Early initiation of home-based sensori-motor training improves muscle strength, activation and size in patients after knee replacement: a secondary analysis of a controlled clinical trial

Effect of low-intensity muscle strength training on postoperative rehabilitation and adverse events in patients with knee osteoarthritis over 55 years of age: a meta-analysis

BACKGROUND

This study aimed to study the effect of low-intensity muscle strength training on postoperative rehabilitation of patients with knee osteoarthritis over 55 years of age and the incidence of adverse events by a meta-analysis.

METHODS

We searched China National Knowledge Infrastructure (CNKI), WanFang, China Science and Technology Journal Database (VIP), PubMed, Web of science, and Embase databases for articles on the effect of low-intensity muscle strength training on the recovery of patients with knee arthritis. And meta-analysis combined effect was performed in R 4.2.2 software. Quantitative analysis and risk of bias were assessed by Begg's and Eegger's test.

RESULTS

Meta-analysis showed that the effect of low-intensity muscle strength training on postoperative knee range of motion in patients with knee arthritis was mean difference (MD) = 5.20, 95% CI=[4.00, 6.40], τ2 = 0.43, P = 0.34; the effect on postoperative muscle strength was standard mean difference (SMD) = 1.24, 95% CI=[0.86, 1.61], τ2 = 0.07, P < 0.01; the effect on postoperative knee joint score was MD = 5.88, 95%CI=[2.09, 9.67], τ2 = 16.60, P < 0.01; the effect on postoperative knee visual analogue scale (VAS) score was MD=-1.12, 95%CI =[-1.43, -0.81], τ2 = 0.09, P < 0.001; the effect on the incidence of adverse events was RR = 0.85, 95%CI= [0.52 1.39], τ2 = 0.79, P = 0.04.

CONCLUSION

Low-intensity muscle strength training can improve the muscle strength of the affected limb and knee joint score, reduce the VAS score and the incidence of adverse events in patients with knee osteoarthritis over 55 years of age after surgery, but it has no effect on the postoperative knee range of motion, so it can be considered as appropriate in clinical selection.

A Nurse-Led App-Based Home Exercise Program After Total Knee Arthroplasty: A Quasi-Experimental Study

PURPOSE

Reduced activity because of pain is a major health issue associated with total knee arthroplasty. This study evaluated the effectiveness of a nurse-led app-based home exercise program for patients who underwent total knee arthroplasty.

METHODS

A nonequivalent control group of pretest-posttest design was used. Data from 45 patients were collected. The control group received individualized face-to-face exercise education, whereas the experimental group received training on the use of app-based home exercise education, including exercise videos and app push notifications to encourage exercise after discharge. Pain, range of motion, exercise self-efficacy, and quality of life were measured at baseline and 3 and 12 weeks after surgery. Nursing care satisfaction was evaluated 12 weeks after surgery.

RESULTS

There were significant overall reductions in pain intensity ( p = .001), improvements in limited range of motion ( p < .001), and increases in exercise self-efficacy ( p = .034) and quality of life ( p = .033) in the experimental group ( n = 22) compared with those in the control group ( n = 23). Nursing care satisfaction was significantly higher in the experimental group than in the control group ( p < .001).

CONCLUSIONS

Rehabilitation nurses can offer app-based home exercise education with push notifications to alleviate pain, enhance range of motion, improve exercise self-efficacy, and increase nursing care satisfaction for patients who have had a knee arthroplasty.

Robotic exoskeletons and total knee arthroplasty: The future of knee rehabilitation and replacement - A meta-analysis

OBJECTIVE

Exoskeletons can play a crucial role in post-TKA rehabilitation by accelerating recovery, improving mobility, and reducing further injury risk. This meta-analysis evaluated the effectiveness of exoskeletons in post-total knee replacement (TKR) rehabilitation.

DESIGN

Comprehensive searches were conducted on PubMed, OVID Medline, Cochrane Collaboration Library, and Embase (period: database inception to March 2023). Randomized controlled trials enrolling patients who underwent TKR and studies examining the effect of robot-assisted rehabilitation on physical function and pain outcomes were eligible for inclusion. Eight studies (302 patients) were thus included.

RESULTS

Exoskeletons significantly improved active range of motion (ROM) (SMD: 10.98, 95% confidence interval (CI): 7.81-14.16, P < .001), passive ROM (SMD: 4.11, 95% CI: 1.02-7.20, P = .009), Hospital for Special Surgery scores (SMD: 7.78, 95% CI: 5.87-9.68, P < .00001), and hospital stay length (SMD: -3.19, 95% CI: -4 to -2.38, P < .00001) compared with conventional rehabilitation. Active and passive ROM improvements suggest that exoskeletons aid knee function restoration and mobility post-TKR, whereas Hospital for Special Surgery score improvements support exoskeleton use in TKR rehabilitation. A shorter hospital stay was an important finding which could potentially reduce healthcare costs and improve outcomes.

CONCLUSION

Despite the inclusion of a limited number of studies, our findings suggest that exoskeletons can enhance post-TKR rehabilitation outcomes and improve quality of life. Robot-assisted rehabilitation may be effective following TKR. Further research should confirm these findings.

The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression

PURPOSE

Muscular strength loss and atrophy are postoperative complications. This systematic review with meta-analysis investigated the course of on knee extensor mass and strength from pre-surgery over total knee arthroplasty to rehabilitation and recovery.

