKR retain marked physical performance deficits 12 months after surgery.
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Affiliation(s)
| | | | | | - Jack Crosbie
- University of Sydney, New South Wales, Australia
| | - Lyn March
- University of Sydney, New South Wales, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | - Ross Crawford
- Queensland University of Technology, Brisbane, Queensland, Australia
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Hussain MS, Li J, Brindal E, van Kasteren Y, Varnfield M, Reeson A, Berkovsky S, Freyne J. Supporting the Delivery of Total Knee Replacements Care for Both Patients and Their Clinicians With a Mobile App and Web-Based Tool: Randomized Controlled Trial Protocol. JMIR Res Protoc 2017; 6:e32. [PMID: 28249832 PMCID: PMC5352858 DOI: 10.2196/resprot.6498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/21/2016] [Accepted: 02/08/2017] [Indexed: 01/25/2023] Open
Abstract
Background Total knee replacement (TKR) surgeries have increased in recent years. Exercise programs and other interventions following surgery can facilitate the recovery process. With limited clinician contact time, patients with TKR have a substantial burden of self-management and limited communication with their care team, thus often fail to implement an effective rehabilitation plan. Objective We have developed a digital orthopedic rehabilitation platform that comprises a mobile phone app, wearable activity tracker, and clinical Web portal in order to engage patients with self-management tasks for surgical preparation and recovery, thus addressing the challenges of adherence to and completion of TKR rehabilitation. The study will determine the efficacy of the TKR platform in delivering information and assistance to patients in their preparation and recovery from TKR surgery and a Web portal for clinician care teams (ie, surgeons and physiotherapists) to remotely support and monitor patient progress. Methods The study will evaluate the TKR platform through a randomized controlled trial conducted at multiple sites (N=5) in a number of states in Australia with 320 patients undergoing TKR surgery; the trial will run for 13 months for each patient. Participants will be randomized to either a control group or an intervention group, both receiving usual care as provided by their hospital. The intervention group will receive the app and wearable activity tracker. Participants will be assessed at 4 different time points: 4 weeks before surgery, immediately before surgery, 12 weeks after surgery, and 52 weeks after surgery. The primary outcome measure is the Oxford Knee Score. Secondary outcome measures include quality of life (Short-Form Health Survey); depression, anxiety, and stress (Depression, Anxiety, and Stress Scales); self-motivation; self-determination; self-efficacy; and the level of satisfaction with the knee surgery and care delivery. The study will also collect quantitative usage data related to all components (app, activity tracker, and Web portal) of the TKR platform and qualitative data on the perceptions of the platform as a tool for patients, carers, and clinicians. Finally, an economic evaluation of the impact of the platform will be conducted. Results Development of the TKR platform has been completed and deployed for trial. The research protocol is approved by 2 human research ethics committees in Australia. A total of 5 hospitals in Australia (2 in New South Wales, 2 in Queensland, and 1 in South Australia) are expected to participate in the trial. Conclusions The TKR platform is designed to provide flexibility in care delivery and increased engagement with rehabilitation services. This trial will investigate the clinical and behavioral efficacy of the app and impact of the TKR platform in terms of service satisfaction, acceptance, and economic benefits of the provision of digital services. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616000504415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370536 (Archived by WebCite at http://www.webcitation.org/6oKES0Gp1)
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Affiliation(s)
- M Sazzad Hussain
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organization, Epping, NSW, Australia
| | - Jane Li
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organization, Epping, NSW, Australia
| | - Emily Brindal
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organization, Adelaide, SA, Australia
| | - Yasmin van Kasteren
- Flinders Digital Health Research Centre, Flinders University, Adelaide, SA, Australia
| | - Marlien Varnfield
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organization, Herston, QLD, Australia
| | - Andrew Reeson
- Data61, Commonwealth Scientific and Industrial Research Organization, Acton, ACT, Australia
| | - Shlomo Berkovsky
- Data61, Commonwealth Scientific and Industrial Research Organization, Sydney, NSW, Australia
| | - Jill Freyne
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organization, Epping, NSW, Australia
