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Jiao S, Feng Z, Dai T, Huang J, Liu R, Meng Q. High-Intensity Progressive Rehabilitation Versus Routine Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2024; 39:665-671.e2. [PMID: 37634879 DOI: 10.1016/j.arth.2023.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND This study aimed to compare the effectiveness of high-intensity progressive rehabilitation training with routine training in the early treatment of patients undergoing total knee arthroplasty. METHODS There were 78 patients who underwent total knee arthroplasty and were randomized into high-intensity progressive training and routine rehabilitation training groups (RRT). The primary outcome measures were the American Hospital for Special Surgery Knee Score (HSS), with secondary outcomes including patient satisfaction, visual analog pain score, first time of standing after surgery, 6-minute walk test, 36-Item Short Form Survey (SF-36), and length of hospital stay. The incidence of postoperative complications were recorded. RESULTS The HSS scores were higher in the intervention group at 2 weeks, 3 months, and 12 months postoperatively (P < .001). The RRT group had higher visual analog pain scores than the intervention group at 24 hours, 3 days, and 2 weeks after surgery (P < .001). The intervention group had an earlier the first time of standing after surgery and a longer 6-minute walk test distance (P < .001, P = .028, P < .001, P < .001). Patient satisfaction was higher in the intervention group, with a higher quality of life rating at 3 months postoperatively (P < .001). However, 1 year after surgery, the 2 groups had no significant differences in mental component summaries. The length of hospital stay was shorter in the intervention group than in the RRT group. CONCLUSION Compared to routine training, high-intensity progressive rehabilitation training is more effective. It reduces postoperative patient pain, accelerates recovery of joint function, increases patient satisfaction, improves quality of life, shortens hospital stays, and promotes rapid recovery.
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Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Tianming Dai
- Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Hubei, China
| | - Ruijia Liu
- Department of Orthopedics, Foshan Fosun Chancheng Hospital, Foshan, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
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Koster A, Stevens M, van Keeken H, Westerveld S, Seeber GH. Effectiveness and therapeutic validity of physiotherapeutic exercise starting within one year following total and unicompartmental knee arthroplasty for osteoarthritis: a systematic review. Eur Rev Aging Phys Act 2023; 20:8. [PMID: 36991323 PMCID: PMC10054030 DOI: 10.1186/s11556-023-00317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/12/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND To determine the effectiveness and therapeutic validity of physiotherapeutic exercise after total and unicompartmental knee arthroplasty for osteoarthritis. It was hypothesized that interventions of high therapeutic validity result in superior functional recovery after total and unicompartmental knee arthroplasty versus interventions of low therapeutic validity. METHODS A systematic review incorporating a comprehensive database search of five major databases relevant to the topic was conducted. Randomized controlled trials were reviewed if they included studies that compared postoperative physiotherapeutic exercise with usual care or compared two types of postoperative physiotherapeutic interventions. All included studies were assessed for risk of bias (using the Cochrane Collaboration's tool) and therapeutic validity (using the Consensus on Therapeutic Exercise Training scale). The characteristics of the included articles and their results on joint and muscle function, functional performance, and participation were extracted. RESULTS Of the 4343 unique records retrieved, 37 articles were included. Six of them showed good therapeutic validity, suggesting low therapeutic validity in 31 studies. Three articles showed a low risk of bias, 15 studies scored some concerns for risk of bias and 19 studies scored high risk of bias. Only one article scored well on both methodological quality and therapeutic validity. CONCLUSION Due to heterogeneity of outcome measures and length of follow-up, as well as limited reporting of details of the physiotherapeutic exercises and control interventions, no clear evidence was found on effectiveness of physiotherapeutic exercises after total and unicompartmental knee arthroplasty. Homogeneity in intervention characteristics and outcome measures would enhance comparability of clinical outcomes between trials. Future studies should incorporate similar methodological approaches and outcome measures. Researchers are encouraged to use the Consensus on Therapeutic Exercise Training scale as a template to prevent insufficient reporting.
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Affiliation(s)
- Amarins Koster
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helco van Keeken
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne Westerveld
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gesine H Seeber
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany.
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3
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Kittelson AJ, Loyd BJ, Graber J, Himawan MA, Waugh D, Davenport J, Hoogeboom TJ, Stevens-Lapsley J. Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice. J Eval Clin Pract 2021; 27:1335-1342. [PMID: 33763961 PMCID: PMC8627122 DOI: 10.1111/jep.13564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Total knee arthroplasty (TKA) rehabilitation trials use exclusion criteria, which may limit their generalizability in practice. We investigated whether patients seen in routine practice who meet common exclusion criteria recover differently from TKA compared to research-eligible patients. We hypothesized that research-ineligible patients would demonstrate poorer average postoperative function and slower rate of functional recovery compared to research-eligible patients. METHODS Patient characteristics and exclusion criteria were extracted and summarized from trials included in the three most recent systematic reviews of TKA rehabilitation. Trial participant characteristics were compared to a clinical dataset of patient outcomes collected in routine TKA rehabilitation. Where possible, individual exclusion criterion from the trials were applied to the clinical dataset to determine "eligible" and "ineligible" groups for research participation. Postoperative functional outcomes including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG) were compared between "eligible" and "ineligible" groups using mixed effects models. RESULTS 2,528 participants from 27 trials were compared to 474 patients from the clinical dataset. Research participants were older, with lower Body Mass Index than patients in the clinical dataset. Many patients in the clinical dataset would be "ineligible" for research participation based upon common exclusion criteria from the trials. Differences were observed in average postoperative functioning between some "eligible" and "ineligible" groups in the clinical dataset. However, no differences were observed in functional recovery rate between groups, except for patients with diabetes whose TUG recovered more slowly than their "eligible" counterparts. CONCLUSIONS Many patients in the clinical dataset were "ineligible" for research participation based upon common TKA rehabilitation trial exclusion criteria. However, the postoperative recovery rate did not differ between "eligible" and "ineligible" groups based on individual exclusion criterion-except for individuals with diabetes. This suggests that both clinical and research populations may recover similarly from TKA.
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Affiliation(s)
- Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA.,Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Michael A Himawan
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Dawn Waugh
- ATI Physical Therapy, Greenville, South Carolina, USA
| | | | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
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4
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Bakaa N, Chen LH, Carlesso L, Richardson J, Macedo L. Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 2021; 22:602. [PMID: 34193139 PMCID: PMC8247251 DOI: 10.1186/s12891-021-04460-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022] Open
Abstract
Objective The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation. Design: Scoping review Literature search A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library. Study selection criteria All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included. Data synthesis The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool. Results There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT. Conclusion The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER). Pre-registration OSF:https://osf.io/9ku8a/ Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04460-w.
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Affiliation(s)
- Nora Bakaa
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada.
| | - Lu Hsi Chen
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Lisa Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Luciana Macedo
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
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Sanzo P, Niccoli S, Droll K, Puskas D, Cullinan C, Lees SJ. The effects of exercise and active assisted cycle ergometry in post-operative total knee arthroplasty patients - a randomized controlled trial. J Exp Orthop 2021; 8:41. [PMID: 34159469 PMCID: PMC8219820 DOI: 10.1186/s40634-021-00363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study was to examine the effect of the use of an active assisted cycle ergometer as an adjunct to post-operative treatment following total knee arthroplasty. Method A total of 55 participants aged 50–80 years who had undergone unilateral total knee arthroplasty were randomly assigned to either the control group (standard of care) or the active assisted cycle ergometer (AACE) group. The effect on patient motivation, blood biomarkers, and knee pain, function, range of motion (ROM), strength, and swelling was examined. Qualitative feedback was also obtained post-operatively. Results Although there was no statistically significant difference in the standard of care compared to the AACE group, there was a trend for a greater reduction in knee pain on the visual analog scale, improved Lower Extremity Functional Scale scores, and knee extension ROM and strength. A greater percentage of the experimental group demonstrated higher motivation. There was no significant difference in swelling or blood biomarker measures. Qualitative feedback from the AACE group post-operatively was also positive. Conclusions The use of an AACE protocol as an adjunct to total knee arthroplasty rehabilitation may improve post-operative clinical outcomes. This study has been registered at clinicaltrials.gov (identifier NCT02265523, Oct 16 2014). Level of evidence: Level 1 – randomized controlled trial. Further research with a larger sample size is needed to confirm the benefits of the ergometer use. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00363-w.
