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Latijnhouwers DAJM, Hoogendoorn KG, Nelissen RGHH, Putter H, Vliet Vlieland TPM, Gademan MGJ. Adherence to the Dutch recommendation for physical activity: prior to and after primary total hip and knee arthroplasty. Disabil Rehabil 2024; 46:2862-2870. [PMID: 37496462 DOI: 10.1080/09638288.2023.2237409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To determine the course of adherence to physical activity (PA) recommendation in hip/knee osteoarthritis patients before and after hip/knee arthroplasty (THA/TKA). Moreover, we explored predictors for non-adherence 12 months postoperatively. MATERIALS AND METHODS Primary THA/TKA were included in a multicenter observational study. Preoperatively and 6/12 months postoperatively, patients reported engagement in moderate-intensity PA in days/week in the past 6 months (PA-recommendation (≥30 min of moderate-intensity ≥5 days/week)). We included predictors stratified by preoperative adherence: sex, age, BMI, comorbidities, smoking, living/working status, season, mental health, HOOS/KOOS subscales before and 6 months postoperatively, and 6-month adherence. RESULTS (1005 THA/972 TKA) Preoperatively, 50% of the population adhered. Adherence increased to 59% at 6 and 12 months. After 12 months, most patients remained at their preoperative PA level, 11% of the preoperative adherers decreased, while 20% of the preoperative non-adherers increased their PA level. In all different groups, adherence to the PA recommendation at 6 months was identified as a predictor (OR-range: 0.16-0.29). In addition, BMI was identified as predictor in the THA adherent (OR = 1.07; 95%CI [1.02-1.15]) and TKA non-adherent groups (OR = 1.08; 95%CI [1.03-1.12]). THA non-adherent group not having paid work (OR = 0.53; 95%CI [0.33-0.85]), and in the TKA adherent group, lower KOOS subscale symptoms (OR = 1.03; 95%CI [1.01-1.05]) were associated with non-adherence. CONCLUSIONS Majority of patients remained at their preoperative PA level. Non-adherence at 6 months was highly predictive for 12-month non-adherence.Implications for rehabilitationPhysical activity (PA) is crucial to decrease mortality risk, especially among patients suffering from osteoarthritis, as these patients have the potential to become more physically active after arthroplasty surgery.We found that physical function and pain improved, but 69% of the patients remained at their preoperative PA level, while 11% decreased and 20% increased their PA levels.Using this information shortly after surgery, orthopedic surgeons and other health care professionals can address patients at risk for decreased PA levels and provide PA advice.
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Affiliation(s)
| | | | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Liu N, Liu G, Chang X, Xu Y, Hou Y, Zhang D, Wang L, Chen S. Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1361037. [PMID: 38562427 PMCID: PMC10984270 DOI: 10.3389/fneur.2024.1361037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This study aims to evaluate the efficacy and safety of various acupuncture treatments in conjunction with multimodal analgesia (MA) for managing postoperative pain and improving knee function in patients undergoing total knee arthroplasty (TKA), based on the findings from clinical research indicating the potential benefits of acupuncture-related therapies in this context. Methods We searched Web of Science, PubMed, SCI-hub, Embase, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) to collect randomized controlled trials of acupuncture-related therapies for post-TKA pain. After independent screening and data extraction, the quality of the included literature was evaluated. The potential for bias in the studies incorporated in the analysis was assessed according to the guidelines outlined in the Cochrane Handbook 5.1. Network meta-analysis (NMA) was conducted using RevMan 5.4 and Stata 16.0 software, with primary outcome measures including visual analog scale (VAS), pain pressure threshold (PPT), hospital for special surgery knee score (HSS), and knee joint range of motion (ROM). Furthermore, the interventions were ranked based on the SUCRA value. Results We conducted an analysis of 41 qualifying studies encompassing 3,003 patients, examining the efficacy of four acupuncture therapies (acupuncture ACU, electroacupuncture EA, transcutaneous electrical acupoint stimulation TEAS, and auricular acupoint therapy AAT) in conjunction with multimodal analgesia (MA) and MA alone. The VAS results showed no significant difference in efficacy among the five interventions for VAS-3 score. However, TEAS+MA (SMD: 0.67; 95%CI: 0.01, 1.32) was more effective than MA alone for VAS-7 score. There was no significant difference in PPT score among the three interventions. ACU + MA (SMD: 6.45; 95%CI: 3.30, 9.60), EA + MA (SMD: 4.89; 95%CI: 1.46, 8.32), and TEAS+MA (SMD: 5.31; 95%CI: 0.85, 9.78) were found to be more effective than MA alone for HSS score. For ROM score, ACU + MA was more efficacious than EA + MA, TEAS+MA, and AAT + MA, MA. Regarding the incidence of postoperative adverse reactions, nausea and vomiting were more prevalent after using only MA. Additionally, the incidence of postoperative dizziness and drowsiness following ACU + MA (OR = 4.98; 95%CI: 1.01, 24.42) was observed to be higher compared to that after AAT + MA intervention. Similarly, the occurrence of dizziness and drowsiness after MA was found to be significantly higher compared to the following interventions: TEAS+MA (OR = 0.36; 95%CI: 0.18, 0.70) and AAT + MA (OR = 0.20; 95%CI: 0.08, 0.50). The SUCRA ranking indicated that ACU + MA, EA + MA, TEAS+MA, and AAT + MA displayed superior SUCRA scores for each outcome index, respectively. Conclusion For the clinical treatment of post-TKA pain, acupuncture-related therapies can be selected as a complementary and alternative therapy. EA + MA and TEAS+MA demonstrate superior efficacy in alleviating postoperative pain among TKA patients. ACU + MA is the optimal choice for promoting postoperative knee joint function recovery in TKA patients. AAT + MA is recommended for preventing postoperative adverse reactions. Systematic review registration https://www.crd.york.ac.uk/, identifier (CRD42023492859).
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Affiliation(s)
- Ningning Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- School of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Gaihong Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaoli Chang
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yingxue Xu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yi Hou
- School of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Dongbin Zhang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lianzhu Wang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Shaozong Chen
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Redfern RE, Crawford DA, Lombardi AV, Tripuraneni KR, Van Andel DC, Anderson MB, Cholewa JM. Outcomes Vary by Pre-Operative Physical Activity Levels in Total Knee Arthroplasty Patients. J Clin Med 2023; 13:125. [PMID: 38202132 PMCID: PMC10780185 DOI: 10.3390/jcm13010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA.
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Affiliation(s)
| | - David A. Crawford
- Joint Implant Surgeons, Inc., New Albany, OH 43054, USA; (D.A.C.); (A.V.L.J.)
| | - Adolph V. Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH 43054, USA; (D.A.C.); (A.V.L.J.)
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Pellegrini CA, Brown D, DeVivo KE, Lee J, Wilcox S. Promoting physical activity via physical therapist following knee replacement: A pilot randomized controlled trial. PM R 2023; 15:965-975. [PMID: 36106651 PMCID: PMC11210327 DOI: 10.1002/pmrj.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/13/2022] [Accepted: 08/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Outpatient physical therapy may be an opportune time to promote aerobic physical activity after knee replacement; however, it is unknown if it is feasible to integrate a physical activity intervention within standard physical therapy. OBJECTIVE To examine the feasibility and acceptability of a physical activity intervention delivered within outpatient physical therapy for adults after knee replacement. METHODS As part of a cluster randomized trial, adults with knee replacement starting outpatient physical therapy were recruited across four physical therapy sites. Sites were randomized and physical therapists delivered either an enhanced physical activity intervention or a control condition. The enhanced physical activity intervention consisted of standard postoperative physical therapy plus goal setting, problem-solving, and use of motivational interviewing techniques to promote 150 minutes/week of aerobic moderate intensity physical activity. The control group received standard postoperative physical therapy only. Feasibility and acceptability were determined based on recruitment and retention rates at 12 weeks after surgery. Outcomes including objectively measured physical activity, pain, and self-reported function were examined at the baseline postoperative visit and 12 weeks later. RESULTS Thirty-three percent of candidates screened were randomized (n = 45) and retention at 12 weeks after surgery was 91% (no difference by condition). Moderate-intensity activity increased, pain decreased, and self-reported function improved, but there were no statistically significant group differences between baseline and 12 weeks. CONCLUSION Implementing a physical activity intervention within outpatient physical therapy for adults after knee replacement is feasible; however, in this pilot study, changes were not observed in moderate intensity physical activity as compared to standard postoperative physical therapy. Future studies are needed to explore additional low-cost strategies and the optimal time to promote physical activity after knee replacement.