METHODS

A systematic literature search was conducted in PubMed (Medline), Cochrane Library (CINAHL, Embase) and Web of Science (until 29th of June 2022). Main inclusion criteria were  ≥ 1 preoperative and  ≥ 1 measurement  ≥ 3-months post-operation and ≥ 1 objective assessment of quadriceps strength, muscle mass or neuromuscular activity, measured at both legs. Studies were excluded if they met the following criteria: further impairment of treated extremity or of the contralateral extremity; further muscle affecting disease, or muscle- or rehabilitation-specific intervention. The Robins-I tool for non-randomized studies, and the Cochrane Rob 2 tool for randomized controlled studies were used for risk of bias rating. Pre-surgery, 3 months, 6 months and 1 year after surgery data were pooled using random effects meta-analyses (standardized mean differences, SMD, Hedge's g) in contrast to the pre-injury values.

RESULTS

1417 studies were screened, 21 studies on 647 participants were included. Thereof, 13 were non-randomized controlled trails (moderate overall risk of bias in most studies) and 7 were randomized controlled trials (high risk of bias in at least one domain in most studies). Three (k = 12 studies; SMD = - 0.21 [95% confidence interval = - 0.36 to - 0.05], I² = 4.75%) and six (k = 9; SMD = - 0.10 [- 0.28 to - 0.08]; I² = 0%) months after total knee arthroplasty, a deterioration in the strength of the operated leg compared with the strength of the non-operated leg was observed. One year after surgery, the operated leg was stronger in all studies compared to the preoperative values. However, this increase in strength was not significant compared to the non-operated leg (k = 6, SMD = 0.18 [- 0.18 to 0.54], I² = 77.56%).

CONCLUSION

We found moderate certainty evidence that deficits in muscle strength of the knee extensors persist and progress until 3 months post-total knee arthroplasty in patients with end-stage knee osteoarthritis. Very low certainty evidence exists that preoperatively existing imbalance of muscle strength and mass in favor of the leg not undergoing surgery is not recovered within 1 year after surgery.

Rehabilitation for Total Knee Arthroplasty: A Systematic Review

ABSTRACT

We sought to determine the comparative benefit and harm of rehabilitation interventions for patients who have undergone elective, unilateral total knee arthroplasty for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We included randomized controlled trials and adequately adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. The team assessed strength of evidence. Evidence from 53 studies randomized controlled trials suggests that various rehabilitation programs after total knee arthroplasty may lead to comparable improvements in pain, range of motion, and activities of daily living. Rehabilitation in the acute phase may lead to increased strength but result in similar strength when delivered in the postacute phase. No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period after total knee arthroplasty; risk of harms among various postacute rehabilitation programs seems comparable. All findings were of low strength of evidence. Evaluation of rehabilitation after total knee arthroplasty needs a systematic overhaul to sufficiently guide future practice or research including the use of standardized intervention components and core outcomes.

The effects of elastic band exercise on the pain, kinesiophobia, functional, and psychological status after total knee arthroplasty: a randomized controlled trial

INTRODUCTION

Elastic band exercise not only improves muscle strength and elasticity, increases efficiency, balance, and quality of life but also decreases the injury risk. This study was conducted to determine the effect of elastic band exercise on pain, kinesiophobia, functional, and psychological status after total knee arthroplasty.

METHODS

This study was conducted out between October 2019 and April 2020 as a randomized controlled experimental study with a total of 60 patients. Data collection tools in this study included a descriptive information form, visual analog scale, Tampa Kinesiophobia, WOMAC Osteoarthritis Index, and Beck Depression Inventory.

RESULTS

Before intervention, the total score of VAS, WOMAC, Tampa Kinesiophobia, and Beck Depression showed no statistically significant difference between intervention group and control group. However, 4 weeks after intervention observed a statistically significant difference between the intervention and control groups in terms of VAS (U = 10,000; p < 0.001), WOMAC (U = 0.00; p < 0.001), Tampa Kinesiophobia (U = 221.5; p = 0.001), and Beck Depression means score (U = 112.5; p < 0.001). In addition, 4 weeks after the intervention, joint range and walking test assessments were statistically significant between the intervention and control groups (p < 0.001).

CONCLUSION

The results of the research showed that elastic band exercise had a positive effect on psychological and functional capacity.

TRIAL REGISTRATION

This study is registered in the Clinical Trial Registry (registration number NCT04981106) Key points • Patients with total knee arthroplasty require rehabilitation exercise to avoid physical function weakness. • Elastic band exercise significantly reduces patients' fear of movement and depression. • Elastic band exercise activities facilitate significant physical motion function. • Elastic band exercise inspires the will of patients to engage in home rehabilitation exercise patients after total knee arthroplasty.

The preventive and therapeutic role of physical activity in knee osteoarthritis

The aim of this narrative review is to discuss the results of studies investigating the role of physical activity in knee osteoarthritis (OA). We also formulated two evidence-based exercise programs that could be prescribed to patients with symptomatic knee OA or after joint replacement. The PubMed and Google Scholar databases were searched for articles related to knee OA and physical activity. A total of 86 papers written in English and published from 1957 to 2021 were selected. Adapted physical activity, even at high intensity, does not appear to trigger or exacerbate knee OA; on the contrary, it may prevent obesity or lower limb muscle weakness, both of which are considered predisposing factors for the disease. In patients already diagnosed with knee OA, scientific evidence suggests that both land-based and aquatic activities combining aerobics, strength, and endurance programs are safe and effective. Physical interventions tailored to the patient may also accelerate recovery time after knee arthroplasty. Knee OA is a painful and disabling rheumatic disease that is very common in the elderly population. Pharmacotherapy has a modest effect in controlling disease progression, possibly due to the still limited understanding of OA pathogenesis. Non-pharmacologic interventions, including dietary and lifestyle changes and physical activity, may be more effective and safer than drugs in preventing or treating knee OA.