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Shetty S, Maiya GA, Kg MR, Vijayan S, George BM. Effect of Core Exercises on Clinical and Functional Outcomes After Total Knee Arthroplasty in Individuals With Knee Osteoarthritis: A Systematic Review. Musculoskeletal Care 2024; 22:e1930. [PMID: 39180196 DOI: 10.1002/msc.1930] [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: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Core muscles constitute the centre of the kinetic chain, and core exercises have been effective in improving outcomes in many postsurgical lower extremity musculoskeletal conditions. However, the literature on the implementation of core exercises after TKA has not been summarised. OBJECTIVE The objective was to review the evidence on the effect of core exercises on clinical and functional outcomes after TKA in individuals with knee osteoarthritis (OA). METHODS PubMed, Scopus, CINAHL, Web of Science, the Cochrane Library, and ProQuest databases were explored with appropriate keywords for studies published on the effect of core exercises on TKA from inception to 1 April 2024. Two authors independently screened the titles and abstracts and full-texts, and a third author solved the discrepancies. Risk of bias assessment was done with the Joanna Briggs Critical Appraisal tool. The final articles were systematically summarised. RESULTS A total of 1485 records were retrieved. Sixty-four articles were included for screening full-texts, and four articles were ultimately included. Core exercises were administered for three to 6 weeks. The administration of core exercises along with the standard knee rehabilitation programme significantly improved balance, mobility, knee function, transverse abdominis muscle thickness, transversus abdominis contraction, and quality of life after TKA (p < 0.05). CONCLUSIONS Core exercises can be administered as an adjunct to standard rehabilitation programs to improve clinical and functional outcomes after TKA. However, there is a dearth of literature in this domain, and more studies are warranted. TRIAL REGISTRATION PROSPERO Registration Number: CRD42024542992.
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Affiliation(s)
- Saidan Shetty
- Department of Anatomy, Melaka Manipal Medical College-Manipal Campus, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - G Arun Maiya
- Department of Physiotherapy, Centre for Podiatry & Diabetic Foot Care and Research, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Mohandas Rao Kg
- Division of Anatomy, Department of Basic Medical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Sandeep Vijayan
- Department of Orthopedics, Kasturba Medical College (KMC) - Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Bincy M George
- Division of Anatomy, Department of Basic Medical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Hummer ET, Porter J, Cates H, Zhang S. Feasibility of Stationary Cycling with Pedal Force Visual Feedback Post-Total Knee Arthroplasty: Implications for Inter-Limb Deficits in Knee Joint Biomechanics. Bioengineering (Basel) 2024; 11:850. [PMID: 39199807 PMCID: PMC11351697 DOI: 10.3390/bioengineering11080850] [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: 06/20/2024] [Revised: 07/27/2024] [Accepted: 08/16/2024] [Indexed: 09/01/2024] Open
Abstract
The purpose of this study was to assess the biomechanical adaptations prompted by stationary cycling paired with visual feedback of vertical pedal reaction forces during both stationary cycling and overground walking for patients who underwent a total knee arthroplasty (TKA). Specifically, an emphasis on the inter-limb deficits in knee joint biomechanics were examined. Ten patients who underwent a TKA took part in an acute intervention with pre- and post-testing measurements of kinematics (240 Hz) and kinetics (1200 Hz) during stationary cycling and overground walking. The intervention phase consisted of six cycling sessions during which participants were provided with visual feedback of their bilateral peak vertical pedal reaction force, with instructions to maintain a symmetrical loading between limbs. A 2 × 2 (work rate/speed × time) repeated measures ANOVA (α = 0.05) was conducted on key outcome variables. Peak knee extension moment asymmetry during stationary cycling significantly improved (p = 0.038, η2p = 0.610) following the acute intervention. Walking velocities for both preferred (p = 0.001, d = 0.583) and fast (p = 0.002, d = 0.613) walking speeds displayed improvements from pre- to post-testing. Significant improvements in the total score (p = 0.009, d = 0.492) and ADL subscale score (p = 0.041, d = 0.270) for the Knee Injury and Osteoarthritis Outcome Score were present following the acute intervention. Stationary cycling with visual feedback may be beneficial post-TKA; however, further investigation is merited.
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Affiliation(s)
- Erik T. Hummer
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Jared Porter
- Department of Kinesiology, Recreation and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA; (J.P.); (S.Z.)
| | - Harold Cates
- Tennessee Orthopedic Clinics, Knoxville, TN 37923, USA;
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA; (J.P.); (S.Z.)
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Nuevo M, Rodríguez-Rodríguez D, Jauregui R, Fabrellas N, Zabalegui A, Conti M, Prat-Fabregat S. Telerehabilitation following fast-track total knee arthroplasty is effective and safe: a randomized controlled trial with the ReHub® platform. Disabil Rehabil 2024; 46:2629-2639. [PMID: 37403684 DOI: 10.1080/09638288.2023.2228689] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE After a total knee arthroplasty (TKA), ensuring rehabilitation is continued at home is essential for a successful recovery. The aim of this randomized clinical trial (NCT04155957) was to demonstrate the safety and efficacy of an interactive telerehabilitation system (ReHub®) to guide and provide feedback during exercise in the postoperative period of a fast-track TKA program. METHODS Fifty-two patients who underwent TKA were randomized to intervention (N = 26) or control (N = 26). Upon discharge, they followed a 4-week plan of 5 daily exercises and up to 10 physiotherapy home visits. The intervention group performed exercises with ReHub® autonomously, control did not use any auxiliary device. Data were collected 1) on the day of discharge, 2) after 2 weeks and 3) after 4 weeks. RESULTS Telerehabilitation patients showed higher adherence to exercise (p = 0.002) and greater quadriceps strength (p = 0.028). No significant differences between groups were found in other outcomes. Only 1 adverse event was linked to ReHub®. Patients gave the platform high System Usability Scale scores (83/100). CONCLUSION Interactive telerehabilitation with ReHub® during a post-TKA exercise program is effective, safe, and well-received by patients. It provides real-time performance feedback and ensures communication. Quadriceps strength and adherence to the exercise plan are improved with ReHub®.