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Affiliation(s)
- Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Debbie Brown
- Prisma Health Orthopedics, Columbia, South Carolina, USA
| | - Katherine E DeVivo
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Effect of combined exercise training and behaviour change counselling versus usual care on physical activity in patients awaiting hip and knee arthroplasty: A randomised controlled trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100308. [DOI: 10.1016/j.ocarto.2022.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022] Open
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Predictors of Adherence to a Step Count Intervention Following Total Knee Replacement: An Exploratory Cohort Study. J Orthop Sports Phys Ther 2022; 52:620-629. [PMID: 35802816 DOI: 10.2519/jospt.2022.11133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore the person-level predictors of adherence to a step count intervention following total knee replacement (TKR). DESIGN Prospective cohort study, nested within the PATHway trial. METHODS Participants who had recently undergone TKR were recruited from 3 rehabilitation hospitals in Sydney, Australia, for the main trial. Only data from participants who were randomized to the TKR intervention group were analyzed. Participants in the intervention group (n = 51) received a wearable tracker to monitor the number of steps taken per day. Step count adherence was objectively measured at 3 months as the number of steps completed divided by the number prescribed and multiplied by 100 to express adherence as a percentage. Participants were classified into 4 groups: withdrawal, low adherence (0%-79%), adherent (80%-100%), and >100% adherent. Ordinal logistic regression was used to identify which factors predicted adherence to the prescribed step count. RESULTS Of the 51 participants enrolled, nine (18% of 51) withdrew from the study before 3 months. Half of participants were classified as >100% adherent (n = 24%, 47%). Ten were classified as low adherence (20%), and 8 participants were classified as adherent (16%). In the univariable model, lower age (OR 0.90; 95% CI 0.83-0.97), higher patient activation (OR 1.03; 95% CI 1.00-1.06), and higher technology self-efficacy (OR 1.03; 95% CI 1.00-1.06) were associated with higher adherence. After adjusting for age in the multivariable model, patient activation and technology self-efficacy were not significant. CONCLUSION Younger age, higher patient activation, and higher technology self-efficacy were associated with higher adherence to a step count intervention following TKR in the univariable model. Patient activation and technology self-efficacy were not associated with higher adherence following adjustment for age. J Orthop Sports Phys Ther 2022;52(9):620-629. Epub: 9 July 2022. doi:10.2519/jospt.2022.11133.
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Hodges A, Harmer AR, Dennis S, March L, Crawford R, Parker D. Prevalence and determinants of physical activity, sedentary behaviour and fatigue five years after total knee replacement. Clin Rehabil 2022; 36:1524-1538. [PMID: 35861777 DOI: 10.1177/02692155221113909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence and predictors of physical activity, sedentary behaviour and fatigue five years after total knee replacement surgery. DESIGN A longitudinal cohort study. SETTING Community-dwelling adults who had previously undergone total knee replacement. METHODS Five-year follow-up questionnaire data were obtained from participants previously enrolled in a randomised controlled trial examining rehabilitation after total knee replacement. Main study outcomes at one year did not differ between randomisation groups, hence data were pooled for the present longitudinal analysis. Before and one and five years after surgery, participants completed questionnaires (Active Australia Survey, WOMAC, SF12 v2, demographics and fatigue). RESULTS 272/422 community-dwelling adults (45-74 years) completed the questionnaires at five years. Excessive sedentary behaviour was evident in 91% of the cohort, predicted by excessive sedentary behaviour and lack of energy at one year. Inadequate physical activity at five years was evident for 59% of the cohort, predicted by higher fatigue and comorbidity scores pre-surgery and inadequate physical activity at one year. Just under half (47%) of the cohort experienced clinically-important fatigue at five years, predicted by clinically-important fatigue before and one year after surgery, lack of sleep before surgery and physical activity one year after surgery. CONCLUSION Documenting physical activity, sedentary behaviour and fatigue before and one year after knee replacement is important to identify those at risk of longer-term inadequate physical activity, excessive sedentary behaviour and clinically-important fatigue. Interventions to maintain activity and reduce sedentary behaviour are needed to reap the potential health benefits of total knee replacement surgery.
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Affiliation(s)
- Alison Hodges
- Department of Physiotherapy, 6078Australian Catholic University, North Sydney, New South Wales, Australia
| | - Alison R Harmer
- Faculty of Medicine and Health, 153399University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Dennis
- University of Sydney, Camperdown, New South Wales, Australia.,South Western Sydney Local Health District, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Lyn March
- University of Sydney and North Shore Hospital, Sydney, New South Wales, Australia
| | - Ross Crawford
- Department of Orthopaedic Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
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Alfatafta H, Alfatafta M, Onchonga D, Hammoud S, Khatatbeh H, Zhang L, Boncz I, Lohner S, Molics B. Effect of the knee replacement surgery on activity level based on ActivPAL: a systematic review and meta-analysis study. BMC Musculoskelet Disord 2022; 23:576. [PMID: 35705950 PMCID: PMC9199222 DOI: 10.1186/s12891-022-05531-2] [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: 01/14/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background The knee replacement (KR) surgery aims to restore the activity level and reduce the risk of experiencing disabilities. The outcomes of this surgery are evaluated mainly with subjective tools or low validity objective tools. However, the effect of the surgery on activity level using high validity objective accelerometer is still in question. Methods A systematic review and meta-analysis were conducted to evaluate the benefit of KR surgery alone to enhance physical activity recommendations based on high validity accelerometer. Two independent reviewers evaluated five electronic databases (Cochrane-Central-Register-of-Controlled Trials, EMBASE, PubMed, Web of Science, and Scopus) to find relative studies between January 2000 and October 2021. The quality assessments and risk of bias assessments were examined. Results Three articles were included with 202 participants (86 males, 116 females), with an average age of 64 years and an average 32 kg/m2 body mass index. The results found that the number of steps was significantly improved up to 36.35 and 45.5% after 6-months and 1-year of the surgery, respectively. However, these changes did not meet the recommended activity level guideline and could be related to the patients’ health status and their activity level before the surgery. No significant changes were seen in sedentary time, standing time, and upright time after 6-months and 1-year follow-ups. Heterogeneity among studies was low to moderate (0–63%). Conclusion Knee replacement surgery is an effective treatment for improving patients’ quality of life with severe knee injuries. However, various factors impact the success of surgical and achieving maximum benefit of the surgery. One factor, sedentary time, can be reduced by implementing pre-and post-surgery exercise or physical activity recommendations. Further studies are needed to understand the benefit of surgery with or without rehabilitation assessed using high validity monitors. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05531-2.
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Affiliation(s)
- Huda Alfatafta
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621, Vörösmartyutca 4, Pécs, Hungary.
| | - Mahmoud Alfatafta
- Orthotics and Prosthetics Department, Rehabilitation Sciences School, University of Jordan, Amman, Jordan
| | - David Onchonga
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621, Vörösmartyutca 4, Pécs, Hungary
| | - Sahar Hammoud
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621, Vörösmartyutca 4, Pécs, Hungary
| | - Haitham Khatatbeh
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621, Vörösmartyutca 4, Pécs, Hungary
| | - Lu Zhang
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621, Vörösmartyutca 4, Pécs, Hungary
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pecs, Pécs, Hungary
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Molics
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pecs, Pécs, Hungary
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Patients' perceived walking abilities, daily-life gait behavior and gait quality before and 3 months after total knee arthroplasty. Arch Orthop Trauma Surg 2022; 142:1189-1196. [PMID: 33956227 PMCID: PMC9110478 DOI: 10.1007/s00402-021-03915-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/13/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Functional outcome and patients' daily-life activities after total knee arthroplasty are becoming more important with a younger and more active patient population. In addition to patient-reported outcome measures (PROMs), trunk-based accelerometry has shown to be a promising method for evaluating gait function after total knee arthroplasty. The aim of this study was to evaluate daily-life perceived walking abilities, gait behavior and gait quality before and 3 months after total knee arthroplasty, using PROMs and trunk-based accelerometry. MATERIALS AND METHODS A cohort of 38 patients completed questionnaires including the Oxford Knee Score and modified Gait Efficacy Scale before and 3 months after primary unilateral total knee arthroplasty. At both time points, they wore a tri-axial accelerometer at the lower back for seven consecutive days and nights. Gait behavior was calculated using gait quantity and walking speed, and multiple gait quality parameters were calculated. RESULTS Significant improvements were seen after 3 months in the Oxford Knee Score [median (interquartile range) 29 (10) vs 39 (8), p < 0.001] and modified Gait Efficacy Scale [median (interquartile range) 67 (24) vs 79 (25), p = 0.001]. No significant changes were observed in gait behavior (quantity and speed) or gait quality variables. CONCLUSIONS In contrast to the significant improvements in patients' perception of their walking abilities and PROMs, patients did not show improvements in gait behavior and gait quality. This implies that after 3 months patients' perceived functional abilities after total knee arthroplasty do not necessarily represent their actual daily-life quantity and quality of gait, and that more focus is needed on postoperative rehabilitation to improve gait and functional behavior.