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10
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Hodges A, Harmer AR, Dennis S, Nairn L, March L, Crosbie J, Crawford R, Parker D, Fransen M. Prevalence and Determinants of Fatigue Following Total Knee Replacement: A Longitudinal Cohort Study. Arthritis Care Res (Hoboken) 2016; 68:1434-42. [DOI: 10.1002/acr.22861] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/15/2016] [Accepted: 02/02/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Alison Hodges
- University of Sydney; Lidcombe New South Wales Australia
| | | | - Sarah Dennis
- University of Sydney; Lidcombe New South Wales Australia
| | - Lillias Nairn
- University of Sydney; Lidcombe New South Wales Australia
| | - Lyn March
- University of Sydney; St. Leonards New South Wales Australia
| | - Jack Crosbie
- University of Sydney; Lidcombe New South Wales Australia
| | - Ross Crawford
- Queensland University of Technology; Brisbane Queensland Australia
| | - David Parker
- Sydney Orthopaedic Research Institute; Chatswood New South Wales Australia
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11
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Strength Training to Contraction Failure Increases Voluntary Activation of the Quadriceps Muscle Shortly After Total Knee Arthroplasty: A Cross-sectional Study. Am J Phys Med Rehabil 2016; 95:194-203. [PMID: 26339729 PMCID: PMC4748860 DOI: 10.1097/phm.0000000000000361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to investigate voluntary activation of the quadriceps muscle during one set of knee extensions performed until contraction failure in patients shortly after total knee arthroplasty. DESIGN This was a cross-sectional study of 24 patients with total knee arthroplasty. One set of knee extensions was performed until contraction failure, using a predetermined 10 repetition maximum loading. In the operated leg, electromyographic (EMG) activity of the lateral and medial vastus, semitendinosus, and biceps femoris muscles was recorded during the set. Muscle activity (%EMGmax) and median power frequency of the EMG power spectrum were calculated for each repetition decile (10%-100% contraction failure). RESULTS Muscle activity increased significantly over contractions from a mean of 90.0 and 93.6 %EMGmax (lateral vastus and medial vastus, respectively) at 10% contraction failure to 99.3 and 105.5 %EMGmax at 100% contraction failure (P = 0.009 and 0.004). Median power frequency decreased significantly over contractions from a mean of 66.8 and 64.2 Hz (lateral vastus and medial vastus, respectively) at 10% contraction failure to 59.9 and 60.1 Hz at 100% contraction failure (P = 0.0006 and 0.0187). CONCLUSION In patients shortly after total knee arthroplasty, 10 repetition maximum-loaded knee extensions performed in one set until contraction failure increases voluntary activation of the quadriceps muscle during the set. CLINICAL TRIALS Gov-identifier: NCT01713140 to the abstract to increase trial transparency.
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Schache MB, McClelland JA, Webster KE. Reliability of measuring hip abductor strength following total knee arthroplasty using a hand-held dynamometer. Disabil Rehabil 2015; 38:597-600. [PMID: 25985716 DOI: 10.3109/09638288.2015.1046565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the test-retest reliability of measuring hip abductor strength in patients with total knee arthroplasty (TKA) using a hand-held dynamometer (HHD) with two different types of resistance: belt and manual resistance. METHOD Test-retest reliability of 30 subjects (17 female, 13 male, 71.9 ± 7.4 years old), 9.2 ± 2.7 days post TKA was measured using belt and therapist resistance. Retest reliability was calculated with intra-class coefficients (ICC3,1) and 95% confidence intervals (CI) for both the group average and the individual scores. A paired t-test assessed whether a difference existed between the belt and therapist methods of resistance. RESULTS ICCs were 0.82 and 0.80 for the belt and therapist resisted methods, respectively. Hip abductor strength increases of 8 N (14%) for belt resisted and 14 N (17%) for therapist resisted measurements of the group average exceeded the 95% CI and may represent real change. For individuals, hip abductor strength increases of 33 N (72%) (belt resisted) and 57 N (79%) (therapist resisted) could be interpreted as real change. CONCLUSIONS Hip abductor strength can be reliably measured using HHD in the clinical setting with the described protocol. Belt resistance demonstrated slightly higher test-retest reliability. IMPLICATIONS FOR REHABILITATION Reliable measurement of hip abductor muscle strength in patients with TKA is important to ensure deficiencies are addressed in rehabilitation programs and function is maximized. Hip abductor strength can be reliably measured with a hand-held dynamometer in the clinical setting using manual or belt resistance.