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Affiliation(s)
- P Sanzo
- School of Kinesiology, Lakehead University, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada. .,Northern Ontario School of Medicine, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada.
| | - S Niccoli
- Northern Ontario School of Medicine, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada
| | - K Droll
- Northern Ontario School of Medicine, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada.,Thunder Bay Regional Health Sciences Centre, 980 Oliver Rd, Thunder Bay, P7B 6V4, Canada
| | - D Puskas
- Northern Ontario School of Medicine, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada.,Thunder Bay Regional Health Sciences Centre, 980 Oliver Rd, Thunder Bay, P7B 6V4, Canada
| | - C Cullinan
- Northern Ontario School of Medicine, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada.,Thunder Bay Regional Health Sciences Centre, 980 Oliver Rd, Thunder Bay, P7B 6V4, Canada
| | - S J Lees
- Northern Ontario School of Medicine, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada
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6
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Lo CWT, Brodie MA, Tsang WWN, Yan CH, Lam PL, Chan CM, Lord SR, Wong AYL. Acceptability and feasibility of a community-based strength, balance, and Tai Chi rehabilitation program in improving physical function and balance of patients after total knee arthroplasty: study protocol for a pilot randomized controlled trial. Trials 2021; 22:129. [PMID: 33573664 PMCID: PMC7877189 DOI: 10.1186/s13063-021-05055-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 01/20/2021] [Indexed: 05/30/2023] Open
Abstract
Background The rate of falls in patients after total knee arthroplasty (TKA) is high and related to lower limb muscle weakness and poor balance control. However, since routine post-TKA rehabilitation is uncommon, it is paramount to explore alternative strategies to enhance balance and physical functioning in post-TKA patients. As Tai Chi is a proven strategy for improving balance in older people, the proposed study aims to determine the feasibility and acceptability of a 12-week community-based post-TKA multimodal Tai Chi program and to collect preliminary data with respect to the efficacy of such a program in improving balance and physical functioning in post-TKA patients as compared to usual postoperative care. Methods A single-blinded 2-arm pilot randomized controlled trial will recruit 52 community-dwelling post-TKA patients (aged > 60 years) in Hong Kong. In addition, 26 untreated asymptomatic controls will be recruited for comparison purposes. The TKA patients will be randomized into either a 12-week multimodal Tai Chi rehabilitation group or a postoperative usual care group (26 each). Participants will perform the outcome assessments at baseline, 6, 12, 24, and 52 weeks after TKA, while asymptomatic controls will have the same assessments at baseline, 12, and 52 weeks after baseline. The rate of recruitment, retention, and attrition, as well as adherence to the intervention, will be measured and used to determine the feasibility of the study and whether a full-scale effectiveness trial is warranted. Further, qualitative interviews will be conducted to explore the acceptability and possible barriers to the implementation of the intervention. Primary and secondary outcomes including both patient-reported surveys and performance-based tests will be compared within and between groups. Discussion The study will determine the feasibility and acceptability/potential efficacy of community-based rehabilitation for post-TKA patients and assess whether the intervention has the potential to be assessed in a future fully powered effectiveness trial. The findings will also be used to refine the study design and guide the conduction of a future definitive randomized controlled trial. Trial registration ClinicalTrials.gov NCT03615638. Registered on 30 May 2018. https://clinicaltrials.gov/ct2/show/NCT03565380 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05055-5.
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Affiliation(s)
- Cathy W T Lo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Matthew A Brodie
- Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, Australia
| | - William W N Tsang
- Department of Physiotherapy, The Open University of Hong Kong, Hong Kong SAR, China
| | - Chun-Hoi Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Priscillia L Lam
- Department of Physiotherapy, Queen Mary Hospital, Hong Kong SAR, China
| | - Chun-Ming Chan
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Hong Kong SAR, China
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, Australia
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
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7
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Jette DU, Hunter SJ, Burkett L, Langham B, Logerstedt DS, Piuzzi NS, Poirier NM, Radach LJL, Ritter JE, Scalzitti DA, Stevens-Lapsley JE, Tompkins J, Zeni Jr J. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther 2020; 100:1603-1631. [PMID: 32542403 PMCID: PMC7462050 DOI: 10.1093/ptj/pzaa099] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/24/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.
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Affiliation(s)
- Diane U Jette
- FAPTA, MGH, Institute of Health Professions, Boston, Massachusetts
| | | | - Lynn Burkett
- ONC, National Association of Orthopaedic Nurses (NAON), Wyomissing, Pennsylvania
| | - Bud Langham
- Home Health and Hospice Services, Encompass Health, Birmingham, Alabama
| | - David S Logerstedt
- Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Noreen M Poirier
- Department of Orthopedics and Rehabilitation, University of Wisconsin (UW) Health, Madison, Wisconsin
| | - Linda J L Radach
- Consumers United for Evidence Based Healthcare, Lake Forest Park, Washington
| | - Jennifer E Ritter
- Department of Rehabilitation Services/Physical Therapy, University of Pittsburgh Medical Center (UPMC) St Margaret Hospital/Catholic Relief Services, Pittsburgh, Pennsylvania
| | - David A Scalzitti
- OCS, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado at Denver & Health Sciences Center, Denver, Colorado
| | - James Tompkins
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona
| | - Joseph Zeni Jr
- Department of Physical Therapy, University of Delaware, Newark, Delaware
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Kim G, Kim WS, Kim TW, Lee YS, Lee H, Paik NJ. Home-based rehabilitation using smart wearable knee exercise device with electrical stimulation after anterior cruciate ligament reconstruction: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e20256. [PMID: 32443364 PMCID: PMC7254399 DOI: 10.1097/md.0000000000020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Rehabilitation after anterior cruciate ligament (ACL) reconstruction is critical to patient outcome. Despite its importance; however, hospital-based rehabilitation is limited, with barriers, including distance and cost. With recent technological advancements, wearable devices have actively been used to address these barriers. In this study, we propose a randomized controlled trial protocol investigating the efficacy and feasibility of home-based rehabilitation after ACL reconstruction using a smart wearable device providing electrical stimulation that allows knee exercise. METHODS AND ANALYSIS This is a protocol proposal for a prospective, single-center, randomized, controlled study. We plan to recruit adults discharged after ACL reconstruction; the recruited subjects will be randomly allocated to 1 of 2 groups, using a computer-generated randomization method: the intervention (n = 20) or control group (n = 20). The intervention group will receive a 6-week home-based rehabilitation program using smart wearable device. The control group will undergo a 6-week self-exercise program as normal. The following outcomes will be assessed at baseline, 2 weeks, and 6 weeks post the 6-week intervention program: quadriceps strength of the affect side as measured by a dynamometer (primary outcome); range of motion; root mean square of quadriceps muscle using surface electromyography; knee function using questionnaire; quality of life; subject's satisfaction score using questionnaire; frequency and duration of exercise; and knee pain. An intention-to-treat analysis will be conducted for the primary outcome. DISCUSSION This study is a prospective, single-center, randomized, controlled study. This study aims to research the feasibility and efficacy of a 6-week, structured home-based rehabilitation program for patients after ACL reconstruction using a smart wearable device. The findings of this study will help to establish a home-based rehabilitation program to better recovery in patients with ACL reconstruction. TRIAL REGISTRATION NUMBER This protocol was registered in ClinicalTrials.gov, under the number NCT04079205.
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Affiliation(s)
- Gowun Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Hooman Lee
- EXOSYSTEMS Inc., Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
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9
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Hsu WH, Hsu WB, Shen WJ, Lin ZR, Chang SH, Hsu RWW. Twenty-four-week hospital-based progressive resistance training on functional recovery in female patients post total knee arthroplasty. Knee 2019; 26:729-736. [PMID: 30902510 DOI: 10.1016/j.knee.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND After total knee arthroplasty (TKA) surgery, a decline in muscle strength is associated with a decrease in function. The aim of this study was to demonstrate the effect of a further 24 weeks of hospital-based resistance training under supervision, and precise dose on knee functional recovery and daily activities for female TKA patients. METHODS Twenty-nine patients who underwent unilateral primary TKA were allocated into either resistance training (RT) (n = 14) or control (CON) (n = 15) groups. All patients were assessed, with an isokinetic dynamometer, for hip and knee flexor and extensor muscle strength, physical function test, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Resistance training was initiated three months after index surgery. The assessments were performed before exercise (Baseline), in the middle of the resistance training at 12 weeks (Mid-exercise), completion of the resistance training (Post-exercise), and 12 weeks after resistance training completion (Follow-up). A statistical test was performed by using generalized estimating equations. RESULTS Patients in RT had more of an increase in both knee extensor and flexor muscle strength than those in CON at the Post-exercise assessment. The six-minute walk test distance was more in RT compared with CON at the same Post-exercise assessment. Furthermore, the RT group had increases in Activities of daily living and Sports subscales compared to the CON group. CONCLUSIONS A further 24 weeks of hospital-based progressive resistance training facilitated improvement in knee muscle strength and functional outcome in TKA patients. Active hospital-based progressive resistance training is recommended for rehabilitation following TKA surgery.
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Affiliation(s)
- Wei-Hsiu Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
| | - Wei-Bin Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
| | - Wun-Jer Shen
- PO CHENG Orthopedic Institute, Kaohsiung, Taiwan, Republic of China
| | - Zin-Rong Lin
- Department of Athletic Sports, National Chung Cheng University, Chiayi, Taiwan, Republic of China
| | - Shr-Hsin Chang
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China
| | - Robert Wen-Wei Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China.