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Objectively Measured Physical Activity, Sedentary Behavior and Functional Performance before and after Lower Limb Joint Arthroplasty: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10245885. [PMID: 34945181 PMCID: PMC8709318 DOI: 10.3390/jcm10245885] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 12/29/2022] Open
Abstract
Patients after joint arthroplasty tend to be less physically active; however, studies measuring objective physical activity (PA) and sedentary behavior (SB) in these patients provide conflicting results. The aim of this meta-analysis was to assess objectively measured PA, SB and performance at periods up to and greater than 12 months after lower limb arthroplasty. Two electronic databases (PubMed and Medline) were searched to identify prospective and cross-sectional studies from 1 January 2000 to 31 December 2020. Studies including objectively measured SB, PA or specific performance tests in patients with knee or hip arthroplasty, were included in the analyses both pre- and post-operatively. The risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN). After identification and exclusion, 35 studies were included. The data were analyzed using the inverse variance method with the random effects model and expressed as standardized mean difference and corresponding 95% confidence intervals. In total, we assessed 1943 subjects with a mean age of 64.9 (±5.85). Less than 3 months post-operative, studies showed no differences in PA, SB and performance. At 3 months post-operation, there was a significant increase in the 6 min walk test (6MWT) (SMD 0.65; CI: 0.48, 0.82). After 6 months, changes in moderate to vigorous physical activity (MVPA) (SMD 0.33; CI: 0.20, 0.46) and the number of steps (SMD 0.45; CI: 0.34, 0.54) with a large decrease in the timed-up-and-go test (SMD −0.61; CI: −0.94, −0.28) and increase in the 6MWT (SMD 0.62; CI: 0.26–0.98) were observed. Finally, a large increase in MVPA (SMD 0.70; CI: 0.53–0.87) and a moderate increase in step count (SMD 0.52; CI: 0.36, 0.69) were observed after 12 months. The comparison between patients and healthy individuals pre-operatively showed a very large difference in the number of steps (SMD −1.02; CI: −1.42, −0.62), but not at 12 months (SMD −0.75; −1.89, 0.38). Three to six months after knee or hip arthroplasty, functional performance already exceeded pre-operative levels, yet PA levels from this time period remained the same. Although PA and functional performance seemed to fully restore and exceed the pre-operation levels at six to nine months, SB did not. Moreover, PA remained lower compared to healthy individuals even longer than twelve months post-operation. Novel rehabilitation protocols and studies should focus on the effects of long-term behavioral changes (increasing PA and reducing SB) as soon as functional performance is restored.
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Hylkema TH, Brouwer S, Kooijman CM, De Vries AJ, Breukelman F, Dekker H, Almansa J, Kuijer PPFM, Bulstra SK, Stevens M. Accelerometer Measured Sedentary and Physical Activity Behaviors of Working Patients after Total Knee Arthroplasty, and their Compensation Between Occupational and Leisure Time. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:350-359. [PMID: 32946009 PMCID: PMC8172507 DOI: 10.1007/s10926-020-09924-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose Objective measurements of sedentary and physical activity (PA) behavior are scarce among working-age patients who undergo total knee arthroplasty (TKA). Aim was to assess sedentary and PA behaviors using accelerometers and to identify compensation effects between occupational and leisure time of sedentary and PA behavior. Methods One year post-TKA, 51 patients wore an ActiGraph(GT3x) accelerometer for 7 days. Sedentary time, prolonged sedentary bouts (≥ 30 min) and PA (light-intensity and moderate-to-vigorous PA) were examined. Compliance with the guideline of > 150 min moderate-to-vigorous PA per week was calculated. Compensation effects were analyzed using multilevel models, splitting effects into routine and within-day compensation, stratifying by physical and non-physical jobs. The routine compensation effects are the ones of interest, representing habitual compensation during a week. Results Participants spent 60% of time in sedentary bouts and 17% in prolonged sedentary bouts, with 37% of PA spent in light-intensity and 3% in moderate-to-vigorous activity. About 70% of patients met the PA guideline. Routine compensation effects were found for workers in physical jobs, who compensated for their occupational light-intensity PA with less light-intensity PA during leisure time. Workers in non-physical jobs did not compensate for their occupational prolonged sedentary bouts, as these continued during leisure time. Conclusion This study showed that working TKA patients are highly sedentary 1 year after surgery, but most met the PA guideline. Especially those with non-physical jobs do not compensate for their occupational prolonged sedentary bouts. This stresses the need to stimulate PA among TKA patients not complying with the guidelines and those with non-physical jobs.
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Affiliation(s)
- T H Hylkema
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - S Brouwer
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Kooijman
- Department of Orthopedics, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - A J De Vries
- Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - F Breukelman
- Department of Orthopedics, Wilhelmina Hospital Assen, Assen, The Netherlands
| | - H Dekker
- Department of Orthopedics, Ommelander Ziekenhuishuisgroep Delfzijl, Delfzijl, The Netherlands
| | - J Almansa
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P P F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S K Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - M Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
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Pellegrini CA, Lee J, DeVivo KE, Harpine CE, Del Gaizo DJ, Wilcox S. Reducing sedentary time using an innovative mHealth intervention among patients with total knee replacement: Rationale and study protocol. Contemp Clin Trials Commun 2021; 22:100810. [PMID: 34195473 PMCID: PMC8239442 DOI: 10.1016/j.conctc.2021.100810] [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: 09/24/2020] [Revised: 04/27/2021] [Accepted: 06/15/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Although knee replacement is effective for improving pain and physical function, subsequent improvements in physical activity typically do not follow. As a result, many patients spend most of their day engaged in sedentary behavior, which may put them at higher risk of experiencing poor function and disability. Intervening on sedentary time, rather than physical activity, may be a more feasible first-step approach for modifying activity-related behaviors in adults who received knee replacement. OBJECTIVE The purpose of this study is to examine the use of a mobile health (mHealth) intervention to reduce sedentary time among adults who received a knee replacement at 3 and 6 months after surgery. METHODS Patients (n = 92) scheduled for knee replacement will be recruited and at 4 weeks after surgery, they will be randomized to either NEAT!2 or Control. NEAT!2 participants will use the NEAT!2 smartphone app, which provides a vibration and/or audible tone to interrupt prolonged bouts of sitting detected from the smartphone's internal accelerometer, until 3 months after surgery. NEAT!2 participants will receive biweekly coaching calls between 4 and 12 weeks after surgery. Control participants will receive an education control app and receive non-intervention calls to assess general surgery recovery. Both groups will receive 3 retention calls between 3 and 6 months. Data collection will occur pre-operatively and at 3 and 6 months after surgery. DISCUSSION The results of this study will help to determine whether an innovative remotely-delivered, mHealth sedentary reduction intervention can decrease sedentary time in adults after knee replacement.
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Affiliation(s)
- Christine A. Pellegrini
- Technology Center to Promote Healthy Lifestyles, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 403, Columbia, SC, 29208, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Katherine E. DeVivo
- Technology Center to Promote Healthy Lifestyles, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 403, Columbia, SC, 29208, USA
| | - Courtnee E. Harpine
- Technology Center to Promote Healthy Lifestyles, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 403, Columbia, SC, 29208, USA
| | | | - Sara Wilcox
- Department of Exercise Science and Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
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Changes in actual daily physical activity and patient-reported outcomes up to 2 years after total knee arthroplasty with arthritis. Geriatr Nurs 2020; 41:949-955. [PMID: 32711902 DOI: 10.1016/j.gerinurse.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022]
Abstract
The current study aimed 1) to describe changes in patient-reported outcomes and physical activity measured with an accelerometer preoperatively, 6 months and 2 years postoperatively in older patients undergoing total knee arthroplasty (TKA) for arthritis, and 2) to examine the predictors of the changes in physical activity (PA). This study included 58 patients (mean age 72.6 years, 84.5% women) who completed the Oxford Knee Score (OKS) and the 8-item Short Form Health Survey. Physical activity measured mean steps per day, duration of light physical activity and moderate-to-vigorous physical activity (MVPA) per week. All PA indicators and patient-reported outcomes improved 6 months postoperatively. After 6 months, knee-related pain and function gradually improved, and MVPA increased. The OKS was a sole predictor of improvement in PA during the 2-year study period, suggesting the importance of disease-specific quality of life.
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Physical Activity Interventions After Hip or Knee Joint Replacement: a Systematic Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Christiansen MB, Thoma LM, Master H, Voinier D, Schmitt LA, Ziegler ML, LaValley MP, White DK. Feasibility and Preliminary Outcomes of a Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement. Arthritis Care Res (Hoboken) 2020; 72:661-668. [PMID: 30908867 DOI: 10.1002/acr.23882] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To explore the feasibility, fidelity, safety, and preliminary outcomes of a physical therapist-administered physical activity (PA) intervention after total knee replacement (TKR). METHODS People who had undergone a unilateral TKR and were receiving outpatient physical therapy (PT) were randomized to a control or intervention group. Both groups received standard PT for TKR. The intervention included being provided with a Fitbit Zip, step goals, and 1 phone call a month for 6 months after discharge from PT. Feasibility was measured by rates of recruitment and retention, safety was measured by the frequency of adverse events, and fidelity was measured by adherence to the weekly steps/day goal created by the physical therapist and participant monitoring of steps/day. An Actigraph GT3X measured PA, which was quantified as steps/day and minutes/week of engaging in moderate-to-vigorous PA. Our preliminary outcome was the difference in PA 6 months after discharge from PT between the control and intervention groups. RESULTS Of the 43 individuals who were enrolled, 53.4% were women, the mean ± SD age was 67.0 ± 7.0 years, and the mean ± SD body mass index was 31.5 ± 5.9 kg/m2 . For both the control and intervention groups, the recruitment and retention rates were 64% and 83.7%, respectively, and adherence to the intervention ranged from 45% to 60%. No study-related adverse events occurred. The patients in the intervention group accumulated a mean 1,798 more steps/day (95% confidence interval [95% CI] 240, 3,355) and spent 73.4 more minutes/week (95% CI -14.1, 160.9) engaging in moderate-to-vigorous PA at 6 months than those in the control group. CONCLUSION A physical therapist-administered PA intervention is feasible and safe, demonstrates treatment fidelity, and may increase PA after TKR. Future research is needed to establish the effectiveness of the intervention.