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Affiliation(s)
- Montse Nuevo
- Clinic Institute of Medical and Surgical Specialties (ICEMEQ), Hospital Clinic of Barcelona, Barcelona, Spain
- Nursing Sciences, Faculty of Health Science, University Jaume I, Castellón de la Plana, Spain
| | | | | | - Núria Fabrellas
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Adela Zabalegui
- Department of Research and Teaching in Nursing, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marco Conti
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Salvi Prat-Fabregat
- Clinic Institute of Medical and Surgical Specialties (ICEMEQ), Hospital Clinic of Barcelona, Barcelona, Spain
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San Martín Valenzuela C, Tabarés-Seisdedos R, Payá Rubio A, Correa-Ghisays P, Pedrero-Sánchez JF, Silvestre Muñoz A. Efficiency assessment of follow-up methodology of patients with knee replacement to predict post-surgical functionality: a protocol for randomised control PROKnee trial. BMJ Open 2024; 14:e077942. [PMID: 38719321 PMCID: PMC11086404 DOI: 10.1136/bmjopen-2023-077942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Even when total knee arthroplasty (TKA) is an extended treatment, most patients experience a suboptimal evolution after TKA. The objectives of this study are the following: (1) to determine the effectiveness of two different prosthesis stabilisation systems on the functionality in activities of daily life, and (2) to determine prognostic biomarkers of knee prosthesis function based on radiological information, quantification of cytokines, intra-articular markers and biomechanical functional evaluation to predict successful evolution. METHODS AND ANALYSIS The PROKnee trial was designed as a randomised controlled patient-blinded trial with two parallel groups that are currently ongoing. The initial recruitment will be 99 patients scheduled for their first TKA, without previous prosthesis interventions in lower limbs, who will be randomly divided into two groups that differed in the stabilisation methodology incorporated in the knee prosthesis: the MEDIAL-pivot group and the CENTRAL-pivot group. The maximum walking speed will be reported as the primary outcome, and the secondary results will be patient-reported questionnaires related to physical status, cognitive and mental state, radiological test, laboratory analysis and biomechanical instrumented functional performance, such as the 6-minute walking test, timed up-and-go test, gait, sit-to-stand, step-over, and ability to step up and down stairs. All the results will be measured 1 week before TKA and at 1.5, 3, 6 and 12 months after surgery. ETHICS AND DISSEMINATION All procedures were approved by the Ethical Committee for Research with Medicines of the University Clinical Hospital of Valencia on 8 October 2020 (order no. 2020/181). Participants are required to provide informed consent for the study and for the surgical procedure. All the data collected will be treated confidentially since they will be blinded and encrypted. The results from the trial will be published in international peer-reviewed scientific journals, regardless of whether these results are negative or inconclusive. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04850300).
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Affiliation(s)
- Constanza San Martín Valenzuela
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rafael Tabarés-Seisdedos
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Alfonso Payá Rubio
- Department of Rehabilitation, University Clinical Hospital of Valencia / INCLIVA Health Research Institute, Valencia, Spain
| | - Patricia Correa-Ghisays
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Antonio Silvestre Muñoz
- Department of Orthopedic Surgery, University Clinical Hospital of Valencia / INCLIVA Health Research Institute, Valencia, Spain
- Department of Surgery, Faculty of Medicine, University of Valencia, Valencia, Spain
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Núñez-Cortés R, López-Bueno L, López-Bueno R, Cuenca-Martínez F, Suso-Martí L, Silvestre A, Casaña J, Cruz-Montecinos C, Andersen LL, Calatayud J. Acute Effects of In-Hospital Resistance Training on Clinical Outcomes in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial. Am J Phys Med Rehabil 2024; 103:401-409. [PMID: 38063321 DOI: 10.1097/phm.0000000000002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The aim of the study is to evaluate the acute responses, in the in-hospital setting, of intensive elastic resistance training on physical function, pain, psychosocial variables, and inflammatory markers in patients undergoing total knee arthroplasty. DESIGN In a randomized controlled trial, 40 patients with total knee arthroplasty (≥55 yrs) were assigned to either (1) the intervention group (elastic resistance strengthening) or (2) a control group (conventional protocol). Patients performed three sessions in the hospital at 24, 48, and 72 hrs after total knee arthroplasty. Outcome measures included: self-administered physical function, pain intensity, kinesiophobia, catastrophizing, self-efficacy, range of motion, perceived change, test timed up and go, knee joint effusion, isometric strength, pressure pain thresholds, and inflammatory markers (levels of procalcitonin and C-reactive protein). RESULTS The mixed analysis of variance model showed a significant group*time interaction in favor of the intervention group with a large effect size for kinesiophobia (ηp 2 = 0.308, P < 0.001), catastrophizing (ηp 2 = 0.242, P < 0.001), and passive range of motion flexion (ηp 2 = 0.167, P < 0.001) and a moderate effect size for physical function (ηp 2 = 0.103, P = 0.004), pain intensity (ηp 2 = 0.139, P < 0.001), timed up and go (ηp 2 = 0.132, P = 0.001), self-efficacy (ηp 2 = 0.074, P = 0.016), active range of motion flexion (ηp 2 = 0.121, P = 0.002), levels of procalcitonin (ηp 2 = 0.099, P = 0.005), and C-reactive protein (ηp 2 = 0.106, P = 0.004). CONCLUSIONS Three sessions of intensive elastic resistance training improve physical function, perceived pain, psychosocial variables, and inflammatory markers during the hospitalization period after total knee arthroplasty.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- From the Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain (RN-C, CC-M); Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile (RN-C, CC-M); Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain (LL-B, RL-B, FC-M, LS-M, JCas, JCal); Physiotherapy Service, University Clinical Hospital of Valencia, Valencia, Spain (LL-B); Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain (RL-B); National Research Centre for the Working Environment, Copenhagen, Denmark (RL-B, LLA, JCal); Department of Orthopaedic Surgery, Clinic Hospital of Valencia, Valencia, Spain (AS); Department of Orthopaedic Surgery, School of Medicine, University of Valencia, Valencia, Spain (AS); and Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile (CC-M)
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Jiao S, Feng Z, Dai T, Huang J, Liu R, Meng Q. High-Intensity Progressive Rehabilitation Versus Routine Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2024; 39:665-671.e2. [PMID: 37634879 DOI: 10.1016/j.arth.2023.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND This study aimed to compare the effectiveness of high-intensity progressive rehabilitation training with routine training in the early treatment of patients undergoing total knee arthroplasty. METHODS There were 78 patients who underwent total knee arthroplasty and were randomized into high-intensity progressive training and routine rehabilitation training groups (RRT). The primary outcome measures were the American Hospital for Special Surgery Knee Score (HSS), with secondary outcomes including patient satisfaction, visual analog pain score, first time of standing after surgery, 6-minute walk test, 36-Item Short Form Survey (SF-36), and length of hospital stay. The incidence of postoperative complications were recorded. RESULTS The HSS scores were higher in the intervention group at 2 weeks, 3 months, and 12 months postoperatively (P < .001). The RRT group had higher visual analog pain scores than the intervention group at 24 hours, 3 days, and 2 weeks after surgery (P < .001). The intervention group had an earlier the first time of standing after surgery and a longer 6-minute walk test distance (P < .001, P = .028, P < .001, P < .001). Patient satisfaction was higher in the intervention group, with a higher quality of life rating at 3 months postoperatively (P < .001). However, 1 year after surgery, the 2 groups had no significant differences in mental component summaries. The length of hospital stay was shorter in the intervention group than in the RRT group. CONCLUSION Compared to routine training, high-intensity progressive rehabilitation training is more effective. It reduces postoperative patient pain, accelerates recovery of joint function, increases patient satisfaction, improves quality of life, shortens hospital stays, and promotes rapid recovery.
