Hand-Held Dynamometry in the Inpatient Care Setting After Total Knee Arthroplasty: Reliability of Static Knee Strength Measurements

Reliability, Concurrent Validity, and Minimal Detectable Change of the Hand-Held Dynamometry for the Assessment of Knee Muscle Strength in Patients With Revision Total Knee Arthroplasty

OBJECTIVE

To determine the concurrent validity, reliability, and minimal detectable change (MDC) of the hand-held dynamometry (HHD) for knee strength measurement in patients with revision total knee arthroplasty (r-TKA).

DESIGN

A reliability and validity analysis.

SETTING

Orthopedic and physical therapy services of university hospital.

PARTICIPANTS

The study included 42 patients with r-TKA (N=42).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Knee muscle strength assessments were performed by 2 physiotherapists in 3 different sessions by using HHD. Participants were instructed to exert a maximal force for lasting 5 seconds against HHD. The first examiner performed the strength testing, and after 30-minutes rest, the second examiner performed the same procedure for inter-examiner reliability. One hour after the initial testing, the first examiner reperformed the strength testing for intra-examiner reliability. The correlations of the knee extensors and knee flexors strength with 50-foot walking test and 30-second chair stand test were assessed for concurrent validity.

RESULTS

The inter-examiner reliabilities of knee extensors and flexors strength measurements were 0.97 and 0.95, respectively. The SEM and the minimal detectable changes at 95% confidence level (MDC95) for knee extensors were 10.39 and 28.65 Newton-meters (Nm), and SEM and MDC95 for knee flexors were 8.70 and 23.99 Nm, respectively. The intra-examiner reliabilities of knee extensors and flexors strength measurements were 0.96. SEM and MDC95 for knee extensors were 12.00 and 33.09 Nm, and SEM and MDC95 for knee flexors were 7.78 and 21.45 Nm, respectively. The knee muscle strength showed strong significant correlations with physical performance tests (all, P<.05).

CONCLUSIONS

The HHD is a reliable and valid method for assessment of static knee strength after r-TKA. The HHD can be used to quantify changes in knee strength and also assists the clinicians to determine the effect of rehabilitation programs on muscle strength following r-TKA surgery.

Effectiveness of an online management platform (Joint Cloud) versus standard process for patients undergoing total knee arthroplasty: study protocol for a prospective randomised controlled trial

INTRODUCTION

Osteoarthritis (OA) is one of the main causes of mobility impairment in the elderly worldwide. Therefore, total knee arthroplasty (TKA) is often performed and is one of the most successful surgery and has resulted in substantial quality-of-life gains for people with end-stage arthritis. There is still room for improvement in the standard treatment process in the preoperative, intraoperative and postoperative period of TKA. Telerehabilitation has the potential to become a positive alternative to face-to-face rehabilitation nowadays. But it remains unclear how well telemedicine interventions cover the entire surgical pathway (preoperation, intraoperation, postoperation). This study aims to explore the effectiveness of Joint Cloud (JC, an online management platform) compared with existing standard process in regulating functional recovery, pain management, muscle strength changes and other health-related outcomes in patients undergoing total knee arthroplasty preoperation, intraoperation and postoperation.

METHODS AND ANALYSIS

A randomised controlled trial was designed to compare the online management platform (JC) with standard process (SP) in patients undergoing TKA. A total of 186 TKA patients will be randomly assigned to the intervention (n=93) or control (n=93) group. Patients in the intervention group will receive access to the 'JC' mini-program. This mini-program provides popular science information (eg, information about OA and TKA), functional exercise information and communication channels. Patients evaluate their condition and functional level through standardised digital questionnaires. The control group of patients will not accept any functions of this mini-program. The primary outcome is knee functional recovery, and the secondary outcomes are pain management, isometric knee extensor muscle strength, patient satisfaction and cost-benefit analysis. Assessments will be performed 1 month and 3 days before surgery (T0) and 1 month and 3 months after surgery. Data analysis will be performed according to the intent-to-treat (ITT) principle. Repeated measures of linear mixed models and parametric and non-parametric testing will be used for statistical analysis.

ETHICS AND DISSEMINATION

The study was reviewed and approved by the Tianjin Hospital Medical Ethics Review Committee on 10 February 2023 (2022YLS155). Test data are considered highly sensitive but are available upon request. The findings will be disseminated in peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ChiCTR2300068486.