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Frimpong E, van der Jagt DR, Mokete L, Pietrzak J, Kaoje YS, Smith A, McVeigh JA, Meiring RM. Improvements in Objectively Measured Activity Behaviors Do Not Correlate With Improvements in Patient-Reported Outcome Measures Following Total Knee Arthroplasty. J Arthroplasty 2020; 35:712-719.e4. [PMID: 31722854 DOI: 10.1016/j.arth.2019.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/29/2019] [Accepted: 10/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Activity monitors have added a new dimension to our ability to objectively measure physical activity in patients undergoing total knee arthroplasty (TKA). The aim of the study is to assess whether changes in the time spent sitting, standing, and stepping were associated with changes in patient-reported outcome measures (PROMs) before and after TKA. METHODS Valid activPAL data (>3 days) and PROMs were obtained from 49 men and women (mean [SD] age, 62.8 [8.6] years; body mass index, 33.8 [7.1] kg/m2) who underwent primary TKA, before and at 6 weeks or 6 months after surgery. Patient-reported symptoms of pain, stiffness, and knee function were obtained using the Knee injury and Osteoarthritis Outcome Score and Oxford Knee Score questionnaires. RESULTS Mean (SD) Knee injury and Osteoarthritis Outcome Score (80.1 [16.3] to 41.6 [6.5], P < .001) and Oxford Knee Score (12.0 [9.8] to 17.7 [22.8], P < .001) scores improved 6 months after TKA. Walking time (mean [95% confidence interval]; min/d) increased from before (79 [67-91]) to 6 months after TKA (101 [88-114], P = .006). Standing time (318 [276-360] to 321 [291-352], P = .782) and sitting time (545 [491-599] to 509.0 [459.7-558.3], P = .285) did not change from before to 6 months after TKA. Participants took more steps (2559 [2128-2991] to 3515 [2983-4048] steps/day, P = .001) and accumulated more steps (31 [30-34] to 34 [33-35] steps/min, P < .001) after TKA compared to before. There were no associations between changes in activity behaviors and changes in PROMs (P > .05). CONCLUSION Despite improvements in self-reported knee pain and functional ability, these changes do not correlate with improvements in objectively measured light-intensity and sedentary activity behaviors.
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Affiliation(s)
- Emmanuel Frimpong
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Dick R van der Jagt
- Division of Orthopaedics, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Lipalo Mokete
- Division of Orthopaedics, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Jurek Pietrzak
- Division of Orthopaedics, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Yusuf S Kaoje
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Bentley Campus, Perth, Australia
| | - Joanne A McVeigh
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa; Occupational Therapy, Speech Therapy and Social Work, Curtin University, Bentley Campus, Perth, Australia
| | - Rebecca M Meiring
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa; Department of Exercise Sciences, Faculty of Science, University of Auckland, Newmarket, Auckland, New Zealand
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Comparison of physical activity among different subsets of patients with knee or hip osteoarthritis and the general population. Rheumatol Int 2020; 40:383-392. [DOI: 10.1007/s00296-019-04507-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/26/2019] [Indexed: 12/15/2022]
Abstract
AbstractTo compare the amount of physical activity (PA) among patients with different subsets of knee or hip osteoarthritis (OA) and the general population. Secondary analyses of data of subjects ≥ 50 years from four studies: a study on the effectiveness of an educational program for OA patients in primary care (n = 110), a RCT on the effectiveness of a multidisciplinary self-management program for patients with generalized OA in secondary care (n = 131), a survey among patients who underwent total joint arthroplasty (TJA) for end-stage OA (n = 510), and a survey among the general population in the Netherlands (n = 3374). The Short QUestionnaire to ASssess Health-enhancing physical activity (SQUASH) was used to assess PA in all 4 studies. Differences in PA were analysed by multivariable linear regression analyses, adjusted for age, body mass index and sex. In all groups, at least one-third of total time spent on PA was of at least moderate-intensity. Unadjusted mean duration (hours/week) of at least moderate-intensity PA was 15.3, 12.3, 18.1 and 17.8 for patients in primary, secondary care, post TJA, and the general population, respectively. Adjusted analyses showed that patients post TJA spent 5.6 h [95% CI: 1.5; 9.7] more time on PA of at least moderate-intensity than patients in secondary care. The reported amount of PA of at least moderate-intensity was high in different subsets of OA and the general population. Regarding the amount of PA in patients with different subsets of OA, there was a substantial difference between patients in secondary care and post TJA patients.
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Small SR, Bullock GS, Khalid S, Barker K, Trivella M, Price AJ. Current clinical utilisation of wearable motion sensors for the assessment of outcome following knee arthroplasty: a scoping review. BMJ Open 2019; 9:e033832. [PMID: 31888943 PMCID: PMC6936993 DOI: 10.1136/bmjopen-2019-033832] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Wearable motion sensors are used with increasing frequency in the evaluation of gait, function and physical activity within orthopaedics and sports medicine. The integration of wearable technology into the clinical pathway offers the ability to improve post-operative patient assessment beyond the scope of current, questionnaire-based patient-reported outcome measures. This scoping review assesses the current methodology and clinical application of accelerometers and inertial measurement units for the evaluation of patient activity and functional recovery following knee arthroplasty. DESIGN This is a systematically conducted scoping review following Joanna Briggs Institute methodology for scoping reviews and reported consulting the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for scoping reviews. A protocol for this review is registered with the Open Science Framework (https://osf.io/rzg9q). DATA SOURCES CINAHL, EMBASE, MEDLINE and Web of Science databases were searched for manuscripts published between 2008 and 2019. ELIGIBILITY CRITERIA We included clinical studies reporting the use of any combination of accelerometers, pedometers or inertial measurement units for patient assessment at any time point following knee arthroplasty. DATA EXTRACTION AND SYNTHESIS Data extracted from manuscripts included patient demographics, sensor technology, testing protocol and sensor-based outcome variables. RESULTS 45 studies were identified, including 2076 knee arthroplasty patients, 620 patients with end-stage osteoarthritis and 449 healthy controls. Primary aims of the identified studies included functional assessment, physical activity monitoring and evaluation of knee instability. Methodology varied widely between studies, with inconsistency in reported sensor configuration, testing protocol and output variables. CONCLUSIONS The use of wearable sensors in evaluation of knee arthroplasty procedures is becoming increasingly common and offers the potential to improve clinical understanding of recovery and rehabilitation. While current studies lack consistency, significant opportunity exists for the development of standardised measures and protocols for function and physical activity evaluation.
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Affiliation(s)
- Scott R Small
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Garrett S Bullock
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Sara Khalid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
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Predicting physical activity recovery after hip and knee arthroplasty? A longitudinal cohort study. Braz J Phys Ther 2019; 25:30-39. [PMID: 31874729 DOI: 10.1016/j.bjpt.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/08/2019] [Accepted: 12/10/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Recovery of physical activity (PA) after telerehabilitation following knee and hip arthroplasty (TKA-THA) has rarely been studied. An improved understanding of PA recovery is needed, as it could be influenced by many factors such as age, gender or pre-operative physical function. OBJECTIVES To assess PA recovery weekly for 3 months after TKA-THA and to determine perioperative factors that could help predict PA recovery at 3 months. METHODS From one week before until 3 months after surgery, 132 patients wore a fitness tracker continuously. Each patient received personalized and daily exercises and feedback through a tablet. Before and after surgery, patient-reported outcome measures of symptoms, pain, activities of daily living and quality of life were recorded. A one-way repeated-measure ANOVA was used to assess the time effect on step count for each post-operative week. To predict the absolute step count at 3 months post-surgery, a backward multiple linear regression was used. RESULTS Patients reached their pre-operative PA level at week 7, with no significant additional improvement by 3 months post-surgery. Pre-operative step count, the number of days using crutches and pre-operative symptoms explained 35% of the variability of step count at 3 months. CONCLUSION This patient population receiving telerehabilitation reached their pre-operative PA level at 7-week post-surgery with no further improvement over the subsequent 5 weeks. The PA level at 3 months could be predicted by pre-operative step count, duration of crutches use, and pre-operative symptoms.
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Effectiveness of ultrasonographic skeletal muscle assessment in patients after total knee arthroplasty. Osteoporos Sarcopenia 2019; 5:94-101. [PMID: 31728427 PMCID: PMC6838742 DOI: 10.1016/j.afos.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/17/2019] [Accepted: 09/06/2019] [Indexed: 12/29/2022] Open
Abstract
Objectives This study aimed to characterize the skeletal muscles of patients who underwent total knee arthroplasty (TKA) using ultrasonography in order to investigate the effectiveness of ultrasonographic skeletal muscle assessment after TKA. Methods This study included 50 TKA patients (TKA group) and 41 residents with osteoarthritis who have not received TKA (non-TKA group). Ultrasonography was used to assess the characteristics of several different muscles. Various postoperative outcomes were evaluated. Muscle thickness (MT) and echo intensity (EI) results were compared among operated knees in the TKA group, nonoperated knees in the TKA group, and more severely affected knees in the non-TKA group. For the TKA group, multiple regression was conducted to examine the association between skeletal muscle characteristics of operated knees and postoperative outcomes. Results The MTs of the vastus medialis, vastus intermedius, and rectus femoris (RF) were significantly smaller and the RF-EI was significantly greater for both operated and nonoperated knees in the TKA group compared with the non-TKA group (P < 0.017). Several parameters of physical function were significantly poorer in the TKA group than in the non-TKA group (P < 0.05). Multiple regression demonstrated that RF-MT was associated with knee range of motion, knee strength, and physical functional performance in the TKA group (P < 0.05). Conclusions The quantity and quality of skeletal muscles were lower in the TKA group than in the non-TKA group. Ultrasonography may be useful for assessing skeletal muscles in TKA patients because MT assessed with ultrasonography was associated with various parameters of physical function.