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Affiliation(s)
- Margaret B Schache
- a School of Allied Health, La Trobe University , Melbourne , Australia , and.,b Donvale Rehabilitation Hospital, Ramsay Health Care , Melbourne , Australia
| | - Jodie A McClelland
- a School of Allied Health, La Trobe University , Melbourne , Australia , and
| | - Kate E Webster
- a School of Allied Health, La Trobe University , Melbourne , Australia , and
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Yaari L, Kosashvili Y, Segal G, Shemesh S, Velkes S, Mor A, Debi R, Bernfeld B, Elbaz A. A Novel Non-Invasive Adjuvant Biomechanical Treatment for Patients with Altered Rehabilitation after Total Knee Arthroplasty: Results of a Pilot Investigation. Clin Orthop Surg 2015. [PMID: 26217465 PMCID: PMC4515459 DOI: 10.4055/cios.2015.7.2.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Many factors contribute to suboptimal results after total knee arthroplasty (TKA) but little is known regarding the value of postsurgical rehabilitation after TKA. We examined the effects of an enhanced closed kinematic chain exercises program (AposTherapy) on gait patterns and clinical outcomes among patients with a lack of progress in their postsurgical rehabilitation. METHODS Twenty-two patients were prospectively followed during the study. Gait spatiotemporal parameters were measured at the initial evaluation, after 15 minutes of therapy, and after 3 months of therapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the short form (SF) 36 health survey were completed by patients before treatment and after 3 months of treatment. RESULTS The WOMAC and SF-36 scores improved significantly after 3 months of treatment. Gait velocity, single limb support, and step length of the operated leg improved significantly even after a single 15 minutes treatment. Normal gait velocity was observed in 36% of patients after 3 months of treatment. CONCLUSIONS A physiotherapy program that included enhanced closed kinematic chain biomechanical therapy was beneficial for patients who experienced a suboptimal rehabilitation course after TKA.
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Affiliation(s)
- Lee Yaari
- Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yona Kosashvili
- Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ganit Segal
- AposTherapy Research Group, Herzliya, Israel
| | - Shai Shemesh
- Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Steven Velkes
- Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Amit Mor
- AposTherapy Research Group, Herzliya, Israel
| | - Ronen Debi
- Department of Orthopedic Surgery, Barzilay Medical Center, Ashkelon, Israel
| | - Benjamin Bernfeld
- Department of Orthopedic Surgery, Carmel Medical Center, Haifa, Israel
| | - Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel
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Brennan GP, Fritz JM, Houck LTCKM, Hunter SJ. Outpatient rehabilitation care process factors and clinical outcomes among patients discharged home following unilateral total knee arthroplasty. J Arthroplasty 2015; 30:885-90. [PMID: 25765128 DOI: 10.1016/j.arth.2014.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/03/2014] [Accepted: 12/09/2014] [Indexed: 02/01/2023] Open
Abstract
Research examining care process variables and their relationship to clinical outcomes after total knee arthroplasty has focused primarily on inpatient variables. Care process factors related to outpatient rehabilitation have not been adequately examined. We conducted a retrospective review of 321 patients evaluating outpatient care process variables including use of continuous passive motion, home health physical therapy, number of days from inpatient discharge to beginning outpatient physical therapy, and aspects of outpatient physical therapy (number of visits, length of stay) as possible predictors of pain and disability outcomes of outpatient physical therapy. Only the number of days between inpatient discharge and outpatient physical therapy predicted better outcomes, suggesting that this may be a target for improving outcomes after total knee arthroplasty for patients discharged directly home.
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Affiliation(s)
| | - Julie M Fritz
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah
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Han ASY, Nairn L, Harmer AR, Crosbie J, March L, Parker D, Crawford R, Fransen M. 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; 67:196-202. [PMID: 25220488 DOI: 10.1002/acr.22457] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/26/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine, at 6 weeks postsurgery, if a monitored home exercise program (HEP) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement (TKR) surgery for osteoarthritis. METHODS We conducted a multicenter, randomized clinical trial. Patients ages 45-75 years were allocated at the time of hospital discharge to usual care rehabilitation (n = 196) or the HEP (n = 194). Outcomes assessed 6 weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales, knee range of motion, and the 50-foot walk time. The upper bound of the 95% confidence interval (95% CI) mean difference favoring usual care was used to determine noninferiority. RESULTS At 6 weeks after surgery there were no significant differences between usual care and HEP, respectively, for pain (7.4 and 7.2; 95% CI mean difference [MD] -0.7, 0.9), physical function (22.5 and 22.4; 95% CI MD -2.5, 2.6), knee flexion (96° and 97°; 95% CI MD -4°, 2°), knee extension (-7° and -6°; 95% CI MD -2°, 1°), or the 50-foot walk time (12.9 and 12.9 seconds; 95% CI MD -0.8, 0.7 seconds). At 6 weeks, 18 patients (9%) allocated to usual care and 11 (6%) to the HEP did not achieve 80° knee flexion. There was no difference between the treatment allocations in the number of hospital readmissions. CONCLUSION The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR.