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10
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Doma K, Grant A, Morris J. The Effects of Balance Training on Balance Performance and Functional Outcome Measures Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Sports Med 2019; 48:2367-2385. [PMID: 30117054 DOI: 10.1007/s40279-018-0964-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several studies have examined the effects of balance training in elderly individuals following total knee arthroplasty (TKA), although findings appear to be equivocal. OBJECTIVES This systematic review and meta-analysis examined the effects of balance training on walking capacity, balance-specific performance and other functional outcome measures in elderly individuals following TKA. METHODS Data sources: Pubmed, PEDro, Cinahl, SportDiscus, Scopus. Eligibility criteria: Data were aggregated following the population-intervention-comparison-outcome (PICO) principles. Eligibility criteria included: (1) randomised controlled trials; (2) studies with comparative groups; (3) training interventions were incorporated post-TKA; and (4) outcome measures included walking capacity, balance-specific performance measures, subjective measures of physical function and pain and knee range-of-motion. PARTICIPANTS Elderly individuals (65 + years) who underwent total knee arthroplasty. INTERVENTIONS Balance interventions that consisted of balance exercises, which were compared to control interventions that did not involve balance exercises, or to a lesser extent. Participants also undertook usual physiotherapy care in conjunction with either the balance and/or control intervention. The intervention duration ranged from 4 to 32 weeks with outcome measures reported immediately following the intervention. Of these, four studies also reported follow-up measures ranging from 6 to 12 months post-interventions. Study appraisal: PEDro scale. SYNTHESIS METHODS Quantitative analysis was conducted by generating forest plots to report on standardised mean differences (SMD; i.e. effect size), test statistics for statistical significance (i.e. Z values) and inter-trial heterogeneity by inspecting I2. A meta-regression was also conducted to determine whether training duration predicted the magnitude of SMD. RESULTS Balance training exhibited significantly greater improvement in walking capacity (SMD = 0.57; Z = 6.30; P < 0.001; I2 = 35%), balance-specific performance measures (SMD = 1.19; Z = 7.33; P < 0.001; I2 = 0%) and subjective measures of physical function (SMD = 0.46; Z = 4.19; P < 0.001; I2 = 0%) compared to conventional training immediately post-intervention. However, there were no differences in subjective measures of pain (SMD = 0.77; Z = 1.63; P > 0.05; I2 = 95%) and knee range-of-motion (SMD = 0.05; Z = 0.39; P > 0.05; I2 = 1%) between interventions. At the 6- to 12-month follow-up period, improvement in combined measures of walking capacity and balance performance (SMD = 041; Z = 3.55; P < 0.001; I2 = 0%) were significantly greater for balance training compared to conventional training, although no differences were observed for subjective measures of physical function and pain (SMD = 0.26; Z = 2.09; P > 0.05; I2 = 0%). Finally, the training duration significantly predicted subjective measures of pain and physical function (r2 = 0.85; standardised β = 0.92; P < 0.001), although this was not observed for walking capacity and balance-specific performance measures (r2 = 0.02; standardised β = 0.13; P = 0.48). LIMITATIONS A number of outcome measures indicated high inter-trial heterogeneity and only articles published in English were included. CONCLUSION Balance training improved walking capacity, balance-specific performance and functional outcome measures for elderly individuals following TKA. These findings may improve clinical decision-making for appropriate post-TKA exercise prescription to minimise falls risks and optimise physical function.
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Affiliation(s)
- Kenji Doma
- College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia.
- Orthopaedic Research Institute of Queensland, Townsville, QLD, 4814, Australia.
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, QLD, 4814, Australia
| | - Jodie Morris
- Orthopaedic Research Institute of Queensland, Townsville, QLD, 4814, Australia
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Griffin D, Wall P, Realpe A, Adams A, Parsons N, Hobson R, Achten J, Fry J, Costa M, Petrou S, Foster N, Donovan J. UK FASHIoN: feasibility study of a randomised controlled trial of arthroscopic surgery for hip impingement compared with best conservative care. Health Technol Assess 2018; 20:1-172. [PMID: 27117505 DOI: 10.3310/hta20320] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a syndrome of hip or groin pain associated with shape abnormalities of the hip joint. Treatments include arthroscopic surgery and conservative care. This study explored the feasibility of a randomised controlled trial to compare these treatments. OBJECTIVES The objectives of this study were to estimate the number of patients available for a full randomised controlled trial (RCT); to explore clinician and patient willingness to participate in such a RCT; to develop consensus on eligibility criteria, surgical and best conservative care protocols; to examine possible outcome measures and estimate the sample size for a full RCT; and to develop trial procedures and estimate recruitment and follow-up rates. METHODS Pre-pilot work: we surveyed all UK NHS hospital trusts (n = 197) to identify all FAI surgeons and to estimate how much arthroscopic FAI surgery they performed. We interviewed a purposive sample of 18 patients, 36 physiotherapists, 18 surgeons and two sports physicians to explore attitudes towards a RCT and used consensus-building methods among them to develop treatment protocols and patient information. Pilot RCT: we performed a pilot RCT in 10 hospital trusts. Patients were randomised to receive either hip arthroscopy or best conservative care and then followed up at 3, 6 and 12 months using patient-reported questionnaires for hip pain and function, activity level, quality of life, and a resource-use questionnaire. Qualitative recruitment intervention: we performed semistructured interviews with all researchers and clinicians involved in the pilot RCT in eight hospital trusts and recorded and analysed diagnostic and recruitment consultations with eligible patients. RESULTS We identified 120 surgeons who reported treating at least 1908 patients with FAI by hip arthroscopy in the NHS in the financial year 2011/12. There were 34 hospital trusts that performed ≥ 20 arthroscopic FAI operations in the year. We found that clinicians were positive about a RCT: only half reported equipoise, but most said that they would be prepared to randomise patients. Patients strongly supported a RCT, but expressed concerns about its design; these were used to develop patient information for the pilot RCT. We developed a surgical protocol and showed that this could be used in a RCT. We developed a physiotherapy-led exercise-based package of best conservative care called 'personalised hip therapy' and showed that this was practicable. In the pilot RCT, we recruited 42 out of 60 eligible patients (70%) across nine sites. The mean duration and recruitment rate across all sites were 4.5 months and one patient per site per month, respectively. The lead site recruited for the longest period (9.3 months) and accrued the largest number of patients (2.1 patients per month). We recorded and analysed 84 diagnostic and recruitment consultations in 60 patients and used these to develop a model for an optimal recruitment consultation. We identified the International Hip Outcome Tool at 12 months as an appropriate outcome measure and estimated the sample size for a full trial as 344 participants: a number that could be recruited in 25 centres over 18 months. CONCLUSION We have demonstrated that it is feasible to perform a RCT to establish the clinical effectiveness of hip arthroscopy compared with best conservative care for FAI. We have designed a full trial and developed and tested procedures for it, including an innovative approach to recruitment. We propose that a full trial be implemented. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Damian Griffin
- Division of Health Sciences, University of Warwick, Warwick, UK
| | - Peter Wall
- Division of Health Sciences, University of Warwick, Warwick, UK
| | - Alba Realpe
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, UK
| | - Ann Adams
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, UK
| | - Nick Parsons
- Department of Statistics and Epidemiology, University of Warwick, Warwick, UK
| | - Rachel Hobson
- Division of Health Sciences, University of Warwick, Warwick, UK
| | - Juul Achten
- Division of Health Sciences, University of Warwick, Warwick, UK
| | | | - Matthew Costa
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Wylde V, Dennis J, Gooberman-Hill R, Beswick AD. Effectiveness of postdischarge interventions for reducing the severity of chronic pain after total knee replacement: systematic review of randomised controlled trials. BMJ Open 2018; 8:e020368. [PMID: 29490967 PMCID: PMC5855247 DOI: 10.1136/bmjopen-2017-020368] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Approximately 20% of patients experience chronic pain after total knee replacement (TKR). The aim of this systematic review was to evaluate the effectiveness of postdischarge interventions commenced in the first 3 months after surgery in reducing the severity of chronic pain after TKR. DESIGN The protocol for this systematic review was registered on PROSPERO (registration number: CRD42017041382). MEDLINE, Embase, CINAHL, PsycINFO and The Cochrane Library were searched from inception to November 2016. Randomised controlled trials of postdischarge intervention which commenced in the first 3 months after TKR surgery were included. The primary outcome of the review was self-reported pain severity at 12 months or longer after TKR. Risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS Seventeen trials with data from 2485 randomised participants were included. The majority of trials evaluated physiotherapy interventions (n=13); other interventions included nurse-led interventions (n=2), neuromuscular electrical stimulation (n=1) and a multidisciplinary intervention (n=1). Opportunities for meta-analysis were limited by heterogeneity. No study found a difference in long-term pain severity between trial arms, with the exception of one trial which found home-based functional exercises aimed at managing kinesiophobia resulted in lower pain severity scores at 12 months postoperatively compared with advice to stay active. CONCLUSION This systematic review and narrative synthesis found no evidence that one type of physiotherapy intervention is more effective than another at reducing the severity of chronic pain after TKR. Further research is needed to evaluate non-physiotherapy interventions, including the provision of care as part of a stratified and multidisciplinary care package. PROSPERO REGISTRATION NUMBER CRD42017041382.
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Affiliation(s)
- Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Andrew David Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Umehara T, Tanaka R. Effective exercise intervention period for improving body function or activity in patients with knee osteoarthritis undergoing total knee arthroplasty: a systematic review and meta-analysis. Braz J Phys Ther 2017; 22:265-275. [PMID: 29174345 DOI: 10.1016/j.bjpt.2017.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/20/2017] [Accepted: 10/26/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Various systematic reviews and/or meta-analyses examining the effects of pre- or postoperative exercise on body function or activity in patients undergoing total knee arthroplasty (TKA) have been published. However, the interventional period needed to at least improve outcomes is unknown. OBJECTIVE The aim of this systematic review and meta-analysis was to investigate the exercise intervention period needed to effectively improve body function or activity before and after TKA in patients with knee osteoarthritis (OA). METHODS Studies published until July 2017 were included in the review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to each meta-analysis to determine the quality of the evidence. RESULTS Twenty-seven randomized controlled trials were identified. A meta-analysis indicated that exercises performed for 8 weeks after discharge in addition to standard postoperative intervention effectively improved body function as assessed using pain level; physical function, and stiffness on the Western Ontario and McMaster Universities Arthritis Index; extension strength; active knee flexion range of motion; timed up and go test; and gait speed. CONCLUSION Overall, we found low- to moderate-quality evidence that an 8-week exercise period was needed after discharge to improve body function and activity in patients with knee OA undergoing TKA.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Saiseikai Kure Hospital, Kure, Japan.
| | - Ryo Tanaka
- Department of Rehabilitation, Hiroshima International University, Higashihiroshima, Japan
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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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Wall PD, Dickenson EJ, Robinson D, Hughes I, Realpe A, Hobson R, Griffin DR, Foster NE. Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med 2017; 50:1217-23. [PMID: 27629405 PMCID: PMC5036255 DOI: 10.1136/bjsports-2016-096368] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. METHODS In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. RESULTS The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12-26 weeks in 6-10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. CONCLUSION PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). TRIAL REGISTRATION NUMBER ISRCTN 09754699.