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Rezzadeh K, Behery OA, Kester BS, Long WJ, Schwarzkopf R. The Effect of Total Knee Arthroplasty on Physical Activity and Body Mass Index: An Analysis of the Osteoarthritis Initiative Cohort. Geriatr Orthop Surg Rehabil 2019; 10:2151459318816480. [PMID: 30729061 PMCID: PMC6350158 DOI: 10.1177/2151459318816480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/03/2018] [Accepted: 11/05/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Preliminary analysis of accelerometry measurements has shown physical activity may not
increase significantly after total knee arthroplasty (TKA). This study evaluates the
effect of TKA on physical activity accelerometry measurements and body mass index
(BMI). Methods: Using the multicenter Osteoarthritis Initiative (OAI) database, a cohort of patients
with physical activity level accelerometry measurements and BMI before and after TKA was
identified. Physical activity levels and BMI were acquired at pre-TKA and post-TKA
accelerometry visits 2 years apart. Survey scores pertaining to knee functionality and
quality of life were also analyzed before and after knee surgery. Each patient included
in the study had a unilateral TKA completed between these 2 accelerometry visits.
Accelerometry measurements, BMI of the patients, and survey scores relating to knee
functionality and pain relief from before and after TKA were compared using paired
samples t tests. Results: Twenty-three patients from the OAI database were identified for the paired analysis.
They were evaluated at a mean postoperative follow-up of 15 months. There were no
statistically significant differences between the post-TKA group and pre-TKA group for
the accelerometry variables and BMI, though patients experienced a significant
improvement in knee function and pain relief measures included in this analysis. Discussion: Although TKA can successfully restore function and relieve pain, there remains no good
evidence that neither physical activity nor BMI improve postoperatively. Conclusion: No significant differences in physical activity and BMI were observed after TKA in this
study.
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Affiliation(s)
- Kevin Rezzadeh
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Hospital for Joint Diseases, NY, USA
| | - Omar A Behery
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Hospital for Joint Diseases, NY, USA
| | - Benjamin S Kester
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Hospital for Joint Diseases, NY, USA
| | - William J Long
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Hospital for Joint Diseases, NY, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Hospital for Joint Diseases, NY, USA
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Agarwal V, Smuck M, Tomkins-Lane C, Shah NH. Inferring Physical Function From Wearable Activity Monitors: Analysis of Free-Living Activity Data From Patients With Knee Osteoarthritis. JMIR Mhealth Uhealth 2018; 6:e11315. [PMID: 30394876 PMCID: PMC6315255 DOI: 10.2196/11315] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/20/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
Background Clinical assessments for physical function do not objectively quantify routine daily activities. Wearable activity monitors (WAMs) enable objective measurement of daily activities, but it remains unclear how these map to clinically measured physical function measures. Objective This study aims to derive a representation of physical function from daily measurements of free-living activity obtained through a WAM. In addition, we evaluate our derived measure against objectively measured function using an ordinal classification setup. Methods We defined function profiles representing average time spent in a set of pattern classes over consecutive days. We constructed a function profile using minute-level activity data from a WAM available from the Osteoarthritis Initiative. Using the function profile as input, we trained statistical models that classified subjects into quartiles of objective measurements of physical function as measured through the 400-m walk test, 20-m walk test, and 5 times sit-stand test. Furthermore, we evaluated model performance on held-out data. Results The function profile derived from minute-level activity data can accurately predict physical performance as measured through clinical assessments. Using held-out data, the Goodman-Kruskal Gamma statistic obtained in classifying performance values in the first quartile, interquartile range, and the fourth quartile was 0.62, 0.53, and 0.51 for the 400-m walk, 20-m walk, and 5 times sit-stand tests, respectively. Conclusions Function profiles accurately represent physical function, as demonstrated by the relationship between the profiles and clinically measured physical performance. The estimation of physical performance through function profiles derived from free-living activity data may enable remote functional monitoring of patients.
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Affiliation(s)
- Vibhu Agarwal
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, United States
| | - Matthew Smuck
- Stanford University Hospital and Clinics, Stanford, CA, United States
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Nigam H Shah
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, United States
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What are the clinical implications of knee crepitus to individuals with knee osteoarthritis? An observational study with data from the Osteoarthritis Initiative. Braz J Phys Ther 2018; 23:491-496. [PMID: 30471964 DOI: 10.1016/j.bjpt.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Crepitus is a common clinical feature of knee osteoarthritis. However, the importance of crepitus in the overall clinical presentation of individuals with knee osteoarthritis is unknown. OBJECTIVE(S) (A) To compare function, pain and quality of life between individuals with knee osteoarthritis with and without crepitus; (B) to compare whether individuals with knee osteoarthritis in both knees, but crepitus in just one, differ in terms of function pain, and knee strength. METHODS Setting: Observational study. PARTICIPANTS (A) A total of 584 participants with crepitus who had the same Kellgren-Lawrence grade on both knees were matched for gender, body mass index and Kellgren-Lawrence grade to participants without crepitus on both knees. (B) 361 participants with crepitus in only one knee and with the same Kellgren-Lawrence grade classification on both knees were included. MAIN OUTCOME MEASURE(S) A - Self-reported function, pain, quality of life, 20-m walk test and chair-stand test. B -Knee extensor and flexor strength, self-reported function and pain. RESULTS A - Individuals with crepitus had lower self-reported function, quality of life and higher pain compared to those without crepitus (3-11%; small effect=0.17-0.41, respectively). No difference was found in objective function between groups. B - Self-reported function was lower in the limb with crepitus compared to the limb without crepitus (15%; trivial effect=0.09). No difference was found in pain and knee strength between-groups. CONCLUSION(S) Individuals with knee osteoarthritis and knee crepitus have slightly lower self-reported physical function and knee-related quality of life (small or trivial effect). However, the presence of knee crepitus is not associated with objective function or knee strength.
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Smith KC, Paltiel AD, Yang HY, Collins JE, Katz JN, Losina E. Cost-effectiveness of health coaching and financial incentives to promote physical activity after total knee replacement. Osteoarthritis Cartilage 2018; 26:1495-1505. [PMID: 30092263 PMCID: PMC6202236 DOI: 10.1016/j.joca.2018.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/12/2018] [Accepted: 07/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We evaluated the cost-effectiveness of Telephonic Health Coaching and Financial Incentives (THC + FI) to promote physical activity in total knee replacement recipients. DESIGN We used the Osteoarthritis Policy Model, a computer simulation of knee osteoarthritis, to evaluate the cost-effectiveness of THC + FI compared to usual care. We derived transition probabilities, utilities, and costs from trial data. We conducted lifetime analyses from the healthcare perspective and discounted all cost-effectiveness outcomes by 3% annually. The primary outcome was the Incremental Cost-Effectiveness Ratio (ICER), defined as the ratio of the differences in costs and Quality-Adjusted Life Years (QALYs) between strategies. We considered ICERs <$100,000/QALY to be cost-effective. We conducted one-way sensitivity analyses that varied parameters across their 95% confidence intervals (CI) and limited the efficacy of THC + FI to 1 year or to 9 months. We also conducted a probabilistic sensitivity analysis (PSA), simultaneously varying cost, utilities, and transition probabilities. RESULTS THC + FI had an ICER of $57,200/QALY in the base case and an ICER below $100,000/QALY in most deterministic sensitivity analyses. THC + FI cost-effectiveness depended on assumptions about long-term efficacy; when efficacy was limited to 1 year or to 9 months, the ICER was $93,300/QALY or $121,800/QALY, respectively. In the PSA, THC + FI had an ICER below $100,000/QALY in 70% of iterations. CONCLUSIONS Based on currently available information, THC + FI might be a cost-effective alternative to usual care. However, the uncertainty surrounding this choice is considerable, and further research to reduce this uncertainty may be economically justified.
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Affiliation(s)
- K C Smith
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - A D Paltiel
- Yale School of Public Health, Yale School of Management, New Haven, CT, USA.
| | - H Y Yang
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - J E Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - J N Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA.
| | - E Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review paper is to provide an overview of the recent research using physical activity monitors in rheumatic populations including those with osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and fibromyalgia. RECENT FINDINGS Recent research demonstrates increased use of physical activity monitors in these populations, especially in those with osteoarthritis. Results from cross-sectional, longitudinal, and intervention studies highlight that physical activity levels are below recommended guidelines, yet evidence suggests benefits such as improving pain, fatigue, function, and overall well-being. While the use of physical activity monitors in rheumatic populations is increasing, more research is needed to better understand physical activity levels in these populations, the effects of activity on relevant clinical outcomes, and how monitors can be used to help more individuals reach physical activity guidelines.