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Affiliation(s)
- Annie S Y Han
- University of Sydney, Lidcombe, New South Wales, Australia
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Lee A, Park J, Lee S. Gait analysis of elderly women after total knee arthroplasty. J Phys Ther Sci 2015; 27:591-5. [PMID: 25931687 PMCID: PMC4395671 DOI: 10.1589/jpts.27.591] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/01/2014] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate ability and muscle activities of
elderly women after total knee arthroplasty (TKA) and compare them with those of healthy
ones. [Subjects and Methods] Fifteen female patients with TKA due to advanced degenerative
arthritis of the measured on knee joint and 19 healthy elderly females participated.
Tibiofemoral angles of TKA patients were using a gait analysis system anterioposterior
X-rays of the weight-bearing knee. The knee flexion angle and gait parameters were
measured. Muscle activities and prolongation time were EMG system. The gait of the treated
limb of each participant was evaluated in three consecutive trials at fast speed and
comfortable speed. [Results] The knee flexion angle %stance phase, stride length, step
length, speed, cadence, and gait cycle significantly decreased at both the fast speed and
comfortable speeds, and the onset and duration time of rectus femoris activity was
significantly increased at the comfortable speed in the TKA group. [Conclusion] In
conclusion, elderly women who received TKA showed decreased gait ability and muscle
activity compared to the healthy elderly women.
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Affiliation(s)
- Aenon Lee
- Department of Physical Therapy, The Graduate School of Sahmyook University, Republic of Korea
| | - Junhyuck Park
- Department of Physical Therapy, The Graduate School of Sahmyook University, Republic of Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Jakobsen TL, Kehlet H, Husted H, Petersen J, Bandholm T. Early progressive strength training to enhance recovery after fast-track total knee arthroplasty: a randomized controlled trial. Arthritis Care Res (Hoboken) 2015; 66:1856-66. [PMID: 25074397 DOI: 10.1002/acr.22405] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/15/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance. METHODS In total, 82 patients with a unilateral primary TKA were randomized to 2 different interventions: 7 weeks of supervised physical rehabilitation with PST (PST group) and without PST (CON group) commenced early after fast-track TKA. The primary outcome was the maximal distance walked in 6 minutes (6-minute walk test). Secondary outcomes were lower extremity strength and power, knee joint effusion and range of motion, knee pain, and self-reported disability and quality of life. All outcome measures were assessed before TKA (baseline) and 4, 8, and 26 weeks after TKA. RESULTS There was no statistically significant difference between the PST and CON groups in the change score from baseline to the 8-week postoperative assessment (primary end point) for the 6-minute walk test with unadjusted baseline scores (mean difference between groups: -11.3 meters [95% confidence interval -45.4, 22.7]; analysis of variance P = 0.51). There were no statistically significant or clinically meaningful differences between groups in change scores from baseline to any other time point for all secondary outcomes. The secondary outcome knee extension strength did not reach the level recorded before surgery in both groups. CONCLUSION Seven weeks of supervised physical rehabilitation with PST was not superior to 7 weeks of supervised physical rehabilitation without PST in improving functional performance, measured as the maximal walking distance in 6 minutes, at the primary end point 8 weeks after fast-track TKA.
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Affiliation(s)
- Thomas Linding Jakobsen
- Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
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18
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Patient outcomes using Wii-enhanced rehabilitation after total knee replacement – The TKR-POWER study. Contemp Clin Trials 2015; 40:47-53. [DOI: 10.1016/j.cct.2014.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/02/2014] [Accepted: 11/05/2014] [Indexed: 11/20/2022]
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Tan C, Loo G, Pua Y, Chong H, Yeo W, Ong P, Lo N, Allison G. Predicting discharge outcomes after total knee replacement using the Risk Assessment and Predictor Tool. Physiotherapy 2014; 100:176-81. [DOI: 10.1016/j.physio.2013.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 02/20/2013] [Indexed: 10/26/2022]
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Bandholm T, Thorborg K, Lunn TH, Kehlet H, Jakobsen TL. Knee pain during strength training shortly following fast-track total knee arthroplasty: a cross-sectional study. PLoS One 2014; 9:e91107. [PMID: 24614574 PMCID: PMC3948740 DOI: 10.1371/journal.pone.0091107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 02/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA. OBJECTIVE To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. DESIGN Cross-sectional study. SETTING Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013. PARTICIPANTS Seventeen patients, no more than 3 weeks after their TKA. MAIN OUTCOME MEASURES In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0-10). RESULTS Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001). Resting knee pain 60 seconds after the final repetition (2.7±2.4 points) was not different from that recorded before strength training (2.7±1.8 points, P = 0.88). CONCLUSION Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived. TRIAL REGISTRATION ClinicalTrials.gov NCT01729520.