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Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Tianming Dai
- Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Hubei, China
| | - Ruijia Liu
- Department of Orthopedics, Foshan Fosun Chancheng Hospital, Foshan, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
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Lee B, Yoon D, Yim J. Effects of an Early Exercise Program with Cryotherapy on Range of Motion, Pain, Swelling, and Gait in Patients with Total Knee Arthroplasty: A Randomized Controlled Trial. J Clin Med 2024; 13:1420. [PMID: 38592218 PMCID: PMC10933851 DOI: 10.3390/jcm13051420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: This study aimed to investigate the effects of cryotherapy on range of motion, pain, swelling, and gait in patients who underwent total knee arthroplasty. Methods: Forty-three patients who underwent TKA (total knee arthroplasty) and met the inclusion criteria were randomly divided into two groups. The experimental (n = 21) and control (n = 22) groups underwent cryotherapy and non-cryotherapy treatments, respectively, six times a week for two weeks, and once each before and after exercise for 3 min. Both groups followed a similar initial rehabilitation exercise program using a continuous passive motion device. Results: The results showed a significant difference in knee flexion range of motion, pain, edema, and 10 MWT comparisons from pre- to post-test (p < 0.001). The above values were also significantly different in the comparison between the two groups (p < 0.05). Conclusions: Therefore, this study confirmed that an initial rehabilitation exercise program accompanied by cryotherapy could be an effective intervention method for range of motion, pain, edema, and walking in patients undergoing total knee arthroplasty.
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Affiliation(s)
| | | | - Jongeun Yim
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul 01795, Republic of Korea; (B.L.); (D.Y.)
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Park KJ, Seo TB, Kim YP. Effects of proprioceptive neuromuscular facilitation and both sides up ball exercise on pain level, range of motion, muscle function after total knee arthroplasty. J Exerc Rehabil 2024; 20:17-23. [PMID: 38433857 PMCID: PMC10902696 DOI: 10.12965/jer.2448004.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 03/05/2024] Open
Abstract
Knee osteoarthritis (OA) is a degenerative joint disease caused tearing and progressive wear of articular cartilage, and total knee arthroplasty (TKA) is recommended to patients with OA. The purpose of this study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF) and both sides up ball (BOSU) exercises on pain, range of motion (ROM), and muscle function in patients following TKA. Ten participants who have limitation of the knee joint from TKA were divided into two groups: the continuous passive motion (CPM)+PNF exercise group (n=5) and the CPM+BOUS exercise group (n=5). Exercise rehabilitation program consisted of PNF and BOSU exercises, and both exercises were performed twice a day for 2 weeks. To examine effect of exercise rehabilitation, visual analogue scale (VAS), sit and reach flexibility, knee ROM, and Timed Up and Go test (TUG) were measured before and after exercise intervention. A two-way repeated analysis of variance was used to confirm the main effect. If there was a significant interaction effect, an independent t-test between groups or a paired t-test between times was applied. VAS, sit and reach flexibility, knee ROM and TUG did not show interaction between the PNF and BOSU exercise groups, but all measured variables showed significant differences over time. Present findings provide information that PNF and BOSU exercise rehabilitation after TKA might be an important part of ensuring successful surgical outcomes as they have a positive impact on reducing pain, increasing ROM, improving muscle strength, and enhancing daily life movements.
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Affiliation(s)
- Keon-Ju Park
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju,
Korea
| | - Tae-Beom Seo
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju,
Korea
| | - Young-Pyo Kim
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju,
Korea
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Jiao S, Feng Z, Huang J, Dai T, Liu R, Meng Q. Enhanced recovery after surgery combined with quantitative rehabilitation training in early rehabilitation after total knee replacement: a randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:74-83. [PMID: 37934189 PMCID: PMC10938034 DOI: 10.23736/s1973-9087.23.07899-1] [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: 01/30/2023] [Revised: 09/22/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The number of patients undergoing total knee replacement (TKR) is increasing yearly; however, there is still a relative lack of specific, individualized, and standardized protocols for functional exercise after TKR. Quantitative rehabilitation training was developed to improve the recovery of postoperative joint function, increase patient satisfaction, shorten the length of the hospital stay, improve the quality of life, and promote rapid patient recovery. AIM We aimed to compare the effectiveness of quantitative rehabilitation training based on the enhanced recovery after surgery (ERAS) concept with conventional rehabilitation training in the early rehabilitation of patients with TKR. DESIGN This was a single-centre, prospective, randomized controlled trial. SETTING Inpatient department. POPULATION Participants were patients who underwent unilateral total knee replacement. METHODS Based on the ERAS concept, a quantitative rehabilitation training program was developed for the quantitative group, and the control group underwent conventional rehabilitation training. Seventy-eight patients undergoing TKR were randomly divided into two blinded groups: the quantitative rehabilitation group and the conventional rehabilitation group. The analysis was performed according to per-protocol practice. The primary outcome metric was the Hospital for Special Surgery Knee Score (HSS Score), and secondary outcomes included patient satisfaction, Visual Analog Pain Score (VAS), time to get out of bed for the first time after surgery, 6-minute-walk test (6MWT), quality-of-life score (SF-36), and number of days in the hospital. The incidence of postoperative complications was also recorded. RESULTS There was no significant difference in HSS scores between the two groups before surgery (P=0.967), but the quantitative rehabilitation training group had significantly higher scores at two weeks (P=0.031), 3 months (P<0.01), and 12 months (P<0.01) after surgery than did the conventional rehabilitation training group, and both groups had higher HSS scores than before surgery. The quantitative training group had significantly higher VAS scores at 24 hours and three days postoperatively than the conventional training group (P<0.01), while there was no statistical significance at any other time points. The quantitative rehabilitation group had an earlier time to get out of bed for the first time after surgery (P<0.01), a longer 6MWT distance (P=0.028), and higher patient satisfaction and quality of life scores (SF-36) (P<0.01) that did the control group. The number of days in the hospital was lower in the quantitative training group than in the control group (P<0.001). There was no significant difference in the incidence of postoperative complications between the two groups. CONCLUSIONS Compared with conventional rehabilitation training, quantitative rehabilitation training based on the ERAS concept was found to be safe and effective and can accelerate the recovery of joint function after surgery, shorten hospitalization time, improve patient satisfaction, and promote rapid recovery. CLINICAL REHABILITATION IMPACT The quantitative rehabilitation training based on the ERAS concept provides a new program for rehabilitation exercises after total knee arthroplasty, which is safe and reliable, accelerates the recovery of joint function, and should be considered for clinical promotion.