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Affiliation(s)
- Peter Dh Wall
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David Robinson
- Southbank Hospital Worcester, Spire Healthcare, Worcester, UK
| | - Ivor Hughes
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Alba Realpe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Hobson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Damian R Griffin
- University Hospitals of Coventry and Warwickshire NHS Trust and Warwick Medical School, University of Warwick, Coventry, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences NIHR Professor of Musculoskeletal Health in Primary Care, Keele University, Keele, UK
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The Effects of Traditional Chinese Exercise in Treating Knee Osteoarthritis: A Systematic Review and Meta-Analysis. PLoS One 2017; 12:e0170237. [PMID: 28121996 PMCID: PMC5266306 DOI: 10.1371/journal.pone.0170237] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/31/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Traditional Chinese exercise (TCE) includes a variety of exercise, which is being accepted by more and more people in the treatment of knee osteoarthritis (OA) from different countries. With the attendant, many clinical reports focus on it. Our meta-analysis aimed to systematically assess the effects of traditional Chinese exercise on pain, stiffness, physical function, quality of life, mental health and adverse events in people with knee osteoarthritis. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), the Web of Science, and Chinese Biomedical Literature Database (CBM) were searched from the time of their inception through April 2016 and risk of bias was independently assessed by two authors. Outcome measures included pain, physical functional, joint stiffness, quality of life, mental health and safety. For pooled outcomes, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. RESULTS Eight randomized controlled trials with a sample size of 375 cases met the criteria to be included in the study indicating that high quality literature is lacking in this field. Results of the meta-analysis showed that short-term TCE could relieve pain (SMD: -0.77;95% CI: -1.13 to -0.41; P<0.0001), improve physical function (SMD -0.75; 95% CI: -0.98 to -0.52; P<0.00001), and alleviate stiffness (SMD: -0.56; 95%: CI -0.96 to -0.16; P<0.006), but had no significant effect on quality of life (SMD: 0.57; 95% CI: 0.17 to 0.97; P = 0.005), and mental health (SMD 4.12; 95% CI: -0.50 to 8.73; P = 0.08). Moreover, TCE was not associated with serious adverse events. CONCLUSIONS Our systematic review revealed that short-term TCE was potentially beneficial in terms of reducing pain, improving physical function and alleviating stiffness. These results may suggest that TCE could prove useful as an adjuvant treatment for patients with knee OA. Further studies are urgently needed to confirm these results.
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Yoon JH, Jo S, Kim SH. Neuromuscular electrical stimulation therapy after knee surgery: a systematic review. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.7.579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jin Hee Yoon
- Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sunyoung Jo
- Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seok-Hyun Kim
- Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Blom AW, Artz N, Beswick AD, Burston A, Dieppe P, Elvers KT, Gooberman-Hill R, Horwood J, Jepson P, Johnson E, Lenguerrand E, Marques E, Noble S, Pyke M, Sackley C, Sands G, Sayers A, Wells V, Wylde V. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BackgroundTotal hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected.ObjectiveTo undertake a programme of research studies to work towards improving patient outcomes after THR and TKR.MethodsWe used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement.ResultsSystematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test.ConclusionsThe RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.Study registrationCurrent Controlled Trials ISRCTN52305381.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil Artz
- School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, UK
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, Birmingham, UK
| | - Emma Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elsa Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Pyke
- North Bristol NHS Trust, Bristol, UK
| | | | - Gina Sands
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Victoria Wells
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Jørgensen PB, Bogh SB, Kierkegaard S, Sørensen H, Odgaard A, Søballe K, Mechlenburg I. The efficacy of early initiated, supervised, progressive resistance training compared to unsupervised, home-based exercise after unicompartmental knee arthroplasty: a single-blinded randomized controlled trial. Clin Rehabil 2016; 31:61-70. [DOI: 10.1177/0269215516640035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To examine if supervised progressive resistance training was superior to home-based exercise in rehabilitation after unicompartmental knee arthroplasty. Design: Single blinded, randomized clinical trial. Setting: Surgery, progressive resistance training and testing was carried out at Aarhus University Hospital and home-based exercise was carried out in the home of the patient. Subjects: Fifty five patients were randomized to either progressive resistance training or home-based exercise. Intervention: Patients were randomized to either progressive resistance training (home based exercise five days/week and progressive resistance training two days/week) or control group (home based exercise seven days/week). Main measures: Preoperative assessment, 10-week (primary endpoint) and one-year follow-up were performed for leg extension power, spatiotemporal gait parameters and knee injury and osteoarthritis outcome score (KOOS). Results: Forty patients (73%) completed 1-year follow-up. Patients in the progressive resistance training group participated in average 11 of 16 training sessions. Leg extension power increased from baseline to 10-week follow-up in progressive resistance training group (progressive resistance training: 0.28 W/kg, P= 0.01, control group: 0.01 W/kg, P=0.93) with no between-group difference. Walking speed and KOOS scores increased from baseline to 10-week follow-up in both groups with no between-group difference (six minutes walk test P=0.63, KOOS P>0.29). Conclusions: Progressive resistance training two days/week combined with home based exercise five days/week was not superior to home based exercise seven days/week in improving leg extension power of the operated leg.
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Affiliation(s)
| | - Søren B Bogh
- Orthopaedic Research Unit, Aarhus University Hospital, Denmark
- Centre for Quality, Region of Southern Denmark, Denmark
| | | | - Henrik Sørensen
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Copenhagen University Hospital Gentofte, Kildegårdsvej, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Unit, Aarhus University Hospital, Denmark
| | - Inger Mechlenburg
- Orthopaedic Research Unit, Aarhus University Hospital, Denmark
- Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
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Moutzouri M, Gleeson N, Billis E, Tsepis E, Gliatis J. Greek Physiotherapists' Perspectives on Rehabilitation Following Total Knee Replacement: a Descriptive Survey. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [PMID: 29027759 DOI: 10.1002/pri.1671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/17/2015] [Accepted: 03/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE In Greece, as in many countries, there is a scarcity of evidence in the type of physiotherapy services offered for the rehabilitation of total knee replacement (TKR). Despite the number of TKRs annually performed in Greece (over 10,000), there are no available clinical guidelines as to the content of best physiotherapy practice. The aim of this nationwide survey undertaken by physiotherapists treating TKR patients post-operatively was to record standard practice and services available in Greece. METHODS Design: cross-country survey Ten per cent of all registered physiotherapists working in public/private sectors were recruited. The developed survey comprised of questions regarding therapists' profile, protocols implemented at different stages of rehabilitation and the aims and modalities used. RESULTS A 58.7% response rate was achieved, where 36% (47/132) of respondents were treating patients in the inpatient phase and 64% (85/132) after hospital discharge. Patients in Greece are discharged with a home-based exercise program (56.7%) and, to a lesser extent, are referred to rehabilitation centres (13.3%). Strengthening, range of movement and functionality seemed to be the primary goals especially in the inpatient phase, whereas in the outpatient phase, apart from the larger differences identified, functionality and balance training were more frequently reported. CONCLUSIONS No significant variations in practice were found during inpatient rehabilitation, whilst there seemed to be diversity across outpatient physiotherapy programs. The current survey suggests that patient's general health and psychological and behavioural issues are the criteria by which physiotherapists select the volume of implemented exercise and progression. However, no specific guidelines were followed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Maria Moutzouri
- Department of Physiotherapy, Branch Department of Aigion, Technological Educational Institute (T.E.I.) of Aigion, Aigion, 25100, Greece
| | - Nigel Gleeson
- Exercise and Rehabilitation Sciences, Queen Margaret University, Edinburgh, UK
| | - Evdokia Billis
- Department of Physiotherapy, Technological Educational Institute of Western Greece, Patras, Greece
| | - Elias Tsepis
- Physiotherapy Department, Technological Educational Institute of Western Greece, Patras, Greece
| | - John Gliatis
- Orthopaedic Department, University Hospital of Patras, Patras, Greece
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Unver B, Bakirhan S, Karatosun V. Does a weight-training exercise programme given to patients four or more years after total knee arthroplasty improve mobility: A randomized controlled trial. Arch Gerontol Geriatr 2016; 64:45-50. [PMID: 26952376 DOI: 10.1016/j.archger.2016.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 12/24/2015] [Accepted: 01/05/2016] [Indexed: 02/08/2023]
Abstract
AIM To investigate the effects of the home exercise therapy performed after at least four years postoperatively on skeletal muscle strength and functionality in patients with total knee arthroplasty (TKA). METHODS Sixty patients (age; 69.66±7.53, weight; 81.56±14.43 kg, 10 male, 50 female) followed up four or more years were randomly divided into two groups. An 8-week exercise program was designed for bilateral TKA patients. While the patients in one group were assigned to weighted exercise group, the patients in the other group were assigned to non-weighted exercise group. The primary outcome was the isometric muscle strength of quadriceps femoris (QF) and hamstring muscles assessed by Hand-Held Dynamometer. The secondary outcomes were the pain level, 30s sit-to-stand test, 10 m walk test, range of motion, and the knee function score of the Hospital for Special Surgery. The assessments were performed before and after the treatment. RESULTS After treatment, significant differences were found in all evaluation parameters (except rest pain and range of motion) in favour of the weighted group. QF muscle strength changes (kg); weighted group: 1.99±1.70, non-weighted group: 0.51±1.14 (p=0.000), 30s sit-to-stand test changes (repetitions); weighted group: 3.66±2.23, non-weighted group: 1.70±1.95 (p=0.000), 10 m walk test changes (seconds); weighted group: -2.60±1.30, non-weighted group: -0.83±3.51 (p=0.000). CONCLUSION Home exercise programs applied to TKA patients after at least four years postoperatively was effective in increasing muscle strength, decreasing severity of pain, and improving functional activities. The improvements were significantly greater in weighted compared with the non-weighted exercise group.