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Sedentary Behavior in Patients With Knee Osteoarthritis Before and After Total Knee Arthroplasty: A Systematic Review. J Aging Phys Act 2018; 26:671-681. [DOI: 10.1123/japa.2017-0214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective:The objective of this systematic review is to integrate the available evidence on changes in sedentary behavior (SB) in patients with knee osteoarthritis after total knee arthroplasty (TKA).Methods:A systematic literature search from January 2002 to October 31, 2017, was performed for studies assessing objectively and/or subjectively measured SB following TKA. The Scottish Intercollegiate Guidelines Network Methodology appraisal tool was used to critically appraise the methodological quality of the included studies.Results:Ten studies reporting on SB with a total of 1,028 participants were included in the review. Three studies reported changes in SB with two showing a reduction in SB and one (with high risk of bias) an increase in SB after TKA. Seven studies showed no change in SB following TKA.Conclusion:Currently, there is insufficient evidence which suggests that SB time improves following TKA. Detailed assessments of SB after TKA are needed.
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Pellegrini CA, Chang RW, Dunlop DD, Conroy DE, Lee J, Van Horn L, Spring B, Cameron KA. Comparison of a Patient-Centered Weight Loss Program starting before versus after knee replacement: A pilot study. Obes Res Clin Pract 2018; 12:472-478. [PMID: 30007535 PMCID: PMC6335652 DOI: 10.1016/j.orcp.2018.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/23/2018] [Accepted: 06/29/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Most patients risk gaining weight in the years after knee replacement, adding further concern to a population that is mostly overweight/obese prior to surgery. OBJECTIVE Via a randomised pilot study, we assessed changes in weight during a Patient Centered Weight Loss Program (PACE) initiated either before or after knee replacement, while simultaneously examining the feasibility of recruiting and retaining participants over 26 weeks. METHODS Recruitment outreach was made to 133 patients scheduled for knee replacement. Sixteen participants were randomised to a 14-session weight loss program that started either ≤6 weeks before surgery (PACE) or at 12 weeks post-op (Delayed PACE). Repeated measures ANOVAs were used to examine preliminary changes in weight, function, patient-reported outcomes, and physical activity across time (baseline/pre-op, 12 and 26 weeks after surgery) and group. RESULTS Retention was 75% and 69% at 12 and 26 weeks after surgery, respectively. Weight significantly decreased across the 26 weeks (P<0.001). A group by time interaction (P=0.03) demonstrated Delayed PACE [-7.6±5.9kg (-7.9±5.9%)] lost significantly more weight than PACE [-2.5±2.7kg (-2.6±2.6%)] participants at 26 weeks. Significant improvements across time were seen for all function and patient reported outcomes, however activity did not change. CONCLUSION Conducting a behavioural intervention was challenging but feasible in a knee replacement population, with preliminary evidence suggesting that initiating a program 12 weeks after surgery produces greater weight losses at 26 weeks compared to a program starting before knee replacement.
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Affiliation(s)
- Christine A Pellegrini
- University of South Carolina, Department of Exercise Science, Technology Center to Promote Health Lifestyles, 915 Greene Street, Suite 403, Columbia, SC 29208, United States; Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States.
| | - Rowland W Chang
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States
| | - Dorothy D Dunlop
- Northwestern University, Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Healthcare Studies, 633 N. St. Clair, Chicago, IL 60611, United States
| | - David E Conroy
- The Pennsylvania State University, Department of Kinesiology, 268U Recreation Building, University Park, PA 16802, United States
| | - Jungwha Lee
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States
| | - Linda Van Horn
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States
| | - Bonnie Spring
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States
| | - Kenzie A Cameron
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States; Northwestern University, Feinberg School of Medicine, Division of Internal Medicine and Geriatrics, Department of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States
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28
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Objectively measured early physical activity after total hip or knee arthroplasty. J Clin Monit Comput 2018; 33:509-522. [PMID: 30039461 DOI: 10.1007/s10877-018-0185-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/17/2018] [Indexed: 01/07/2023]
Abstract
Although reduced early physical function after total hip- and knee arthroplasty (THA/TKA) is well-described, the underlying reasons have not been clarified with detailed studies on pathophysiological mechanisms related to recovery, thereby prohibiting advances in rehabilitation. Thus, we aimed to describe early post-THA/TKA physical activity measured by actigraphy and potential underlying pathophysiological mechanisms related to recovery in a well-defined cohort of THA and TKA patients. Daytime-activity was measured from 2 days before until 13 (THA) or 20 (TKA) days after surgery. The primary outcome was individualized recovery in activity, with secondary analyses of activity-intensities and association to the perioperative factors: sex, age, BMI, hemoglobin (hgb), C-reactive protein and postoperative pain. Eighty-one THA/TKA-patients were examined. A large inter-individual variation in early physical activity was found. On a group level, activity was significantly reduced compared to preoperatively the first 2 (THA) or 3 (TKA) weeks after surgery (mean-difference - 64 counts × 103/day, p < 0.001 and - 78 counts × 103/day, p < 0.001, respectively). All activity-intensities were affected with the largest decline in high intense activity. A slight overall improvement in activity was seen during the postoperative phase [THA: 1%/day (SD 2.15); TKA: 0.7%/day (SD 1.04)], but approximately 30% of THA and 20% of TKA patients had reduced and declining activity. Hgb, CRP, BMI (THA) and postoperative pain (TKA) were only weakly associated with impaired physical activity. Physical activity was reduced the first weeks following THA/TKA, but with large inter-individual variations in recovery profiles. No single pathogenic factor was associated with a poor recovery. Early risk stratified interventions are needed in patients on a suboptimal course.
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Bindawas SM. Total knee arthroplasty status and patient-reported, knee-related quality of life over a 4-year follow-up period: data from the osteoarthritis initiative. Patient Prefer Adherence 2018; 12:477-482. [PMID: 29636603 PMCID: PMC5881523 DOI: 10.2147/ppa.s155317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To examine the relationship between baseline total knee arthroplasty (TKA) status and patient-reported, knee-related quality of life (QoL) over a 4-year follow-up relative to no knee osteoarthritis (OA). PATIENTS AND METHODS Data from the Osteoarthritis Initiative were included, comprising 4,674 adults aged 45-79 years at baseline. Patients were categorized into four groups: no knee OA (n=3,711), non-TKA (n=902), pre-TKA (n=36), and post-TKA (n=25). QoL was measured using the Knee Injury Osteoarthritis Outcome Score-QoL subscale. General linear mixed models were used for the relationship between TKA and QoL. RESULTS After adjusting for covariates, a reduced QoL was noted for patients in the non-TKA (mean [standard error], -13.97 [0.73]; P<0.0001), pre-TKA (-21.34 [3.57]; P<0.0001), and post-TKA (-9.68 [3.94]; P=0.0143) groups compared with the no knee OA group. QoL in the non-TKA group also decreased over time (-0.16 [0.07]; P=0.226). CONCLUSION Non-, pre-, and post-TKA status is associated with a lower QoL.
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Affiliation(s)
- Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Saad M Bindawas. Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, PO Box 10219, Riyadh 11433, Saudi Arabia, Tel +966 11 469 6226, Fax +966 11 469 3589, Email
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30
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Webber SC, Strachan SM, Pachu NS. Sedentary Behavior, Cadence, and Physical Activity Outcomes after Knee Arthroplasty. Med Sci Sports Exerc 2017; 49:1057-1065. [PMID: 28099297 DOI: 10.1249/mss.0000000000001207] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE This study comprehensively examined sedentary behavior and physical activity patterns in people with severe knee osteoarthritis awaiting total knee arthroplasty (TKA) and in individuals after TKA. METHODS Preoperative (n = 32, mean ± SD = 69.9 ± 5.3 yr) and 1-yr postoperative participants with TKA (n = 38, 67.9 ± 7.3 yr) wore ActiGraph GT3X+ activity monitors for 6.8 ± 0.6 d. Total sedentary time, time in long sedentary bouts (≥30 min), and physical activity outcomes (steps, time in moderate-to-vigorous physical activity [MVPA], cadence) were examined. RESULTS There were no differences between pre- and postoperative groups for total sedentary time (9.3 ± 1.4 vs 9.2 ± 1.4 h·d, P = 0.62) and number of long sedentary bouts per day (median [interquartile range] = 3.4 [1.9] vs 3.1 [2.0], P = 0.37). Daily steps, peak 30-min cadence, and peak 1-min cadence values were greater in people after TKA compared with those awaiting surgery (5935 [3316] vs 3724 [2338], 55.6 [31.0] vs 35.9 [19.3], and 91.5 ± 20.6 vs 70.0 ± 23.7, respectively, all P < 0.01). There were no differences in lifestyle MVPA between groups. The number of bouts of Freedson MVPA was greater in postoperative participants, but the differences were not substantial (one bout per week). CONCLUSION Patients report less knee pain and improved function after TKA; however, sedentary behavior does not differ and physical activity is only marginally increased compared with those awaiting surgery. After TKA, daily walking at slow, moderate, and brisk paces and engagement in MVPA do not match levels seen in healthy older adults, which, when combined with high levels of sedentary behavior, leaves patients at increased risk for physical disability and cardiovascular disease.