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Affiliation(s)
- Thomas Bandholm
- Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Department of Physical Therapy, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Kristian Thorborg
- Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Department of Physical Therapy, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Arthroscopic Center Amager, Amager Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Troels Haxholdt Lunn
- Department of Anaesthesiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Lundbeckfoundation Centre for Fast-track Hip and Knee Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kehlet
- Lundbeckfoundation Centre for Fast-track Hip and Knee Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Linding Jakobsen
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Lundbeckfoundation Centre for Fast-track Hip and Knee Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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Buhagiar MA, Naylor JM, Harris IA, Xuan W, Kohler F, Wright RJ, Fortunato R. Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (The HIHO study): study protocol for a randomized controlled trial. Trials 2013; 14:432. [PMID: 24341348 PMCID: PMC3878550 DOI: 10.1186/1745-6215-14-432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/25/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Formal rehabilitation programs are often assumed to be required after total knee arthroplasty to optimize patient recovery. Inpatient rehabilitation is a costly rehabilitation option after total knee arthroplasty and, in Australia, is utilized most frequently for privately insured patients. With the exception of comparisons with domiciliary services, no randomized trial has compared inpatient rehabilitation to any outpatient based program. The Hospital Inpatient versus HOme (HIHO) study primarily aims to determine whether 10 days of post-acute inpatient rehabilitation followed by a hybrid home program provides superior recovery of functional mobility on the 6-minute walk test (6MWT) compared to a hybrid home program alone following total knee arthroplasty. Secondarily, the trial aims to determine whether inpatient rehabilitation yields superior recovery in patient-reported function. METHODS/DESIGN This is a two-arm parallel randomized controlled trial (RCT), with a third, non-randomized, observational group. One hundred and forty eligible, consenting participants who have undergone a primary total knee arthroplasty at a high-volume joint replacement center will be randomly allocated when cleared for discharge from acute care to either 10 days of inpatient rehabilitation followed by usual care (a 6-week hybrid home program) or to usual care. Seventy participants in each group (140 in total) will provide 80% power at a significance level of 5% to detect an increase in walking capacity from 400 m to 460 m between the Home and Inpatient groups, respectively, in the 6MWT at 6 months post-surgery, assuming a SD of 120 m and a drop-out rate of <10%.The outcome assessor will assess participants at 10, 26 and 52 weeks post-operatively, and will remain blind to group allocation for the duration of the study, as will the statistician. Participant preference for rehabilitation mode stated prior to randomization will be accounted for in the analysis together with any baseline differences in potentially confounding characteristics as required. DISCUSSION The HIHO Trial will be the first RCT to investigate the efficacy of inpatient rehabilitation compared to any outpatient alternative following total knee arthroplasty. TRIAL REGISTRATION U.S. National Institutes of Health Clinical Trials Registry (http://clinicaltrials.gov) ref: NCT01583153.