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Affiliation(s)
- Bayram Unver
- School of Physiotherapy and Rehabilitation, Dokuz Eylül University, Izmir 35340, Turkey.
| | - Serkan Bakirhan
- School of Health, Department of Physiotherapy and Rehabilitation, Izmir University, Izmir 35350, Turkey.
| | - Vasfi Karatosun
- Department of Orthopaedics, School of Medicine, Dokuz Eylül University, Izmir 35340, Turkey.
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López-Liria R, Padilla-Góngora D, Catalan-Matamoros D, Rocamora-Pérez P, Pérez-de la Cruz S, Fernández-Sánchez M. Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement. BIOMED RESEARCH INTERNATIONAL 2015; 2015:450421. [PMID: 25961017 PMCID: PMC4415465 DOI: 10.1155/2015/450421] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/26/2015] [Accepted: 03/08/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. MATERIALS AND METHODS A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients' functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS The groups did not significantly differ in the leg side (right/left) or clinical characteristics (P > 0.05). After the intervention, both groups showed significant improvements (P < 0.001) from the baseline values in the level of pain (visual analogue scale), the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking. CONCLUSIONS This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective.
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Affiliation(s)
- Remedios López-Liria
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
| | - David Padilla-Góngora
- Department of Psychology, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
| | | | - Patricia Rocamora-Pérez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
| | - Sagrario Pérez-de la Cruz
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
| | - Manuel Fernández-Sánchez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
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Artz N, Elvers KT, Lowe CM, Sackley C, Jepson P, Beswick AD. Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskelet Disord 2015; 16:15. [PMID: 25886975 PMCID: PMC4333167 DOI: 10.1186/s12891-015-0469-6] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/15/2015] [Indexed: 12/18/2022] Open
Abstract
Background Rehabilitation, with an emphasis on physiotherapy and exercise, is widely promoted after total knee replacement. However, provision of services varies in content and duration. The aim of this study is to update the review of Minns Lowe and colleagues 2007 using systematic review and meta-analysis to evaluate the effectiveness of post-discharge physiotherapy exercise in patients with primary total knee replacement. Methods We searched MEDLINE, Embase, PsycInfo, CINAHL and Cochrane CENTRAL to October 4th 2013 for randomised evaluations of physiotherapy exercise in adults with recent primary knee replacement. Outcomes were: patient-reported pain and function, knee range of motion, and functional performance. Authors were contacted for missing data and outcomes. Risk of bias and heterogeneity were assessed. Data was combined using random effects meta-analysis and reported as standardised mean differences (SMD) or mean differences (MD). Results Searches identified 18 randomised trials including 1,739 patients with total knee replacement. Interventions compared: physiotherapy exercise and no provision; home and outpatient provision; pool and gym-based provision; walking skills and more general physiotherapy; and general physiotherapy exercise with and without additional balance exercises or ergometer cycling. Compared with controls receiving minimal physiotherapy, patients receiving physiotherapy exercise had improved physical function at 3–4 months, SMD −0.37 (95% CI −0.62, −0.12), and pain, SMD −0.45 (95% CI −0.85, −0.06). Benefit up to 6 months was apparent when considering only higher quality studies. There were no differences for outpatient physiotherapy exercise compared with home-based provision in physical function or pain outcomes. There was a short-term benefit favouring home-based physiotherapy exercise for range of motion flexion. There were no differences in outcomes when the comparator was hydrotherapy, or when additional balancing or cycling components were included. In one study, a walking skills intervention was associated with a long-term improvement in walking performance. However, for all these evaluations studies were under-powered individually and in combination. Conclusion After recent primary total knee replacement, interventions including physiotherapy and exercise show short-term improvements in physical function. However this conclusion is based on meta-analysis of a few small studies and no long-term benefits of physiotherapy exercise interventions were identified. Future research should target improvements to long-term function, pain and performance outcomes in appropriately powered trials. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0469-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neil Artz
- Peninsula Allied Health Centre, School of Health Professions, University of Plymouth, Plymouth, PL6 8BH, UK.
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, BS10 5NB, UK.
| | | | - Cath Sackley
- King's College London, Capital House, Guy's Campus, London, SE1 3QD, UK.
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, BS10 5NB, UK.
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Asakawa Y, Jung JH, Koh SE. Neuromuscular electrical stimulation improves strength, pain and weight distribution on patients with knee instability post surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.14474/ptrs.2014.3.2.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Ji-Hye Jung
- Physical Therapy Team, Hangeoleum Rehabilitation Hospital, Seoul, Republic of Korea
| | - Si-Eun Koh
- Physical Therapy Team, Ilsan High Hospital, Goyang, Republic of Korea
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25
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TRAK ontology: Defining standard care for the rehabilitation of knee conditions. J Biomed Inform 2013; 46:615-25. [DOI: 10.1016/j.jbi.2013.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/23/2013] [Accepted: 04/25/2013] [Indexed: 11/24/2022]
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Pelland L, Brosseau L, Wells G, MacLeay L, Lambert J, Lamothe C, Robinson V, Tugwell P. Efficacy of strengthening exercises for osteoarthritis (Part I): A meta-analysis. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331904225005052] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Barker KL, Jenkins C, Pandit H, Murray D. Muscle power and function two years after unicompartmental knee replacement. Knee 2012; 19:360-4. [PMID: 21664822 DOI: 10.1016/j.knee.2011.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/21/2011] [Accepted: 05/23/2011] [Indexed: 02/02/2023]
Abstract
Unicompartmental knee replacement (UKR) is a commonly performed procedure, suitable for one in four patients requiring knee replacement for end-stage osteoarthritis. Recovery and return of function is quicker than with total knee replacement (TKR), but little information is known about the recovery of muscle power. We prospectively studied a cohort of forty four patients undergoing medial UKR to document their functional recovery and leg extensor power. Muscle power was measured using a Leg Extensor Power rig preoperatively and at 1 and 2 years after surgery. Function was self reported using the Oxford Knee Score (OKS) and Tegner Activity Scale (TAS). At 1 year all patients had made significant improvements on all functional measures, with a mean gain in OKS of 15.9 and TAS of 0.84. There were also significant increases in leg extensor power (LEP) of both legs. The mean change in LEP of the operated leg at 1 year was 0.50 W/kg and the non-operated leg was 0.10 W/kg. Between 1 and 2 years there were very slight improvements in strength in both legs, but these were not significant. Compared with healthy age matched normative values, the UKR LEP values at 2 years after surgery were decreased. The recovery of strength and function following UKR had stabilised by 1 year and during the following year further improvements were minimal.
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Affiliation(s)
- Karen L Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre NHS Trust, Oxford, OX3 7LD, UK.
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28
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Loew L, Brosseau L, Wells GA, Tugwell P, Kenny GP, Reid R, Maetzel A, Huijbregts M, McCullough C, De Angelis G, Coyle D. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Aerobic Walking Programs in the Management of Osteoarthritis. Arch Phys Med Rehabil 2012; 93:1269-85. [PMID: 22421624 DOI: 10.1016/j.apmr.2012.01.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 12/26/2011] [Accepted: 01/03/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Laurianne Loew
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
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29
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Lower limb proprioception deficits persist following knee replacement surgery despite improvements in knee extension strength. Knee Surg Sports Traumatol Arthrosc 2012; 20:1097-103. [PMID: 22005965 DOI: 10.1007/s00167-011-1710-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 10/06/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE Knee pain and disability can persist following knee replacement surgery which may place patients at increased risk of falls. This study investigated the falls risk and the occurrence of falls of people with knee osteoarthritis (OA) before and at 12 months following knee replacement surgery. METHOD Thirty-five patients with knee OA were tested prior to undergoing knee replacement surgery and at 12 months following surgery using the short form Physiological Profile Assessment, which incorporates tests of vision, lower limb proprioception, knee extension strength, reaction time and postural sway. Physical activity, number of falls, fear of falling, pain, disability and health-related quality of life were also assessed. RESULTS No significant differences were found between the number of falls pre- and post-surgery (n.s.), with 48.5 and 40% reporting at least one fall in the 12 months before and following the surgery, respectively. Improvements in knee strength, reaction time and fear of falling were evident following surgery, with no improvement in lower limb proprioception. Self-reported pain, function and stiffness were significantly improved, but health-related quality of life deteriorated following the surgery. CONCLUSION The number of falls experienced following knee replacement surgery remained relatively high, which may be attributed to the persistence of impaired lower limb proprioception. Although knee replacement surgery improves function and alleviates pain, people who undergo this procedure may need to engage in rehabilitation following the surgery to reduce the risk of falling. LEVEL OF EVIDENCE Therapeutic study investigating the result of treatment on patient outcomes, Level IV.
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30
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Majumdar SS, Luccisano M, Evans C. Perceptions of physiotherapy best practice in total knee arthroplasty in hospital outpatient settings. Physiother Can 2012; 63:234-41. [PMID: 22379264 DOI: 10.3138/ptc.2010-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The primary purpose of this study was to examine experienced physiotherapists' perceptions of best practices for patients following total knee arthroplasty (TKA) in publicly funded outpatient hospital settings in the Greater Toronto Area (GTA). The secondary objective was to identify the facilitators of and barriers to implementing best practices in the subacute phase of rehabilitation. METHODS A qualitative, descriptive, focused ethnographic approach was used to explore physiotherapists' perceptions of best practices for patients with TKA. In-depth semi-structured interviews were conducted with expert physiotherapists acting as key informants. A snowball sampling method was used to recruit physiotherapists in the GTA. Interviews were conducted in person by two of the investigators. RESULTS Physiotherapists from seven acute-care hospitals in the GTA participated in the study. Analysis of the 140 pages of transcripts from the interviews with 10 physiotherapists revealed that participants perceived best practices as encompassing the adoption of a client-centred approach; inter-professional collaboration; aggressive rehabilitation for patients who are unsuccessful in achieving their outcomes; the use of relevant outcome measures; and consideration of the impact of scarce resources on care. CONCLUSIONS The findings of this study highlight physiotherapists' perceived best practices for patients with TKA and the unique contribution that hospital-based outpatient physiotherapy can make to patients' rehabilitation.