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Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopedics, The Central Hospital of Xiaogan, Hubei, China
| | - Tianming Dai
- Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Ruijia Liu
- Department of Orthopedics, Fosun Chancheng Hospital of Foshan, Foshan, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China -
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Prüfer F, Pavlović M, Matko Š, Löfler S, Fischer MJ, Šarabon N, Grote V. Responsiveness of Isokinetic Dynamometry in Patients with Osteoarthritis after Knee and Hip Arthroplasty: A Prospective Repeated-Measures Cohort Study. Healthcare (Basel) 2024; 12:314. [PMID: 38338199 PMCID: PMC10855832 DOI: 10.3390/healthcare12030314] [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: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Functional assessments are crucial for the evaluation of rehabilitation after total knee (TKA) and hip (THA) arthroplasty. Muscle strength, a key determinant of physical function (PF), is often measured with isokinetic dynamometry (ID), which is considered the gold standard. However, studies lack evaluations of responsiveness-the ability to detect changes over time. This study aims to determine the responsiveness of ID in measuring PF in TKA and THA rehabilitation-is muscle strength a valid indicator for assessing improvement in rehabilitation processes? The pre- and post-surgery PF of 20 osteoarthritis patients (age 55-82) was assessed, using ID, performance-based and self-reported measures. Responsiveness was evaluated by comparing the observed relationship of changes in ID and PF scores with the a priori defined expected relationship of change scores. While the performance-based and self-reported measures showed significant improvements post-surgery (Cohen's d [0.42, 1.05] p < 0.05), ID showed no significant differences. Moderate correlations were found between changes in some ID parameters and selected functional tests (r ≈|0.5|, p < 0.05). Responsiveness was solely found for the peak torque of knee extension at 180°/s on the operated side. Responsiveness is an often-overlooked psychometric property of outcome measurements. The findings suggest that ID may not be fully responsive to the construct of PF after TKA and THA, raising questions about its role and usefulness in this context and the need for more appropriate assessment methods.
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Affiliation(s)
- Ferdinand Prüfer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Monika Pavlović
- Faculty of Health Sciences, University of Ljubljana, SI-1000 Ljubljana, Slovenia;
| | - Špela Matko
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Vamed Rehabilitation Center Kitzbühel, A-6370 Kitzbühel, Austria
| | - Nejc Šarabon
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Faculty of Health Sciences, University of Primorska, SI-6310 Izola, Slovenia
- Innorenew CoE, SI-6310 Izola, Slovenia
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
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Eymir M, Unver B, Karatosun V. 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. Arch Phys Med Rehabil 2024; 105:34-39. [PMID: 37263533 DOI: 10.1016/j.apmr.2023.05.002] [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: 03/10/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Musa Eymir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Erzurum Technical University, Yakutiye-Erzurum, Turkey.
| | - Bayram Unver
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balçova-Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylul University, Balçova-Izmir, Turkey
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Mennella C, Maniscalco U, Pietro GD, Esposito M. A deep learning system to monitor and assess rehabilitation exercises in home-based remote and unsupervised conditions. Comput Biol Med 2023; 166:107485. [PMID: 37742419 DOI: 10.1016/j.compbiomed.2023.107485] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
In the domain of physical rehabilitation, the progress in machine learning and the availability of cost-effective motion capture technologies have paved the way for innovative systems capable of capturing human movements, automatically analyzing recorded data, and evaluating movement quality. This study introduces a novel, economically viable system designed for monitoring and assessing rehabilitation exercises. The system enables real-time evaluation of exercises, providing precise insights into deviations from correct execution. The evaluation comprises two significant components: range of motion (ROM) classification and compensatory pattern recognition. To develop and validate the effectiveness of the system, a unique dataset of 6 resistance training exercises was acquired. The proposed system demonstrated impressive capabilities in motion monitoring and evaluation. Notably, we achieved promising results, with mean accuracies of 89% for evaluating ROM-class and 98% for classifying compensatory patterns. By complementing conventional rehabilitation assessments conducted by skilled clinicians, this cutting-edge system has the potential to significantly improve rehabilitation practices. Additionally, its integration in home-based rehabilitation programs can greatly enhance patient outcomes and increase access to high-quality care.
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Affiliation(s)
- Ciro Mennella
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy.
| | - Umberto Maniscalco
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy.
| | - Giuseppe De Pietro
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
| | - Massimo Esposito
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
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13
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Wang Z, Zhou Z, Wang Q. Hip Exoskeleton Based Indirect Intervention Strategy Towards Gait Training After Total Knee Arthroplasty. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941168 DOI: 10.1109/icorr58425.2023.10304818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Total Knee Arthroplasty (TKA) is the most effective approach for function restoration in patients with severe knee osteoarthritis. However, kinematic, kinetic and muscle activation differences between post-TKA patients and healthy people can be observed in many studies. Exoskeletons have been applied to post-TKA rehabilitation for many years, while few studies concentrated on the stance phase abnormality, neither in the aspect of kinematics nor in muscle activation. In this paper, we propose an indirect resistance strategy for post-operative TKA patient gait training. Three healthy subjects were asked to wear the hip exoskeleton and provided with 8 N·m resistance on the hip extension phase of the gait cycle. The intervention leads to an increment in the knee extension muscle activity as well as the augmentation in maximum knee angle in loading response. The results indicated that the application of resistance in the hip extension phase is a potential therapeutic approach for post-TKA rehabilitation, and may increase the gait training efficiency in the near future.