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Affiliation(s)
- Mark A Buhagiar
- Braeside Hospital, HammondCare, Locked Bag 82, Wetherill Park 2164, NSW, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW 2170, Australia
| | - Justine M Naylor
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW 2170, Australia
- South West Sydney Local Health District, Locked Bag 7103, Liverpool 2170NSW, Australia
- Whitlam Orthopaedic Research Centre, PO Box 906, Caringbah, NSW 2229, Australia
- 5Ingham Institute of Applied Medical Research, PO Box 3151Westfields Liverpool, Liverpool 2170NSW, Australia
| | - Ian A Harris
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW 2170, Australia
- South West Sydney Local Health District, Locked Bag 7103, Liverpool 2170NSW, Australia
- Whitlam Orthopaedic Research Centre, PO Box 906, Caringbah, NSW 2229, Australia
- 5Ingham Institute of Applied Medical Research, PO Box 3151Westfields Liverpool, Liverpool 2170NSW, Australia
| | - Wei Xuan
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW 2170, Australia
- 5Ingham Institute of Applied Medical Research, PO Box 3151Westfields Liverpool, Liverpool 2170NSW, Australia
| | - Friedbert Kohler
- Braeside Hospital, HammondCare, Locked Bag 82, Wetherill Park 2164, NSW, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW 2170, Australia
- South West Sydney Local Health District, Locked Bag 7103, Liverpool 2170NSW, Australia
| | - Rachael J Wright
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW 2170, Australia
| | - Renee Fortunato
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW 2170, Australia
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Agaliotis M, Fransen M, Bridgett L, Nairn L, Votrubec M, Jan S, Heard R, Mackey M. Risk factors associated with reduced work productivity among people with chronic knee pain. Osteoarthritis Cartilage 2013; 21:1160-9. [PMID: 23973126 DOI: 10.1016/j.joca.2013.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the burden and risk factors associated with reduced work productivity among people with chronic knee pain. METHOD A longitudinal study, nested within a randomised controlled trial (RCT) evaluating the long-term effects of dietary supplements, was conducted among people with chronic knee pain in paid employment (n = 360). Participants recorded days off work (absenteeism) and reduced productivity while at work (presenteeism) for seven days every two months over a 12-month period in a study specific diary. Examined risk factors included knee pain severity, occupational group, radiographic disease severity, physical activity, body mass index (BMI), health-related quality of life (SF-12) and co-morbidity. RESULTS Over the 12-month follow up period, 50 (14%) participants reported one or more days off work due to knee problems, while 283 (79%) reported reduced productivity while at work (presenteeism <100%). In multivariate analysis, the only significant risk factor for absenteeism was having an SF-12 Mental Component Summary (MCS) score <40 (OR: 2.49 [95% CI: 1.03-5.98]). Significant risk factors for presenteeism included; reporting an; SF-12 Physical Component Summary (PCS) score <50 (OR: 1.99 [95% CI: 1.05-3.76]), semi-manual labour (OR: 2.23 [1.09-4.59]) or manual labour (OR: 6.40 [1.44-28.35]) or a high maximum knee pain (4-6 out of 10) (OR: 2.29 [1.17-4.46]). CONCLUSIONS This longitudinal study found that among this cohort of people with chronic knee pain, the burden of reduced work productivity is mainly attributable to presenteeism rather absenteeism. This study demonstrated that effective strategies to increase work productivity should focus on reducing knee pain or physical disability especially among workers in manual or semi-manual labour.
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Affiliation(s)
- M Agaliotis
- Faculty of Health Sciences, University of Sydney, Australia.
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Chan EY, Blyth FM, Nairn L, Fransen M. Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis Cartilage 2013; 21:1257-63. [PMID: 23973139 DOI: 10.1016/j.joca.2013.06.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The increasingly shorter hospitalization following total knee arthroplasty (TKA) requires patients to assume earlier responsibility to self-manage their pain. Poorly managed acute pain increases the risk of persistent pain, reduces quality of life and increases unnecessary healthcare utilization. This study aims to examine post-discharge pain intensity, pain management behaviors and potential barriers to optimal self-management of pain. DESIGN We administered a questionnaire at 2 weeks after discharge to 174 patients undergoing TKA in 10 Australian hospitals. Participants rated pain expectation and severity, use of analgesics and non-pharmacological methods, side-effects, walking and exercise times, perceptions of analgesics, adequacy of pain management information provided and satisfaction with pain relief. RESULTS Of 171 (98%) participants who completed the questionnaire, 88 (52%) reported that the worst pain period occurred during the first 2 weeks at home. During the first 2 weeks at home, the average pain was 'severe/extreme' for 40 (23%) participants and 92 (54%) experienced severe pain at least some of the time. Many participants sought further medical help for their pain. Adequate information on analgesics and non-pharmacological methods for pain relief were reported by only 73% and 47%, respectively. Approximately 20% had negative perceptions about analgesic use. Higher pain severity was associated with lower satisfaction and less time spent walking daily. CONCLUSIONS Effective pain relief after hospital discharge following TKA is a challenge. Many participants reported significant pain, sought further medical help for pain relief and had inadequate information at discharge to effectively self-manage their postoperative knee pain.
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Affiliation(s)
- E Y Chan
- Faculty of Health Sciences, University of Sydney, NSW, Australia.