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Affiliation(s)
- Sampa Samanta Majumdar
- Sampa Samanta Majumdar, MScPT, BScPT: Department of Physical Therapy, Faculty of Medicine, University of Toronto, Ontario
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31
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Lowe CJM, Barker KL, Holder R, Sackley CM. Comparison of postdischarge physiotherapy versus usual care following primary total knee arthroplasty for osteoarthritis: an exploratory pilot randomized clinical trial. Clin Rehabil 2011; 26:629-41. [PMID: 22180446 DOI: 10.1177/0269215511427749] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate a pilot trial of a postdischarge physiotherapy intervention to improve patient function versus usual physiotherapy in patients undergoing total knee arthroplasty aiming to assess: recruitment rate, feasibility and acceptability of the intervention and control, suitability of outcomes, retention and adverse events and to inform sample size calculation for a definitive trial. Design: Exploratory pilot randomized controlled trial using independent assessment. Setting: Mixed urban and rural, UK. Participants: Patients undergoing primary, elective unilateral knee arthroplasty for osteoarthritis. Intervention: Two additional home physiotherapy visits of functional weight-bearing exercises, functional task-specific training versus treatment as usual. Main outcome: Oxford Knee Score at 12 months. Secondary outcomes: completion rates, adverse events, Knee Injury and Osteoarthritis Outcome Score, leg extensor power, timed 10-m walk, timed sit-to-stand, resource use diaries. Assessments completed at baseline (pre-operatively), 3, 6 and 12 months. Results: Of 181 eligible participants 107 (59.1%) were randomized over 13 months, one participant withdrew, no adverse events. Intervention group n = 56 (mean age 67.8), control group n = 51 (mean age 70.8). The difference in mean change of Oxford Knee Scores between groups (intervention – control) at 12 months was 0.2 (95% confidence interval (CI) –3.8, 4.2), P = 0.94. Patient diaries revealed non-trial additional physiotherapy requires improved measurement. Conclusions: Successful recruitment and retention rates were achieved. The intervention appeared feasible and acceptable but may be suboptimal in intensity given recent research. A sample size of 1271 participants would be required for a fully powered randomized controlled trial using the main outcome. However new outcomes, potentially of greater validity and responsiveness, require consideration.
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Affiliation(s)
- Catherine J Minns Lowe
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospital NHS Trust, Oxford, UK
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham UK
| | - Karen L Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospital NHS Trust, Oxford, UK
- NIHR Musculoskeletal Biomedical Research Unit, NDORMS, University of Oxford, Oxford, UK
| | - Roger Holder
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham UK
| | - Catherine M Sackley
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham UK
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Button K, Iqbal AS, Letchford RH, van Deursen RWM. Clinical effectiveness of knee rehabilitation techniques and implications for a self-care treatment model. Physiotherapy 2011; 98:288-99. [PMID: 23122433 DOI: 10.1016/j.physio.2011.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/02/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND Physiotherapy is a complex intervention frequently recommended for knee conditions. The International Classification of Functioning and Disability (ICF) can be used as a framework to evaluate evidence to develop care models and clinical guidelines. OBJECTIVE To evaluate the clinical effectiveness of knee rehabilitation modalities categorised according to the ICF domains. DATA SOURCES A keyword search of Medline, Cinahl, Amed, Embase and Cochrane databases from 1996 to 2010 using terms related to the knee joint and physiotherapeutic interventions. STUDY SELECTION Reviewer assessment using inclusion/exclusion criteria and a quality assessment tool compiled from the Critical Appraisal Skills Programme Tool, Consort and Cochrane Bone Joint and Muscle Trauma Groups. DATA EXTRACTION Information about the research design, intervention and subjects was extracted. Outcome measures and findings were categorised according to ICF domains. DATA SYNTHESIS The majority of studies evaluated exercise. Findings were supportive but specific recommendations were limited due to variations in content and application. There was limited quality research to support the theory that manual therapy, electrotherapy or taping in isolation contributes to recovery. Multimodality physiotherapy programmes were found to be beneficial and to reflect clinical practice, but the effectiveness of each component is unknown. Outcome measures from the participation domain of the ICF were used least frequently and were not generally true measures of participation. CONCLUSION Development of participation outcome measures is required to evaluate the long-term benefits of interventions. Rehabilitation should be based around delivery of effective exercise programmes incorporating participation outcomes to provide feedback and complement self-care for knee conditions.
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Affiliation(s)
- Kate Button
- Physiotherapy Department, School of Healthcare Studies, Cardiff University, Cardiff, UK.
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Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery. Knee Surg Sports Traumatol Arthrosc 2011; 19:1082-9. [PMID: 21107530 DOI: 10.1007/s00167-010-1325-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Knee osteoarthritis (OA) is a major cause of disability and a risk factor for falls in older people. The purpose of this study was to assess the falls risk of people with knee OA before surgery and at 4 months following surgery and to compare this to a control group. METHODS Thirty-five patients with knee OA prior to undergoing knee replacement surgery and 27 asymptomatic age-matched controls participated in the study. The surgical group were tested prior to their surgery and at 4 months post-surgery. The short form of the Physiological Profile Assessment was used to assess falls risk and included tests of vision, lower limb proprioception, knee extension strength, reaction time and postural sway. Physical activity, quality of life, fear of falls and disability before and after surgery were also documented. RESULTS At least one fall in the previous 12 months was reported for 48% of the surgical group compared with 30% of the control group. Following the surgery, there was a reduction in fear of falling and pain, and improvements in function for the surgical group. However, compared to the control group, the surgical group exhibited a greater fear of falling and reduced lower limb proprioception and knee extension strength both pre- and post-surgery. CONCLUSION People who undergo knee replacement surgery may be at increased risk of falls both prior to and 4 months following their surgery, primarily due to deficits in knee extension strength and lower limb proprioception. Therefore, interventions to reduce the risk of falls should be implemented early after the surgery.
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Labraca NS, Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Sánchez-Joya MDM, Moreno-Lorenzo C. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial. Clin Rehabil 2011; 25:557-66. [DOI: 10.1177/0269215510393759] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare the benefits of initiating rehabilitation treatment within 24 hours versus 48–72 hours after total knee arthroplasty for osteoarthritis. Design: Experimental study with clinical trial design. Subjects: Patients undergoing primary total knee arthroplasty for osteoarthritis were randomly assigned to experimental (n = 153) and control (n = 153) groups. Interventions: Rehabilitation was started within 24 hours post surgery in the experimental group and between 48 hours and 72 hours post surgery in the controls. Main measures: Measurement variables included joint range of motion, muscle strength, pain, autonomy, gait and balance. Results: In comparison with the controls, the experimental group showed significantly shorter hospital stay (by (mean ± standard deviation) 2.09 ± 1.45 days; P < 0.001), fewer rehabilitation sessions until medical discharge (by 4.95 ± 2.34; P < 0.001), lesser pain (by 2.36 ± 2.47 points; P < 0.027), greater joint range of motion in flexion (by 16.29 ± 11.39 degrees; P < 0.012) and extension (by 2.12 ± 3.19; P < 0.035), improved strength in quadriceps (by 0.98 ± 0.54; P < 0.042) and hamstring muscles (by 1.05 ± 0.72; P < 0.041), and higher scores for gait (P < 0.047) and balance (P < 0.045). Conclusion: Initiation of rehabilitation within 24 hours after total knee arthroplasty reduces the mean hospital stay and number of sessions required to achieve autonomy and normal gait and balance.
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Russell TG, Buttrum P, Wootton R, Jull GA. Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2011; 93:113-20. [PMID: 21248209 DOI: 10.2106/jbjs.i.01375] [Citation(s) in RCA: 245] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee. Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function. Access to high-quality rehabilitation services is not always possible, especially for those who live in rural or remote areas. The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty. METHODS this investigation was a single-blinded, prospective, randomized, controlled noninferiority trial. Sixty-five participants were randomized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured at baseline and six weeks by a blinded independent assessor. Secondary outcomes included the Patient-Specific Functional Scale, the timed up-and-go test, pain intensity, knee flexion and extension, quadriceps muscle strength, limb girth measurements, and an assessment of gait. Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics. RESULTS baseline characteristics between groups were similar, and all participants had significant improvement on all outcome measures with the intervention (p < 0.01 for all). After the six-week intervention, participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion, muscle strength, limb girth, pain, timed up-and-go test, quality of life, and clinical gait and WOMAC scores. Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group (p < 0.05). The telerehabilitation intervention was well received by participants, who reported a high level of satisfaction with this novel technology. CONCLUSIONS the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation. LEVEL OF EVIDENCE therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Trevor G Russell
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane 4072, Australia.