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14
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Thorsen T, Wen C, Porter J, Reinbolt JA, Weinhandl JT, Zhang S. Do Interlimb Knee Joint Loading Asymmetries Persist throughout Stance during Uphill Walking Following Total Knee Arthroplasty? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6341. [PMID: 37510574 PMCID: PMC10378950 DOI: 10.3390/ijerph20146341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
The purpose of this study was to determine differences in total (TCF), medial compartment (MCF), and lateral compartment (LCF) tibiofemoral joint compressive forces and related muscle forces between replaced and non-replaced limbs during level and uphill walking at an incline of 10°. A musculoskeletal modeling and simulation approach using static optimization was used to determine the muscle forces and TCF, MCF, and LCF for 25 patients with primary TKA. A statistical parametric mapping repeated-measures ANOVA was conducted on knee compressive forces and muscle forces using statistical parametric mapping. Greater TCF, MCF, and LCF values were observed throughout the loading response, mid-stance, and late stance during uphill walking. During level walking, knee extensor muscle forces were greater throughout the first 50% of the stance during level walking, yet greater during uphill walking during the last 50% of the stance. Conversely, knee flexor muscle forces were greater through the loading response and push-off phases of the stance. No between-limb differences were observed for compressive or muscle forces, suggesting that uphill walking may promote a more balanced loading of replaced and non-replaced limbs. Additionally, patients with TKA appear to rely on the hamstrings muscle group during the late stance for knee joint control, thus supporting uphill walking as an effective exercise modality to improve posterior chain muscle strength.
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Affiliation(s)
- Tanner Thorsen
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Chen Wen
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Jared Porter
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Jeffery A Reinbolt
- Department of Mechanical, Aerospace, and Biomedical Engineering, The University of Tennessee, Knoxville, TN 37996, USA
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
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15
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Baltaci G, Ozunlu Pekyavas N, Atay OA. Short-time Effect of Sterile Kinesio Tape applied during Anterior Cruciate Ligament Reconstruction on Edema, Pain and Range of Motion. Res Sports Med 2023; 31:550-561. [PMID: 34856838 DOI: 10.1080/15438627.2021.2010203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate the effects of edema, pain, and range of motion of knee by sterile kinesio taping within 3 days after ACLR. We hypothesized that sterile taping which is a new material of kinesio taping reduces knee pain and swelling and improves knee range of movement after ACLR. Fifty-sixth subjects who underwent an elective ACLR with were randomized into intervention(n=28) and control groups(n=28). Subjects from both groups received standardized postoperative physiotherapy. Pain by VAS, total ROM of the knee, and circumferential girth were measured at the first, second- and third-day post-surgery. There were found statistically significant differences in all study parameters within each group. Comparison of the study parameters between both groups revealed a statistical significance at various time points except the reduction of pain in the taping group in the early postoperative phase (between the first and second day) (P<0.05). There was no statistical significance in the reduction of swelling or improvement of knee total ROM with kinesio taping. This study showed that sterile kinesio taping reduced pain, improved ROM of the knee and decreased edema in the early post-operative period after ACLR.
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Affiliation(s)
- Gul Baltaci
- Department of Physical Therapy and Rehabilitation, Private Guven Hospital, Ankara, Turkey
| | - Nihan Ozunlu Pekyavas
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Baskent University, Ankara, Turkey
| | - Ozgur Ahmet Atay
- Faculty of Medicine, Department of Orthopaedics and Traumotology, Hacettepe University, Ankara, Turkey
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16
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Cheuy VA, Dayton MR, Hogan CA, Graber J, Anair BM, Voigt TB, Nelms NJ, Stevens-Lapsley JE, Toth MJ. Neuromuscular electrical stimulation preserves muscle strength early after total knee arthroplasty: Effects on muscle fiber size. J Orthop Res 2023; 41:787-792. [PMID: 35856287 PMCID: PMC9852352 DOI: 10.1002/jor.25418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/04/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023]
Abstract
Loss of quadriceps strength after total knee arthroplasty (TKA) is most pronounced acutely but persists long-term, negatively impacting physical function in daily activities. Neuromuscular electrical stimulation (NMES) early after surgery is an effective adjuvant to standard of care rehabilitation (SOC) for attenuating strength loss following TKA, but the mechanisms whereby NMES maintains strength are unclear. This work aimed to determine the effects of early NMES on quadriceps strength and skeletal muscle fiber size 2 weeks after TKA compared to SOC. Patients scheduled for primary, unilateral TKA were enrolled and randomized into SOC (n = 9) or NMES plus SOC (n = 10) groups. NMES was started within 48 h of TKA, with 45-min sessions twice a day for 2 weeks. Isometric quadriceps strength was assessed preoperatively and 2 weeks following TKA. Vastus lateralis muscle biopsies of the involved leg were performed at the same time points and immunohistochemistry conducted to assess muscle fiber cross-sectional area and distinguish fiber types. Groups did not differ in age, body mass index, sex distribution, or preoperative strength. Both groups got weaker postoperatively, but the NMES group had higher normalized strength. After 2 weeks, the group receiving NMES and SOC had significantly greater MHC IIA and MHC IIA/IIX fiber size compared to SOC alone, with no group differences in MHC I fiber size. These results suggest that NMES mitigates early muscle weakness following TKA, in part, via effects on fast-twitch, type II muscle fiber size. This investigation advances our understanding of how adjuvant, early postoperative NMES aids muscle strength recovery.