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Mak JCS, Fransen M, Jennings M, March L, Mittal R, Harris IA. Evidence-based review for patients undergoing elective hip and knee replacement. ANZ J Surg 2013; 84:17-24. [PMID: 23496209 DOI: 10.1111/ans.12109] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the evidence for different interventions in the preoperative, perioperative and post-operative care for people undergoing elective total hip (THR) and knee (TKR) replacement surgery. METHOD A multidisciplinary working group comprising consumers, managers and clinicians from the areas of orthopaedics, rheumatology, aged care and rehabilitation evaluated randomized controlled trials (RCTs) and systematic reviews/meta-analyses concerning aspects of preoperative, perioperative and post-operative clinical care periods for THR/TKR through systematic searching of Medline, Embase, CENTRAL and the Cochrane Database of Systematic Reviews from May 2007 to April 2011. Multiple reviewers determined study eligibility and one or more members extracted primary study findings. The body of evidence were assessed and specific recommendations made according to NHMRC guidelines. RESULTS Twenty-five aspects were identified for review. Recommendations for 16 of 25 areas of care were made: impact of waiting, multidisciplinary preparation, preoperative exercise, smoking cessation, interventions for comorbid conditions, predictors of outcome, clinical pathways, implementation of a blood management programme, antibiotic prophylaxis, regional anaesthesia and analgesia, use of a tourniquet in knee replacement, venous thromboembolism prophylaxis, early post-operative cryotherapy, early mobilization and continuous passive motion. In the post-operative period, study heterogeneity across all aspects of care precluded specific recommendations. CONCLUSIONS There was a deficiency in the quality of the evidence supporting key aspects of the continuum of care for primary THR/TKR surgery. Consequently, recommendations were limited. Prioritization and funding for research into areas likely to impact clinical practice and patient outcomes after elective joint replacement surgery are the next important steps.
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Affiliation(s)
- Jenson C S Mak
- Department of Geriatric Medicine, Gosford Hospital, Gosford, New South Wales, Australia; Department of Medicine, Ryde Hospital, Eastwood, New South Wales, Australia
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Maclean C, Deakin AH, Picard F. Is patient self-assessment of flexion after TKR able to identify risk of manipulation under anaesthesia? Orthop Traumatol Surg Res 2012; 98:672-6. [PMID: 22939105 DOI: 10.1016/j.otsr.2012.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/17/2012] [Accepted: 05/30/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patient self-assessment of postoperative knee flexion following knee replacement was introduced at our institution. This protocol had a dual objective: improve follow-up and act as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. The aim of our study was to audit the use of this patient self-assessment tool and evaluate whether these outcomes were being achieved. MATERIALS AND METHODS A prospective audit of patients admitted for total knee replacements under the care of one orthopaedic consultant between April and October 2009. Participants were asked to measure and record daily maximum knee flexion whilst sitting, from discharge through to six-week follow-up. Patients were advised to contact the arthroplasty team if flexion reduced by 10° or more for three consecutive days. Patient's documented knee flexion was compared to that measured on discharge and at six weeks postoperatively by clinicians. RESULTS Seventy-nine participants (82 knees) were included with 61 participants (64 knees) returning data for analysis (78% compliance rate). Comparison of patient and clinician measurements showed a mean difference of +2° with limits of agreements from -12° to +15°. At a mean follow-up of six weeks maximum flexion (measured by clinician) was 99° (95%CI 97°, 102°) and 92% had a 90°flexion or greater. During the audit period, six patients met the criteria to contact the arthroplasty team, however none of them followed this instruction. DISCUSSION Patient self-assessment of knee flexion at home with a simple goniometer was accurate enough to be useful and 92% of patients reached 90° maximum flexion at six weeks. However this self-assessment method was not successful as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. Future studies into alternative identifiers are required. LEVEL OF EVIDENCE Level III. Investigating a diagnostic test.