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Wood LRJ, Peat GM, Mullis R, Thomas E, Foster NE. Impairment-targeted exercises for older adults with knee pain: protocol for a proof-of-principle study. BMC Musculoskelet Disord 2011; 12:2. [PMID: 21214901 PMCID: PMC3025930 DOI: 10.1186/1471-2474-12-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 01/07/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Exercise therapy for knee pain and osteoarthritis remains a key element of conservative treatment, recommended in clinical guidelines. Yet systematic reviews point to only modest benefits from exercise interventions.One reason for this might be that clinical trials tend to use a one-size-fits-all approach to exercise, effectively disregarding the details of their participants' clinical presentations. This uncontrolled before-after study (TargET-Knee-Pain) aims to test the principle that exercises targeted at the specific physical impairments of older adults with knee pain may be able to significantly improve those impairments. It is a first step towards testing the effectiveness of this more individually-tailored approach. METHODS/DESIGN We aim to recruit 60 participants from an existing observational cohort of community-dwelling older adults with knee pain. Participants will all have at least one of the three physical impairments of weak quadriceps, a reduced range of knee flexion and poor standing balance. Each participant will be asked to undertake a programme of exercises, targeted at their particular combination and degree of impairment(s), over the course of twelve weeks. The exercises will be taught and progressed by an experienced physiotherapist, with reference to a "menu" of agreed exercises for each of the impairments, over the course of six fortnightly home visits, alternating with six fortnightly telephone calls. Primary outcome measures will be isometric quadriceps strength, knee flexion range of motion, timed single-leg standing balance and the "Four Balance Test Scale" at 12 weeks. Key secondary outcome measures will be self-reported levels of pain, stiffness and difficulties with day-to-day functional tasks (WOMAC). Outcome measures will be taken at three time-points (baseline, six weeks and twelve weeks) by a study nurse blinded to the exercise status of the participants. DISCUSSION This study (TargET-Knee-Pain) is the first step towards exploring whether an impairment-targeted approach to exercise prescription for older adults with knee pain may have sufficient efficacy to warrant further testing. If warranted, future randomised clinical trials may compare this approach with more traditional one-size-fits-all exercise approaches. TRIAL REGISTRATION Current Controlled Trials ISRCTN61638364.
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Affiliation(s)
- Laurence RJ Wood
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST7 8AE, UK
| | - George M Peat
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST7 8AE, UK
| | - Ricky Mullis
- General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, IPH, Forvie Site, Robinson Way, Cambridge, Cambridgeshire, CB2 0SR, UK
| | - Elaine Thomas
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST7 8AE, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST7 8AE, UK
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Chow TPY, Ng GYF. Active, passive and proprioceptive neuromuscular facilitation stretching are comparable in improving the knee flexion range in people with total knee replacement: a randomized controlled trial. Clin Rehabil 2010; 24:911-8. [DOI: 10.1177/0269215510367992] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To compare the immediate and medium-term effects of three stretching methods on the knee flexion range in people with a total knee replacement. Design: Randomized clinical trial. Setting: Rehabilitation hospital. Subjects: 117 patients were recruited and 100 (mean age: 68.43 ± 7.95 years) of them completed the study. Interventions: Patients receiving total knee replacement due to knee osteoarthritis were randomly assigned into 3 groups of: active stretching (group 1, n =32), passive stretching (group 2, n =35) and proprioceptive neuromuscular facilitation stretching (group 3, n =33). Main measures: The immediate change in both active and passive knee flexion range after the first treatment session and the pattern of change in these ranges throughout the 2-week study period were compared among the three groups. Results: All groups demonstrated significant improvement in knee ranges with time. The active range of group 1 improved by 19.9°, group 2 by 25.3° and group 3 by 22.5° throughout the 2-week period, whereas the improvements in the passive range were 18.8°, 24.5° and 22.7°, respectively. For between-group comparisons, no significant difference was found in both active (P = 0.647) and passive (P = 0.501) knee range immediately after stretching. For the changes at 2 weeks, there was also no significant difference among the groups in both active (P = 0.716) and passive (P = 0.959) knee ranges. Conclusion: This study revealed that all three modes of stretching were associated with an increase in the knee flexion range of patients after total knee replacement, with no statistically significant differences between the changes seen.
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Affiliation(s)
- Tiffany PY Chow
- Department of Physiotherapy, Tai Po Hospital and Department of Rehabilitation Sciences, Hong Kong Polytechnic University
| | - Gabriel YF Ng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China,
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A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial. Phys Ther 2010; 90:880-94. [PMID: 20378678 PMCID: PMC2879033 DOI: 10.2522/ptj.20090150] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with total knee arthroplasty (TKA) have impaired balance and movement control. Exercise interventions have not targeted these impairments in this population. OBJECTIVES The purposes of this study were: (1) to determine the feasibility of applying a balance exercise program in patients with TKA, (2) to investigate whether a functional training (FT) program supplemented with a balance exercise program (FT+B program) could improve physical function compared with an FT program alone in a small group of individuals with TKA, and (3) to test the methods and calculate sample size for a future randomized trial with a larger study sample. DESIGN This study was a double-blind, pilot randomized clinical trial. SETTING The study was conducted in the clinical laboratory of an academic center. PARTICIPANTS The participants were 43 individuals (30 female, 13 male; mean age=68 years, SD=8) who underwent TKA 2 to 6 months prior to the study. INTERVENTIONS The interventions were 6 weeks (12 sessions) of a supervised FT or FT+B program, followed by a 4-month home exercise program. MEASUREMENTS Feasibility measures included pain, stiffness, adherence, and attrition. The primary outcome measure was a battery of physical performance tests: self-selected gait speed, chair rise test, and single-leg stance time. Secondary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index and the Lower Extremity Functional Scale. RESULTS Feasibility of the balance training in people with TKA was supported by high exercise adherence, a relatively low dropout rate, and no adverse events. Both groups demonstrated clinically important improvements in lower-extremity functional status. The degree of improvement seemed higher for gait speed, single-leg stance time, and stiffness in the FT+B group compared with the FT group. LIMITATIONS Due to the pilot nature of the study, differences between groups did not have adequate power to show statistical significance. CONCLUSIONS There is a need for conducting a larger randomized controlled trial to test the effectiveness of an FT+B program after TKA.
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Bezalel T, Carmeli E, Katz-Leurer M. The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: a parallel randomised single-blind clinical trial. Physiotherapy 2010; 96:137-43. [PMID: 20420960 DOI: 10.1016/j.physio.2009.09.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 09/11/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme. DESIGN A parallel randomised single-blind clinical trial. PARTICIPANTS Fifty patients aged 65 years or over with knee osteoarthritis. INTERVENTIONS The study group (n=25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n=25) were given a brief course in short-wave diathermy treatment. MAIN OUTCOME MEASURES Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test. RESULTS At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) -12.3 to -6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was -9.0 points (95%CI -14.5 to -3.4). CONCLUSION A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.
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Affiliation(s)
- Tomer Bezalel
- Sackler Faculty of Medicine, Stanely Steyer School of Health Professions, Physical Therapy Department, Tel-Aviv University, Ramat-Aviv, Israel
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Monaghan B, Caulfield B, O'Mathúna DP. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement. Cochrane Database Syst Rev 2010; 2010:CD007177. [PMID: 20091621 PMCID: PMC7211999 DOI: 10.1002/14651858.cd007177.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Total knee replacement has been demonstrated to be one of the most successful procedures in the treatment of osteoarthritis. However quadriceps weakness and reductions in function are commonly reported following surgery. Recently Neuromuscular Electrical Stimulation (NMES) has been used as an adjunct to traditional strengthening programmes. This review considers the effectiveness of NMES as a means of increasing quadriceps strength in patients before and after total knee replacement. OBJECTIVES To assess the effectiveness of NMES as a means of improving quadriceps strength before and after total knee replacement. SEARCH STRATEGY We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to January week 1 2008), EMBASE (1980 to 2008 week 2), Cumulative Index to Nursing and Allied Health Literature (CINAHL)(1982 to 2007/11), AMED (1985 to Jan 2008), Web of Science, and Pedro (Jan 2008) (http://www.pedro.fhs.usyd.edu.au/index.html) for randomised controlled trials and controlled clinical trials. The electronic search was complimented by hand searches and experts in the area and companies supplying NMES equipment were also contacted. SELECTION CRITERIA Randomised controlled trials and controlled clinical trials were accepted that used NMES for the purpose of quadriceps strengthening either pre or post total knee replacement. DATA COLLECTION AND ANALYSIS Two review authors decided which studies were suitable for inclusion based on the inclusion and exclusion criteria in the protocol and the data was extracted using pre-developed data extraction forms. Two review authors (BM and BC) independently assessed the methodological quality of the included trials using a descriptive approach as advocated by the Musculoskeletal group. Only two studies were included in the review. Neither study presented results in a form suitable for meta-analysis. The authors of both studies were contacted to obtain the raw data but they were no longer available.The data from both studies are described in the review. MAIN RESULTS Two studies were identified for inclusion in the review. No significant differences were reported in either study for maximum voluntary isometric torque or endurance between the NMES group and the control group but significantly better quadriceps muscle activation was reported in the exercise and neuromuscular stimulation group compared with the exercise group alone in the second study. This difference was significant at the mid training (six week) time point but not at the twelfth week post training time point. Further analysis of both studies were not possible due to the absence of raw data scores. Both studies carried a high risk of bias. Mean values were not given for strength, endurance, cross sectional area or quality of life. Pain outcomes, patient satisfaction or adverse effects were not reported in either study. The results were presented as percentage improvements from baseline and the number of subjects in each group was unclear. AUTHORS' CONCLUSIONS The studies found in this review do not permit any conclusions to be made about the application of neuromuscular stimulation for the purposes of quadriceps strengthening before or after total knee replacement. At this time the evidence for the use of neuromuscular stimulation for the purposes of quadriceps strengthening in this patient group is unclear.