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Affiliation(s)
- Victor A Cheuy
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Michael R Dayton
- Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Craig A Hogan
- Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Bradley M Anair
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Thomas B Voigt
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Nathaniel J Nelms
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Michael J Toth
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, Vermont, USA
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17
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Humphrey TJ, Salimy MS, Jancuska JM, Egan CR, Melnic CM, Alpaugh K, Bedair HS. Sarcopenia is an independent risk factor for failure to achieve the 1-year MCID of the KOOS, JR and PROMIS PF-SF10a after TKA. Knee 2023; 42:64-72. [PMID: 36913864 DOI: 10.1016/j.knee.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/07/2023] [Accepted: 02/28/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Sarcopenia, which is a progressive and multifactorial condition of decreased muscle strength, has been identified as an independent predictor for falls, revision, infection, and readmissions following total knee arthroplasty (TKA), but its association to patient reported outcomes (PROMs) is less studied. The aim of this study is to determine if sarcopenia and other measures of body composition are correlated with ability to achieve the 1-year minimal clinically important difference (MCID) of the KOOS JR and PROMIS-PF-SF10a following primary TKA. METHODS A multicenter retrospective case-control study was performed. Inclusion criteria consisted of patients over the age of 18 undergoing primary TKA, body composition metrics determined by computed tomography (CT), and available pre- and post-operative PROM scores. Predictors of achievement of the 1-year MCID of the KOOS JR and PROMIS PF-SF-10a were determined through a multivariate linear regression. RESULTS 140 primary TKAs met inclusion criteria. 74 (52.85%) patients achieved the 1-year KOOS, JR MCID and 108 (77.41%) patients achieved the 1-year MCID for the PROMIS PF-SF10a. Sarcopenia was independently associated with decreased odds of achieving the MCID of both the KOOS, JR (OR 0.31, 95%CI 0.10-0.97, p = 0.04) and the PROMIS-PF-SF10a (OR 0.32, 95%CI 0.12-0.85, p = 0.02) CONCLUSIONS: In our study, sarcopenia was independently associated with increased odds of failure to achieve the 1-year MCID of the KOOS, JR and PROMIS PF-SF10a after TKA. Early identification of sarcopenic patients may be beneficial for arthroplasty surgeons so that targeted nutritional counseling and exercises can be recommended prior to TKA.
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Affiliation(s)
- Tyler J Humphrey
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States.
| | - Jeffrey M Jancuska
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Cameron R Egan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, MA, United States.
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18
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Rudolph KS, Cloutier M, Stackhouse S. Pain inhibition-the unintended benefit of electrically elicited muscle strengthening contractions. BMC Musculoskelet Disord 2023; 24:131. [PMID: 36803339 PMCID: PMC9938574 DOI: 10.1186/s12891-023-06243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/15/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) is effective in muscle strengthening after orthopedic injury particularly when muscle activation failure is present, but the associated pain can be a barrier. Pain itself can produce a pain inhibitory response called Conditioned Pain Modulation (CPM). CPM is often used in research studies to assess the state of the pain processing system. However, the inhibitory response of CPM could make NMES more tolerable to patients and could improve functional outcomes in people with pain. This study compares the pain-inhibitory effect of NMES compared to volitional contractions and noxious electrical stimulation (NxES). METHODS Healthy participants, 18-30 years of age experienced 3 conditions: 10 NMES contractions, 10 bursts of NxES on the patella, and 10 volitional contractions on the right knee. Pressure pain thresholds (PPT) were measured before and after each condition in both knees and the middle finger. Pain was reported on an 11-point VAS. Repeated measures ANOVAs with 2 factors: site and time were performed for each condition followed by post-hoc paired t-tests, with Bonferroni correction. RESULTS Pain ratings were higher in the NxES condition compared to NMES (p = .000). No differences in PPTs prior to each condition were observed but PPTs were significantly higher in the right and left knees after the NMES contractions (p = .000, p = .013, respectively) and after the NxES (p = .006, P-.006, respectively). Pain during NMES and NxES did not correlate with pain inhibition (p > .05). Self-reported pain sensitivity correlated with pain during NxES. CONCLUSION NxES and NMES produced higher PPTs in both knees but not in the finger, suggesting that the mechanisms responsible for the reduction in pain are located in the spinal cord and local tissues. Pain reduction was elicited during the NxES and NMES conditions regardless of the self-reported pain ratings. When NMES is used for muscle strengthening significant pain reduction can also occur, which is an unintended benefit of the intervention that could improve functional outcomes in patients.
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Affiliation(s)
- Katherine S. Rudolph
- grid.266826.e0000 0000 9216 5478Department of Physical Therapy, University of New England, 716 Stevens Ave., Portland, ME 04103 USA
| | - Matthew Cloutier
- grid.266826.e0000 0000 9216 5478College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
| | - Scott Stackhouse
- grid.266826.e0000 0000 9216 5478Department of Physical Therapy, University of New England, 716 Stevens Ave., Portland, ME 04103 USA
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Thorsen T, Wen C, Porter J, Reinbolt J, Weinhandl JT, Zhang S. Tibiofemoral compressive force during downhill walking in patients with primary total knee arthroplasty: A statistical parametric mapping approach. Clin Biomech (Bristol, Avon) 2023; 102:105900. [PMID: 36739666 DOI: 10.1016/j.clinbiomech.2023.105900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/09/2023] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Downhill walking is a necessary part of daily life and an effective activity in post-operative rehabilitation following total knee arthroplasty. The purpose of this study was to determine differences in the behavior of total, medial, and lateral tibiofemoral compressive forces as well as knee extensor and flexor muscle forces between different limbs of patients with total knee arthroplasty (replaced, non-replaced) during downhill and level walking. METHODS Musculoskeletal modeling and simulation were implemented to determine muscle forces and tibiofemoral compressive forces in 25 patients with total knee arthroplasty. A 2 × 2 [Limb (replaced, non-replaced) × Slope (0°, 10°)] Statistical parametric mapping repeated measures analysis of variance was conducted on selected variables. FINDINGS Statistical parametric mapping did not identify any between-limb differences for compressive or muscle forces. Differences in joint compressive and muscle forces persisted throughout different intervals of stance-phase between level and downhill walking. Knee extensor muscle forces were distinctly greater during level walking for nearly all of stance phase. Knee flexor muscle force was greater during downhill walking for >60% of stance. Statistical parametric mapping did identify regions of significance between level and downhill walking that coincided temporally (near loading response and push off) with peak joint moment and joint compressive forces traditionally reported using discrete variable analyses. INTERPRETATION Downhill walking may be a safe and useful rehabilitation tool for post-knee arthroplasty rehabilitation that will not disproportionally load either the replaced or the non-replaced joint and where the quadriceps muscles can be strengthened during a gait-specific task.
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Affiliation(s)
- Tanner Thorsen
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Chen Wen
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Jared Porter
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Jeffery Reinbolt
- Department of Mechanical, Aerospace, and Biomedical Engineering, The University of Tennessee, Knoxville, TN, USA
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA.