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Affiliation(s)
- C Maclean
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
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Naylor JM, Ko V. Heart rate response and factors affecting exercise performance during home- or class-based rehabilitation for knee replacement recipients: lessons for clinical practice. J Eval Clin Pract 2012; 18:449-58. [PMID: 21114797 DOI: 10.1111/j.1365-2753.2010.01596.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patients undergoing total knee replacement (TKR) are typically de-conditioned and manifest medical co-morbidities associated with a lack of fitness. Consequently, an argument exists for rehabilitation programmes to target cardiovascular fitness. Doubt exists, however, as to the capacity of TKR recipients to exercise intensely and effectively. This preliminary study aimed to: (1) determine whether patients participating in a home- or class-based exercise programme can exercise in their heart rate (HR) training zone, and (2) identify confounding factors influencing performance. METHODS A mixed method study nested within a randomized trial was undertaken. Forty-two people (mean age 70 years; 23 women) randomized to commence a 6-week group-based (GRP) or monitored home-based programme (MHP) 2 weeks post surgery participated. Assessments were undertaken weeks 5 (GRP and MHP) and 8 (GRP only) post surgery. HR and participant perceived exertion (PE, 0-10 point scale) captured exercise intensity. Qualitative description using triangulation of informant sources identified factors influencing exercise performance. RESULTS For both programmes, attainment of training HR was almost universal (93% or more), average time spent above the training HR exceeded 30 minutes, and PE indicated moderate exertion (5/10). Individual inconsistency in time spent above the training HR was evident between testing weeks in GRP participants. Therapist skill and focus, and patient co-morbidity, knee pain and stiffness and willingness were confounders of performance. CONCLUSION TKR recipients participating in exercise programmes can exercise moderately hard indicating a potential for rehabilitation to improve cardiovascular fitness. Whether individual fitness actually improves likely depends in part on therapist recognition of key modifiable factors. It is recommended that therapists use these observations to inform practice so patients extract the most benefit from their rehabilitation.
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Affiliation(s)
- Justine M Naylor
- Orthopaedic Department, Liverpool Hospital, Sydney, NSW, Australia.
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Escobar A, Gonzalez M, Quintana JM, Vrotsou K, Bilbao A, Herrera-Espiñeira C, Garcia-Perez L, Aizpuru F, Sarasqueta C. Patient acceptable symptom state and OMERACT-OARSI set of responder criteria in joint replacement. Identification of cut-off values. Osteoarthritis Cartilage 2012; 20:87-92. [PMID: 22155074 DOI: 10.1016/j.joca.2011.11.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/08/2011] [Accepted: 11/14/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify new cut-off values beyond which patients can be considered as satisfied or as responders through patient acceptable symptom state (PASS) and OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) set of responder criteria in total joint replacement. METHODS Secondary analysis of a 1-year prospective multicenter study of 861 patients, 510 with total knee replacement (TKR) and 351 with total hip prosthesis (THR). Pain and function data were collected by the reverse scoring option of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). PASS values were identified with the 25th centile estimation using an anchoring question about satisfaction with actual symptoms. OMERACT-OARSI set of responder criteria was based on a combination of absolute and relative change of pain, function and global patient's assessment. Receiver operating characteristic (ROC) analysis was used as a complementary approach. RESULTS The values for PASS were about 80 and 69 for pain and function in THR, while these values were 80 and 68 when using OMERACT-OARSI criteria. Regarding TKR, PASS values were about 75 and 67 in pain and function with both criteria. ROC values were slightly lower in all cases. PASS and OMERACT-OARSI values varied moderately across tertiles of baseline severity. CONCLUSION With the provided data we can establish when a patient can be considered as satisfied/responder in joint replacement. The scores achieved at 1 year were very similar according to both criteria.
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Affiliation(s)
- A Escobar
- Unidad de Investigación, Hospital de Basurto - CIBER Epidemiología y Salud Pública (CIBERESP), Bilbao, Bizkaia, Spain.
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Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible? Disabil Rehabil 2011; 34:1034-40. [PMID: 22084974 DOI: 10.3109/09638288.2011.629019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA). METHODS A pilot study was conducted at an outpatient training facility. Fourteen patients with unilateral TKA were included from a fast-track orthopedic arthroplasty unit. They received rehabilitation including progressive strength training of the operated leg (leg press and knee-extension), using relative loads of 10 repetition maximum with three training sessions per week for 2 weeks. Rehabilitation was commenced 1 or 2 days after TKA. At each training session, knee pain, knee joint effusion and training load were recorded. Isometric knee-extension strength and maximal walking speed were measured before the first and last session. RESULTS The training load increased progressively (p < 0.0001). Patients experienced only moderate knee pain during the strength training exercises, but knee pain at rest and knee joint effusion (p < 0.0001) were unchanged or decreased over the six training sessions. Isometric knee-extension strength and maximal walking speed increased by 147 and 112%, respectively. CONCLUSION Progressive strength training initiated immediately after TKA seems feasible, and increases knee-extension strength and functional performance without increasing knee joint effusion or knee pain.
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Affiliation(s)
- Thomas Linding Jakobsen
- Department of Physical Therapy, Clinical Research Centre and Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Hvidovre, Denmark.
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