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

BACKGROUND

Kinesiophobia is an important risk factor for functional activities of patients in the early stage following total knee arthroplasty (TKA).

AIMS

This study aimed to investigate the relationship between fear of movement and associated factors in older patients in the late stage after TKA.

METHODS

The study included 45 older patients (mean age:70.11 ± 0.90 years) with knee osteoarthritis who underwent TKA. Kinesiophobia was assessed with the Tampa Scale of Kinesiophobia (TSK). Pain and strength in the quadriceps femoris (QF) muscle were assessed by the Visual Analog Scale and hand-held dynamometer, respectively. Functional level was determined using the 30-s sit-to-stand test (STS) and 10-m walking test.

RESULTS

There were correlations between TSK and QF muscle strength (r =  -0.538, p < 0.001), activity pain level (r = 0.489, p = 0.001), and 30-s STS (r =  -0.306, p = 0.041). There were no correlations between TSK and age (r = 0.207, p = 0.172) and 10-m walking test (r = 0.112, p = 0.465).

CONCLUSIONS

Increased pain and decreased QF muscle strength and functional level on STS were related with fear of movement in TKA patients. It was concluded that kinesiophobia of older patients with TKA must be considered during the assessment and rehabilitation program in the late stage after TKA.

Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial

PURPOSE

This study aimed to compare progressive muscle relaxation (PMR) + standard physiotherapy (PT) to standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of post-operative outcomes. The hypothesis was that PMR + standard PT would lead to better pain, function, and neuromuscular outcomes than standard PT.

METHODS

A total of 106 patients were randomly allocated into PMR or standard rehabilitation (SR) groups. Both groups received standard PT during their hospital stay. PMR group additionally performed PMR exercise on post-operative days 1, 2, and 3. Patients were evaluated regarding pain intensity, functional outcomes, muscle strength, active range of motion, knee edema, anxiety, depression, and kinesiophobia.

RESULTS

There were no differences between groups at baseline (n.s.). During the inpatient period and at discharge, the PMR group had better results in terms of pain relief (p < 0.05), quadriceps strength (p = 0.001), kinesiophobia level (p = 0.011) compared to the SR group. No difference was detected between groups regarding other evaluation parameters during the inpatient period, at discharge, and third post-operative month (n.s.). The within-group analysis showed statistically significant differences over time in both groups in each variable (p < 0.05).

CONCLUSION

Our findings support that PMR therapy offers beneficial results in subjective and objective measures of TKA patients during the inpatient period. Therefore, PMR therapy could be implemented into the rehabilitation program of TKA patients to enhance their early recovery from various symptoms following TKA.

LEVEL OF EVIDENCE

II.

Comparison of kinesio taping and cold therapy in patients with total knee arthroplasty: A randomized controlled trial

OBJECTIVE

To investigate the effects of kinesio taping and cold therapy on pain, edema, range of motion, muscle strength, functional level and quality of life in patients with total knee arthroplasty.

DESIGN

Randomised controlled trial.

SETTING

A university hospital.

SUBJECTS

One-hundred patients were included.

INTERVENTION

Patients were allocated into three groups; control group, kinesio group and cold therapy group. The control group received a standard rehabilitation program. Kinesio taping group received two fan-shaped kinesio taping bands and cold therapy group received cold packs in addition to the standard rehabilitation program.

MAIN MEASURES

The outcome measures were pain, edema, range of motion, muscle strength, functional level and quality of life. Participants were assessed at preoperative, discharge and postoperative third month.

RESULTS

The groups were similar at preoperative. A significant difference was determined in terms of pain in kinesio taping group compared to the control group at the discharge. Cold therapy was efficient in reducing postoperative swelling but kinesio taping had no significant effects on swelling control. There was no difference between the groups in terms of range of motion, muscle strength, functional level and quality of life. The groups were similar in all parameters at the postoperative third month measurements.

CONCLUSION

Fan-shaped kinesio taping is an effective technique in terms of postoperative pain relief. Cold therapy is an effective method in terms of edema control. Kinesio taping and cold therapy has no specific beneficial effect on functional level, muscle strength and quality of life compared to control group.