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Affiliation(s)
- Sandra C Webber
- 1Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CANADA; 2Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, CANADA; and 3Applied Health Sciences Program, University of Manitoba, Winnipeg, Manitoba, CANADA
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Twiggs J, Salmon L, Kolos E, Bogue E, Miles B, Roe J. Measurement of physical activity in the pre- and early post-operative period after total knee arthroplasty for Osteoarthritis using a Fitbit Flex device. Med Eng Phys 2017; 51:31-40. [PMID: 29117912 DOI: 10.1016/j.medengphy.2017.10.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/29/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022]
Abstract
Total knee arthroplasty (TKA) is a standard treatment for patients with end stage knee Osteoarthritis (OA) to reduce pain and restore function. The aim of this study was to assess pre- and early post-operative physical activity (PA) with Fitbit Flex devices for patients with OA undergoing TKA and determine any benchmarks for expected post-operative activity. Significant correlations of pre-operative step count, post-operative step count, Body Mass Index (BMI) and Short Form 12 Physical Component Summaries (SF-12 PCS) were found. Mean step counts varied by 3,203 steps per day between obese and healthy weight patients, and 3,786 steps per day between those with higher and lower SF-12 PCS scores, suggesting the need for benchmarks for recovery that vary by patient pre-operative factors. A backwards stepwise regression model developed to provide patient specific step count predictions at 6 weeks had an R2 of 0.754, providing a robust patient specific benchmark for post-operative recovery, while population means from BMI and SF-12 subgroups provide a clinically practical alternative.
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Affiliation(s)
- Joshua Twiggs
- 360 Knee Systems Pty Ltd, Suite 3 Building 1, 20 Bridge Street, Pymble 2073, Australia; Biomedical Engineering, AMME, University of Sydney, Sydney, NSW 2006, Australia.
| | - Lucy Salmon
- North Sydney Orthopaedic & Sports Medicine Centre, Mater Hospital, NSW 2065, Australia.
| | - Elizabeth Kolos
- 360 Knee Systems Pty Ltd, Suite 3 Building 1, 20 Bridge Street, Pymble 2073, Australia.
| | - Emily Bogue
- 360 Knee Systems Pty Ltd, Suite 3 Building 1, 20 Bridge Street, Pymble 2073, Australia.
| | - Brad Miles
- 360 Knee Systems Pty Ltd, Suite 3 Building 1, 20 Bridge Street, Pymble 2073, Australia.
| | - Justin Roe
- North Sydney Orthopaedic & Sports Medicine Centre, Mater Hospital, NSW 2065, Australia.
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32
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Smith TO, Dainty JR, MacGregor A. Trajectory of physical activity following total hip and knee arthroplasty: data from the English Longitudinal Study of Ageing (ELSA) cohort. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1332683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Toby O. Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jack R. Dainty
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alex MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK
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33
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Taniguchi M, Sawano S, Kugo M, Maegawa S, Kawasaki T, Ichihashi N. Response to Letter to the Editor on "Physical Activity Promotes Gait Improvement in Patients With Total Knee Arthroplasty". J Arthroplasty 2017; 32:3259-3260. [PMID: 28705545 DOI: 10.1016/j.arth.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/06/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Masashi Taniguchi
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu-city, Shiga, Japan; Development and Rehabilitation of Motor Function, Department of Physical Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Sawano
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu-city, Shiga, Japan
| | - Masato Kugo
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu-city, Shiga, Japan
| | - Shoji Maegawa
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu-city, Shiga, Japan
| | - Taku Kawasaki
- Department of Rehabilitation, Shiga University of Medical Science Hospital, Otsu-city, Shiga, Japan
| | - Noriaki Ichihashi
- Development and Rehabilitation of Motor Function, Department of Physical Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Smith TO, Mansfield M, Dainty J, Hilton G, Mann CJV, Sackley CM. Does physical activity change following hip and knee replacement? Matched case-control study evaluating Physical Activity Scale for the Elderly data from the Osteoarthritis Initiative. Physiotherapy 2017; 104:80-90. [PMID: 28917522 DOI: 10.1016/j.physio.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether physical activity measured using the Physical Activity Scale for the Elderly (PASE), changes during the initial 24 months post-total hip (THR) or knee replacement (TKR), and how this compares to a matched non-arthroplasty cohort. DESIGN Case-controlled study analysis of a prospectively collected dataset. SETTING USA community-based. PARTICIPANTS 116 people post-THR, 105 people post-TKR compared to 663 people who had not undergone THR or TKR, or had hip or knee osteoarthritis. Cohorts were age-, gender- and BMI-matched. MAIN OUTCOME MEASURES Physical activity assessed using the 12-item PASE at 12 and 24 months post operatively. RESULTS There was no significant difference in total PASE score between pre-operative to 12 months (mean: 136 vs 135 points; p=0.860) or 24 months following THR (mean: 136 vs 132 points; p=0.950). Whilst there was no significant difference in total PASE score from pre-operative to 12 months post-TKR (126 vs 121 points; p=0.930), by 24 months people following TKR reported significantly greater physical activity (126 vs 142 points; p=0.040). There was no statistically significant difference in physical activity between the normative matched and THR (p≥0.140) or TKR (p≥0.060) cohorts at 12 or 24 months post joint replacement. CONCLUSIONS Physical activity is not appreciably different to pre-operative levels at 12 or 24 months post-THR, but was greater at 24 months following TKR. Health promotion strategies are needed to encourage greater physical activity participation following joint replacement, and particularly targeting those who undergo THR.
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Affiliation(s)
- T O Smith
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Queen's Building, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom.
| | - M Mansfield
- Guy's and St Thomas' Hospitals NHS Foundation Trust and Academic Department of Physiotherapy, King's College London, United Kingdom.
| | - J Dainty
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - G Hilton
- The Royal Ballet, Covent Garden, London, United Kingdom.
| | - C J V Mann
- Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
| | - C M Sackley
- Division of Health and Social Care Research, King's College, London, United Kingdom.
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Smith T, Withers T, Luben R, Sackley C, Jones A, MacGregor A. Changes in physical activity following total hip or knee arthroplasty: a matched case-control study from the EPIC-Norfolk cohort. Clin Rehabil 2017; 31:1548-1557. [DOI: 10.1177/0269215517704270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To assess self-reported physical activity changes pre- compared to post-operatively in patients undergoing total hip or knee arthroplasty, and to compare this to an age- and gender-matched cohort of people who have not undergone arthroplasty. Design: Population-based prospective cohort study. Setting: Norfolk, United Kingdom. Subjects: People who had undergone hip or knee arthroplasty, compared to an age- and gender-matched non-arthroplasty cohort. Intervention: Primary total hip or knee arthroplasty. Main measures: Physical activity, measured using the EPIC Physical Activity Questionnaire (EPAQ2). Results: A total of 400 people from the EPIC-Norfolk community cohort were identified who had undergone hip or knee arthroplasty. In all, 767 people were identified to form an age- and gender-matched non-arthroplasty cohort. Mean post-operative follow-up was 43 months post-total hip and 41 months post-total knee arthroplasty. There was a statistically significant reduction from pre- to post-arthroplasty in the number of flights of stairs climbed weekly (hip: mean difference (MD): 6.8; P < 0.01; knee: MD: 10.2; P < 0.01), duration of walking (hip: MD: 1.4 hours/week; P = .02; knee: MD: 2.2 hours/week; P < 0.01) and duration of total recreational activity (hip: MD: 1.1 hours/week; P = 0.02). Compared to the non-arthroplasty cohort, duration of physical activity was lower post-total hip arthroplasty (MD: 1.8 hours/week; P = 0.01). The number of flights of stairs climbed weekly (MD: 12.0; P < 0.01), total recreational activity (MD: 1.7 hours/week; P = 0.04) and physical activity energy expenditure (MD: 5.7 Mets-hours/week; P = 0.05) were lower for people post-total knee arthroplasty compared to the matched controls. Conclusions: Physical activity did not increase, and in some instances decreased, following total hip or knee arthroplasty.
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Affiliation(s)
- Toby Smith
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Thomas Withers
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Robert Luben
- EPIC, Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
| | - Catherine Sackley
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alex MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK
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36
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Meessen JMTA, Peter WF, Wolterbeek R, Cannegieter SC, Tilbury C, Bénard MR, van der Linden HMJ, Onstenk R, Tordoir R, Vehmeijer SB, Verdegaal SHM, Vermeulen HM, Nelissen RGHH, Vliet Vlieland TPM. Patients who underwent total hip or knee arthroplasty are more physically active than the general Dutch population. Rheumatol Int 2016; 37:219-227. [PMID: 27853860 PMCID: PMC5258787 DOI: 10.1007/s00296-016-3598-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/04/2016] [Indexed: 01/22/2023]
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) bring relief of pain and functional disability to patients with end-stage osteoarthritis, and however, the literature on their impact on patients' level of physical activity (PA) is scarce. Cross-sectional study in patients who underwent THA/TKA surgery in the preceding 6-22 months and a random sample of persons aged >40 years from the Dutch general population, participating in a national survey. PA in minutes per week (min/week) and adherence to the Dutch recommendation for PA (NNGB yes/no) were measured by the short questionnaire to assess health-enhancing PA. Multivariable linear (total min/week) and logistic regression analyses (meeting recommendations PA), adjusting for confounders, were performed for THA and TKA separately. In total, 258 THA [62.3% female, aged 69.4 (9.1)] and 221 TKA [65.7% female, aged 69.5 (8.9)] patients and 4373 persons from the Dutch general population [51.4% female, aged 58.9 (11.6)] were included. The presence of THA was associated after adjusting for age, sex, BMI education and musculoskeletal comorbidities, with more total min/week spent on PA (THA 13.8% increase, 95% CI 1.6-27.6%), whilst both TJA groups were associated with adhering to NNGB (THA: OR 1.79, 95% CI 1.26-2.56; TKA: OR 1.73, 95% CI 1.20-2.51). As this study used questionnaires to compare the PA of THA/TKA patients to the general population, some recall and selection bias might have been induced. After surgery, overall, TJA patients are more likely to adhere NNGB than a representative sample of persons >40 years from the Dutch general population.