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Affiliation(s)
| | - Brian Caulfield
- UCDPhysiotherapy and performance ScienceUCD School of Physiotherapy and Performance ScienceHealth Science Centre, Belfield, UCDDublinIreland
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Minns Lowe CJ, Barker KL, Dewey ME, Sackley CM. Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials. BMC Musculoskelet Disord 2009; 10:98. [PMID: 19653883 PMCID: PMC2734755 DOI: 10.1186/1471-2474-10-98] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 08/04/2009] [Indexed: 11/10/2022] Open
Abstract
Background Physiotherapy has long been a routine component of patient rehabilitation following hip joint replacement. The purpose of this systematic review was to evaluate the effectiveness of physiotherapy exercise after discharge from hospital on function, walking, range of motion, quality of life and muscle strength, for osteoarthritic patients following elective primary total hip arthroplasty. Methods Design: Systematic review, using the Cochrane Collaboration Handbook for Systematic Reviews of Interventions and the Quorom Statement. Database searches: AMED, CINAHL, EMBASE, KingsFund, MEDLINE, Cochrane library (Cochrane reviews, Cochrane Central Register of Controlled Trials, DARE), PEDro, The Department of Health National Research Register. Handsearches: Physiotherapy, Physical Therapy, Journal of Bone and Joint Surgery (Britain) Conference Proceedings. No language restrictions were applied. Selection: Trials comparing physiotherapy exercise versus usual/standard care, or comparing two types of relevant exercise physiotherapy, following discharge from hospital after elective primary total hip replacement for osteoarthritis were reviewed. Outcomes: Functional activities of daily living, walking, quality of life, muscle strength and range of hip joint motion. Trial quality was extensively evaluated. Narrative synthesis plus meta-analytic summaries were performed to summarise the data. Results 8 trials were identified. Trial quality was mixed. Generally poor trial quality, quantity and diversity prevented explanatory meta-analyses. The results were synthesised and meta-analytic summaries were used where possible to provide a formal summary of results. Results indicate that physiotherapy exercise after discharge following total hip replacement has the potential to benefit patients. Conclusion Insufficient evidence exists to establish the effectiveness of physiotherapy exercise following primary hip replacement for osteoarthritis. Further well designed trials are required to determine the value of post discharge exercise following this increasingly common surgical procedure.
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Affiliation(s)
- Catherine J Minns Lowe
- Department of Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
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Moreno Palacios JA, Cátedra Vallés E, Plazas Andreu N, Sancho Loras R, Manjón-Cabezas Subirats J, Mozo Muriel A. [Comparative results of total knee arthroplasty according to age]. Rev Esp Geriatr Gerontol 2009; 44:120-3. [PMID: 19443085 DOI: 10.1016/j.regg.2008.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 10/29/2008] [Accepted: 10/29/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Surgical treatment of osteoarthritis with total knee arthroplasty (TKA) has become a routine technique in patients of "almost" any age. The aim of the present study was to compare the results of TKA according to patient age. MATERIAL AND METHODS A prospective study was performed in 112 patients with osteoarthritis who underwent TKA from March 1st, 2007 through May 31st, 2007. There were two groups; the first comprised 61 patients aged 65- to 75-years-old and the second included 51 patients aged 76- to 85-years-old. Sociodemographic data and health system use were evaluated. The results were evaluated by using the Hospital Special Surgery (HSS) scale, the SF-36 health survey questionnaire, the visual analogue scale (VAS) for pain, and joint measurement with manual goniometrics. The patients were evaluated before surgery and at 6 months after surgery. RESULTS No significant differences were observed between the two groups. Complications and length of hospital stay were similar in both groups. A greater proportion of older patients were referred to a rehabilitation hospital but this difference was not statistically significant. CONCLUSIONS The results of the present study were similar to those of other studies that found that greater age does not lead to worse functional results.
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Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: A randomized, single-blind trial. ACTA ACUST UNITED AC 2009; 61:184-91. [DOI: 10.1002/art.24420] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Fischer HBJ, Simanski CJP, Sharp C, Bonnet F, Camu F, Neugebauer EAM, Rawal N, Joshi GP, Schug SA, Kehlet H. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 2008; 63:1105-23. [PMID: 18627367 DOI: 10.1111/j.1365-2044.2008.05565.x] [Citation(s) in RCA: 230] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The PROSPECT Working Group, a collaboration of anaesthetists and surgeons, conducts systematic reviews of postoperative pain management for different surgical procedures (http://www.postoppain.org). Evidence-based consensus recommendations for the effective management of postoperative pain are then developed from these systematic reviews, incorporating clinical practice observations, and transferable evidence from other relevant procedures. We present the results of a systematic review of pain and other outcomes following analgesic, anaesthetic and surgical interventions for total knee arthroplasty (TKA). The evidence from this review supports the use of general anaesthesia combined with a femoral nerve block for surgery and postoperative analgesia, or alternatively spinal anaesthesia with local anaesthetic plus spinal morphine. The primary technique, together with cooling and compression techniques, should be supplemented with paracetamol and conventional non-steroidal anti-inflammatory drugs or COX-2-selective inhibitors, plus intravenous strong opioids (high-intensity pain) or weak opioids (moderate- to low-intensity pain).
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Affiliation(s)
- H B J Fischer
- Department of Anaesthesia, Alexandra Hospital, Redditch, UK.
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Juhakoski R, Tenhonen S, Anttonen T, Kauppinen T, Arokoski JP. Factors Affecting Self-Reported Pain and Physical Function in Patients With Hip Osteoarthritis. Arch Phys Med Rehabil 2008; 89:1066-73. [PMID: 18503801 DOI: 10.1016/j.apmr.2007.10.036] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 09/20/2007] [Accepted: 10/14/2007] [Indexed: 11/26/2022]
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Khan F, Ng L, Gonzalez S, Hale T, Turner-Stokes L. Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev 2008; 2008:CD004957. [PMID: 18425906 PMCID: PMC8859927 DOI: 10.1002/14651858.cd004957.pub3] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Joint replacements are common procedures and treatment of choice for those with intractable joint pain and disability arising from arthropathy of the hip or knee. Multidisciplinary rehabilitation is considered integral to the outcome of joint replacement. OBJECTIVES To assess the evidence for effectiveness of multidisciplinary rehabilitation on activity and participation in adults following hip or knee joint replacement for chronic arthropathy. SEARCH STRATEGY We searched the Cochrane Musculoskeletal Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL up to September 2006. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared organised multidisciplinary rehabilitation with routine services following hip or knee replacement, and included outcome measures of activity and participation in accordance with the International Classification of Functioning, Health and Disability (ICF). DATA COLLECTION AND ANALYSIS Four authors independently extracted data and assessed methodological quality of included trials. MAIN RESULTS Five trials (619 participants) met the inclusion criteria; two addressed inpatient rehabilitation (261 participants) and three (358 participants) home-based settings. There were no trials addressing outpatient centre-based programmes. Pooling of data was not possible due to differences in study design and outcomes used. Methodological assessment showed all trials were of low quality. For inpatient settings early commencement of rehabilitation and clinical pathways led to more rapid attainment of functional milestones (disability) (Functional Independence Measure (FIM) transfer WMD 0.5, 95% CI 0.15, 0.85, number needed to treat to benefit (NNTB) = 6, FIM ambulation WMD 1.55 (95%CI 0.96, 2.14), NNTB = 3), shorter hospital stay, fewer post-operative complications and reduced costs in the first three to four months. Home-based multidisciplinary care improved functional gain (Oxford Hip Score (OHS) WMD at 6 months -7.00 (95%CI -10.36, -3.64), NNT = 2 and quality of life (QoL) and reduced hospital stay in the medium term (six months). No trials addressed longer-term outcomes following hip replacement only. AUTHORS' CONCLUSIONS Based on the heterogeneity and the low quality of the included trials that precluded pooled meta-analysis, there is silver level evidence that following hip or knee joint replacement, early multidisciplinary rehabilitation can improve outcomes at the level of activity and participation. The optimal intensity, frequency and effects of rehabilitation over a longer period and associated social costs need further study. Future research should focus on improving methodological and scientific rigour of clinical trials, and use of standardised outcome measures, so that results can be pooled for statistical analysis.
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Affiliation(s)
- F Khan
- University of Melbourne, Department of Rehabilitation Medicine, Poplar Road, Parkville, Melbourne, Victoria, Australia, 3052.
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Genêt F, Mascard E, Coudeyre E, Revel M, Rannou F. Intérêt d'une prescription de kinésithérapie ambulatoire à la sortie du service de chirurgie après la pose d'une prothèse totale de genou? Élaborations de recommandations françaises pour la pratique clinique. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.annrmp.2007.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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The benefits of ambulatory physiotherapy for patients able to leave the surgery department directly for home just after total knee replacement. Development of French guidelines for clinical practice. ACTA ACUST UNITED AC 2007; 50:793-801, 783-92. [DOI: 10.1016/j.annrmp.2007.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 10/02/2007] [Indexed: 11/24/2022]
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Abstract
Acupuncture has no additional benefit in people taking a course of exercise
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50
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Franklin PD, McLaughlin J, Boisvert CB, Li W, Ayers DC. Pilot study of methods to document quantity and variation of independent patient exercise and activity after total knee arthroplasty. J Arthroplasty 2006; 21:157-63. [PMID: 16950079 DOI: 10.1016/j.arth.2006.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 05/01/2006] [Indexed: 02/06/2023] Open
Abstract
Variation in patients' independent exercise and activity after total knee arthroplasty (TKA) surgery may contribute to variable functional gains but have never been quantified. We pilot tested daily exercise logs and step activity monitors to quantify exercise and general home activity post-TKA. Patients successfully maintained logs and wore activity monitors. Logs documented significant variation in quantity of daily exercises. Women with poor emotional health recorded fewer repetitions and greater variation. More daily exercise repetitions correlated with larger 6-month functional improvement. Activity peaks on step monitors correlated with logged exercise sessions. However, most step activity was in addition to exercise sessions. Further research is needed to validate these findings and to clarify the relationship among post-TKA exercise, activity, and functional gain.
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Affiliation(s)
- Patricia D Franklin
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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