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20
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Kitamura G, Nankaku M, Yuri T, Kuriyama S, Nakamura S, Nishitani K, Ikeguchi R, Matsuda S. Interactive Combinations Between Gait Speed and Physical Function at Acute Phase Can Predict the Physical Activity at 2 Years After Total Knee Arthroplasty Using Classification and Regression Tree Analysis. Arch Phys Med Rehabil 2023:S0003-9993(23)00030-8. [PMID: 36706890 DOI: 10.1016/j.apmr.2022.12.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To clarify the interactive combinations of various clinical factors associated with physical activity (PA) at 2 years after total knee arthroplasty (TKA) using classification and regression tree (CART) analysis. DESIGN A retrospective cohort study. SETTING A single university hospital. PARTICIPANTS 286 patients who underwent TKA (N=286). MAIN OUTCOME MEASURES PA was assessed preoperatively, 3 weeks, and 2 years after TKA. Physical functions, namely, 10 m walking test (10MWT), timed Up and Go test, 1-leg standing time, isometric knee extension and flexion strength, knee joint stability, knee pain, femora-tibial angle, and the passive knee extension and flexion angle, were measured before surgery as a baseline and 3 weeks after TKA as acute phase. CART analysis was conducted to clarify the interactive combinations that accurately predict the PA at 2 years after TKA. RESULTS The results of CART analysis indicated that gait speed (≥1.05 m/s) at the acute phase after TKA was the primal predictor for the postoperative PA at 2 years. The highest postoperative PA at 2 years was determined by gait speed (≥1.05 m/s) and PA (>74.5) at the acute phase. The PA at baseline and at acute phase, as well as the body mass index were also selected as predictors of postoperative PA at 2 years. CONCLUSION The present study suggested that acquiring gait speed (≥1.05 m/s) and PA (>74.5) in the postoperative acute phase is the predictive of a high PA at 2 years after TKA.
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Affiliation(s)
- Gakuto Kitamura
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takuma Yuri
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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21
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Ong CB, Cororaton AD, Westrich GH, Cushner FD, Haas SB, Della Valle AG. COVID-19 disruptions to elective postoperative care did not adversely affect early complications or patient reported outcomes of primary TKA. Arch Orthop Trauma Surg 2023; 143:1579-1591. [PMID: 35378597 PMCID: PMC8978771 DOI: 10.1007/s00402-022-04422-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/10/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Elective orthopedic care, including in-person office visits and physical therapy (PT), was halted on March 16, 2020, at a large, urban hospital at the onset of the local COVID-19 surge. Post-discharge care was provided predominantly through a virtual format. The purpose of this study was to assess the impact of postoperative care disruptions on early total knee arthroplasty (TKA) outcomes, specifically 90-day complications, 120-day rate of manipulation under anesthesia (MUA) and 1-year patient-reported outcome measures (PROMs). MATERIALS AND METHODS Institutional records were queried to identify 624 patients who underwent primary, unilateral TKA for osteoarthritis and who were discharged home between 1/1/20 and 3/15/20. These patients were compared to 558 controls discharged between 1/1/19 and 3/15/2019. Cohort demographics and in-hospital characteristics were equivalent apart from inpatient morphine milligram equivalent (MME) consumption. Patient-reported access to PT (p < 0.001) and post-discharge care (p < 0.001) were worse among study patients. Study patients were prescribed fewer post-discharge PT sessions (19.8 vs. 23.5; p < 0.001) and utilized telehealth more frequently (p < 0.001). Mann-Whitney U, T, Fisher's Exact, and chi-squared tests were used to compare outcomes. RESULTS Ninety-day CMS complications were lower among study patients (3.5% vs. 5.9%; p = 0.05). Rates of MUA were similar between groups. Study patients reported similar PROMs and marginally inferior VR-12 mental and LEAS functional outcomes at 1 year. CONCLUSION Disruptions to elective orthopedic care in March 2020 seemed to have had no major consequences on clinical outcomes for TKA patients. Our findings question the usefulness of pre-pandemic post-discharge protocols, which may over-emphasize in-person visits and PT.
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Affiliation(s)
- Christian B. Ong
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Agnes D. Cororaton
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Geoffrey H. Westrich
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Fred D. Cushner
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Steven B. Haas
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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22
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King SW, Eltayeb M, van Duren BH, Jain S, Kerry J, Pandit HG, Palan J. “Wearable Sensors to Guide Remote Rehabilitation Following Knee Arthroplasty Surgery”. Indian J Orthop 2022; 57:624-634. [PMID: 37128555 PMCID: PMC10147850 DOI: 10.1007/s43465-022-00785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Background Total knee arthroplasty requires effective rehabilitation to achieve optimal results, but institutions often rely on unsupervised home exercises due to cost constraints. Wearable sensors have become increasingly popular as a potential method of monitoring patients remotely to ensure efficacy and compliance. This review assesses the current evidence for their use in remotely monitored rehabilitation following knee arthroplasty. Methods A systematic review of the literature from 1st January 2000 to 17th February 2022 was undertaken. Devices were categorised as joint-specific or physical activity sensors. Studies were classified as those providing remotely supervised rehabilitation as an additional or as an alternative intervention. Results Remotely supervised rehabilitation using wearable sensors demonstrated similar outcomes when provided as an alternative to standard care in most studies. One group found improved outcomes for knee-specific sensors compared with standard care. There were improved physical activity and healthcare resource use outcomes described in the literature where sensors were used in addition to standard care. Discussion This review found evidence for the use of wearable sensors in remotely supervised rehabilitation following knee arthroplasty surgery. This included methodological heterogeneity, differing definitions of standard care, and variable follow-up periods. Robust randomised control trial data with a longer follow-up period are needed.