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Affiliation(s)
- J M T A Meessen
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - W F Peter
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - R Wolterbeek
- Department of Medical Statistics, LUMC, Leiden, The Netherlands
| | - S C Cannegieter
- Department of Clinical Epidemiology, LUMC, Leiden, The Netherlands
| | - C Tilbury
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - M R Bénard
- Department of Orthopaedics, Reinier de Graaf Groep, Delft, The Netherlands
| | - H M J van der Linden
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - R Onstenk
- Department of Orthopaedics, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - R Tordoir
- Department of Orthopaedics, Rijnland Ziekenhuis, Leiderdorp, The Netherlands
| | - S B Vehmeijer
- Department of Orthopaedics, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - S H M Verdegaal
- Department of Orthopaedics, Rijnland Ziekenhuis, Leiderdorp, The Netherlands
| | - H M Vermeulen
- Department of Physiology, LUMC, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, J11R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Rijnlands Rehabilitation Centre, Leiden, The Netherlands.,Sophia Rehabilitation, The Hague, The Netherlands
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37
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Fournier MN, Hallock J, Mihalko WM. Preoperative Optimization of Total Joint Arthroplasty Surgical Risk: Obesity. J Arthroplasty 2016; 31:1620-4. [PMID: 27143019 DOI: 10.1016/j.arth.2016.02.085] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 02/01/2023] Open
Abstract
Obesity is a problem that is increasing in prevalence in the United States and in other countries, and it is a common comorbidity in patients seeking total joint arthroplasty for degenerative musculoskeletal diseases. Obesity, as well as commonly associated comorbidities such as diabetes mellitus, cardiovascular disease, and those contributing to the diagnosis of metabolic syndrome, have been shown to have detrimental effects on total joint arthroplasty outcomes. Although there are effective surgical and nonsurgical interventions which can result in weight loss in these patients, concomitant benefit on arthroplasty outcomes is not clear. Preoperative optimization of surgical risk in obese total joint arthroplasty patients is an important point of intervention to improve arthroplasty outcomes.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Bariatric Surgery
- Comorbidity
- Diabetes Mellitus/epidemiology
- Humans
- Metabolic Syndrome/epidemiology
- Obesity/epidemiology
- Obesity/therapy
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- Postoperative Complications/prevention & control
- Preoperative Care/standards
- Prevalence
- Risk Factors
- United States/epidemiology
- Weight Reduction Programs
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Affiliation(s)
- Matthew N Fournier
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - Justin Hallock
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - William M Mihalko
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
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38
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Meiring RM, Frimpong E, Mokete L, Pietrzak J, Van Der Jagt D, Tikly M, McVeigh JA. Rationale, design and protocol of a longitudinal study assessing the effect of total knee arthroplasty on habitual physical activity and sedentary behavior in adults with osteoarthritis. BMC Musculoskelet Disord 2016; 17:281. [PMID: 27411316 PMCID: PMC4944438 DOI: 10.1186/s12891-016-1141-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/29/2016] [Indexed: 01/11/2023] Open
Abstract
Background Physical activity levels are decreased and sedentary behaviour levels are increased in patients with knee osteoarthritis (OA). However, previous studies have shown that following total knee arthroplasty (TKA), objectively measured physical activity levels do not change compared to before the surgery. Very few studies have objectively assessed sedentary behaviour following TKA. This study aims to assess patterns of objective habitual physical activity and sedentary behaviour in patients with knee OA and to determine whether these change following TKA. Methods Patients diagnosed with knee osteoarthritis and scheduled for unilateral primary total knee arthroplasty will be recruited from the Orthopaedic Division at the Charlotte Maxeke Johannesburg Academic Hospital. Eligible participants will have assessments completed one week before the scheduled arthroplasty, six weeks, and six months post-operatively. The primary outcomes are habitual physical activity and sedentary behaviour which will be measured using accelerometry (Actigraph GTX3+ and activPal monitors) at the specific time points. The secondary outcomes will be improvements in osteoarthritis-specific quality of life measures using the following questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Knee Society Clinical Rating System (KSS), UCLA activity index; subjective pain scores, and self reported sleep quality. Discussion The present study will contribute to the field of musculoskeletal health by providing a rich detailed description of the patterns of accumulation of physical activity and sedentary behaviour in patients with knee OA. These data will contribute to existing knowledge using an objective measurement for the assessment of functional ability after total knee arthroplasty. Although studies have used accelerometry to measure physical activity in knee OA patients, the data provided thus far have not delved into the detailed patterns of how and when physical activity is accumulated before and after TKA. Accurate assessment of physical activity is important for physical activity interventions that target special populations. Trial registration NCT02675062 (4 February 2016).
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Affiliation(s)
- Rebecca M Meiring
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa.
| | - Emmanuel Frimpong
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Lipalo Mokete
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Jurek Pietrzak
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Dick Van Der Jagt
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, Department of Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Joanne A McVeigh
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa.,School of Physiotherapy and Exercise Science, Curtin University, Kent St, Bentley, Western Australia
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39
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Kahn TL, Schwarzkopf R. Do Total Knee Arthroplasty Patients Have a Higher Activity Level Compared to Patients With Osteoarthritis? Geriatr Orthop Surg Rehabil 2016; 7:142-7. [PMID: 27551572 PMCID: PMC4976738 DOI: 10.1177/2151458516654518] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Despite the alleviation of osteoarthritis (OA) symptoms that total knee arthroplasty (TKA) provides for patients with end-stage knee OA, recent studies have suggested that TKA may not increase physical activity levels. In this study, we compare the physical activity levels of patients with OA treated nonoperatively (non-TKA) with both patients who had received TKA (post-TKA) and patients who received TKA within 3 years of data collection (pre-TKA). Methods: Utilizing the Osteoarthritis Initiative database, accelerometry data were collected from non-TKA, pre-TKA, and post-TKA patients. Accelerometry data were subdivided by physical activity intensity levels, yielding daily minutes of each level of activity. Physical activity levels were then compared between non-TKA and pre-TKA/post-TKA patients. Physical activity levels for each patient were also compared to the Department of Health and Human Services (DHHS) guidelines for physical activity. Results: There was no difference in physical activity between non-TKA and pre-TKA patients, with the exception of non-TKA patients achieving more daily minutes of vigorous activity (P < .001). There was no difference in physical activity between non-TKA and post-TKA patients. Although 11.6% of non-TKA patients met DHHS guidelines, only 4.8% of pre-TKA and 5.3% of post-TKA patients met guidelines. Conclusion: Despite the improvements in patient-reported outcome measures following TKA, we found that TKA alone does not improve physical activity levels beyond those seen in the average patient with OA. In our study, the vast majority of patients with OA, treated nonoperatively or operatively, did not meet current DHHS guidelines for physical activity.
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Affiliation(s)
- Timothy L Kahn
- University of California Irvine Medical Center, Orange, CA, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital For Joint Diseases, New York, NY, USA
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40
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Taniguchi M, Sawano S, Kugo M, Maegawa S, Kawasaki T, Ichihashi N. Physical Activity Promotes Gait Improvement in Patients With Total Knee Arthroplasty. J Arthroplasty 2016; 31:984-8. [PMID: 26707650 DOI: 10.1016/j.arth.2015.11.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The study aimed to examine whether the improvement in gait function after total knee arthroplasty (TKA) correlated with the amount of physical activity and whether both gait self-efficacy and gait function are predictors of the amount of physical activity up to 6 months after surgery. METHODS Eighty-one patients were tested preoperatively and at the first and sixth postoperative months after TKA. Physical performance (timed up and go [TUG], sit to stand, muscle strength) and the modified gait efficacy scale scores were evaluated. The average amount of physical activity during the 6 postoperative months was measured with a pedometer with triaxial accelerometer. Stepwise multiple regression analyses were performed using TUG changes and postoperative physical activity. The discriminative properties of physical activity for improvement in gait function were subsequently investigated by applying a receiver operating characteristic curve analysis. RESULTS The multiple regression analyses indicated that the amount of physical activity and the improvement in sit-to-stand time were important in predicting improvement in TUG scores after TKA, and postoperative physical activity up to 6 months was predicted by the modified gait efficacy scale and TUG scores at the first postoperative month. The receiver operating characteristic curve analysis suggests that with a cutoff point of 3053 steps/d, the amount of physical activity may be a good predictive factor for gait function after TKA. CONCLUSION The clinical implications are that increases in physical activity can promote improvement in gait function after TKA and present with a solid numerical target for the recommended amount of physical activity.
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Affiliation(s)
- Masashi Taniguchi
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan; Development and Rehabilitation of Motor Function, Department of Physical Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Shinichiro Sawano
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan
| | - Masato Kugo
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan
| | - Shoji Maegawa
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan
| | - Taku Kawasaki
- Department of Rehabilitation, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan
| | - Noriaki Ichihashi
- Development and Rehabilitation of Motor Function, Department of Physical Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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