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Affiliation(s)
- Samuel W. King
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Momin Eltayeb
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Bernard H. van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Sameer Jain
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Joel Kerry
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Hemant G. Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Jeya Palan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
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23
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Yeung S, Kim HK, Carleton A, Munro J, Ferguson D, Monk AP, Zhang J, Besier T, Fernandez J. Integrating wearables and modelling for monitoring rehabilitation following total knee joint replacement. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107063. [PMID: 35994872 DOI: 10.1016/j.cmpb.2022.107063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/24/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Wearable inertial devices integrated with modelling and cloud computing have been widely adopted in the sports sector, however, their use in the health and medical field has yet to be fully realised. To date, there have been no reported studies concerning the use of wearables as a surrogate tool to monitor knee joint loading during recovery following a total knee joint replacement. The objective of this study is to firstly evaluate if peak tibial acceleration from wearables during gait is a good surrogate metric for computer modelling predicted functional knee loading; and secondly evaluate if traditional clinical patient related outcomes measures are consistent with wearable predictions. METHODS Following ethical approval, four healthy participants were used to establish the relationship between computer modelling predicted knee joint loading and wearable measured tibial acceleration. Following this, ten patients who had total knee joint replacements were then followed during their 6-week rehabilitation. Gait analysis, wearable acceleration, computer models of knee joint loading, and patient related outcomes measures including the Oxford knee score and range of motion were recorded. RESULTS A linear correlation (R2 of 0.7-0.97) was observed between peak tibial acceleration (from wearables) and musculoskeletal model predicted knee joint loading during gait in healthy participants first. Whilst patient related outcome measures (Oxford knee score and patient range of motion) were observed to improve consistently during rehabilitation, this was not consistent with all patient's tibial acceleration. Only those patients that exhibited increasing peak tibial acceleration over 6-weeks rehabilitation were positively correlated with the Oxford knee score (R2 of 0.51 to 0.97). Wearable predicted tibial acceleration revealed three patients with a consistent knee loading, five patients with improving knee loading, and two patients with declining knee loading during recovery. Hence, 20% of patients did not present with satisfactory joint loading following total knee joint replacement and this was not detected with current patient related outcome measures. CONCLUSIONS The use of inertial measurement units or wearables in this study provided additional insight into patients who were not exhibiting functional improvements in joint loading, and offers clinicians an 'off-site' early warning metric to identify potential complications during recovery and provide the opportunity for early intervention. This study has important implications for improving patient outcomes, equity, and for those who live in rural regions.
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Affiliation(s)
- S Yeung
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - H K Kim
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; School of Kinesiology, Louisiana State University, United States
| | - A Carleton
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - J Munro
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - D Ferguson
- Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - A P Monk
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - J Zhang
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - T Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - J Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Engineering Science, University of Auckland, Auckland, New Zealand.
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24
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Steenhuis S, Hofstra G, Portrait F, Amankour F, Koolman X, van der Hijden E. The potential risk of using historic claims to set bundled payment prices: the case of physical therapy after lower extremity joint replacement. BMC Health Serv Res 2022; 22:1061. [PMID: 35986285 PMCID: PMC9392222 DOI: 10.1186/s12913-022-08410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
One of the most significant challenges of implementing a multi-provider bundled payment contract is to determine an appropriate, casemix-adjusted total bundle price. The most frequently used approach is to leverage historic care utilization based on claims data. However, those claims data may not accurately reflect appropriate care (e.g. due to supplier induced demand and moral hazard effects). This study aims to examine variation in claims-based costs of post-discharge primary care physical therapy (PT) utilization after total knee and hip arthroplasties (TKA/THA) for osteoarthritis patients.
Methods
This retrospective cohort study used multilevel linear regression analyses to predict the factors that explain the variation in the utilization of post-discharge PT after TKA or THA for osteoarthritis patients, based on the historic (2015–2018) claims data of a large Dutch health insurer. The factors were structured as predisposing, enabling or need factors according to the behavioral model of Andersen.
Results
The 15,309 TKA and 14,325 THA patients included in this study received an average of 20.7 (SD 11.3) and 16.7 (SD 10.1) post-discharge PT sessions, respectively. Results showed that the enabling factor ‘presence of supplementary insurance’ was the strongest predictor for post-discharge PT utilization in both groups (TKA: β = 7.46, SE = 0.498, p-value< 0.001; THA: β = 5.72, SE = 0.515, p-value< 0.001). There were also some statistically significant predisposing and need factors, but their effects were smaller.
Conclusions
This study shows that if enabling factors (such as supplementary insurance coverage or co-payments) are not taken into account in risk-adjustment of the bundle price, they may cause historic claims-based pricing methods to over- or underestimate appropriate post-discharge primary care PT use, which would result in a bundle price that is either too high or too low. Not adjusting bundle prices for all relevant casemix factors is a risk because it can hamper the successful implementation of bundled payment contracts and the desired changes in care delivery it aims to support.
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25
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Frenkel Rutenberg T, Izchak H, Rosenthal Y, Barak U, Shemesh S, Heller S. Earlier Initiation of Postoperative Physical Therapy Decreases Opioid Use after Total Knee Arthroplasty. J Knee Surg 2022; 35:933-939. [PMID: 33167053 DOI: 10.1055/s-0040-1721034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For patients with advanced osteoarthritis of the knee, total knee arthroplasty (TKA) has been shown to provide significant pain relief and improved function with consistent, reproducible results. Post-operative physical therapy (PT) plays an important role is restoring muscle strength and range of motion (ROM). Yet, the impact of earlier physical therapy initiation after TKA has not been well defined. We assessed 205 patients that underwent primary TKA including 136 patients who started PT on the first post-operative day (POD1) and a second group that started PT 3 days after surgery (POD3), or later. Length of hospital stay (LOS), opioid use during hospital stay, complications, re-admissions, knee ROM and the need for subsequent hospitalized rehabilitation were recorded. LOS was not significantly shorter in the early PT group, compared with the delayed PT group (6.4 ± 2.2 days vs. 6.8 ± 2 days, respectively, P = .217). Patients in the delayed PT group consumed more opioids during their inpatient stay compared with the early PT group on both POD 3 (89% vs 82%, p = 0.013) and POD 4 (81% vs 66%, p = 0.005). There was no significant difference in the incidence of Immediate post-operative complications or final knee ROM between the two groups. While early postoperative PT did not impact hospital LOS or final knee ROM, it was associated with an earlier reduction in postoperative opioid consumption after primary TKA.
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Affiliation(s)
- Tal Frenkel Rutenberg
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Izchak
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Rosenthal
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Barak
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Shemesh
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Snir Heller
- Orthopedic Department, Rabin Medical Center, HaSharon Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Peterson S. A physical therapist-led clinical decision-making program reduced risk of adverse events after total knee arthroplasty over 3 years: A retrospective review. Clin Rehabil 2022; 36:1411-1420. [PMID: 35698742 DOI: 10.1177/02692155221107734] [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
CONTEXT Reducing adverse events after total knee arthroplasty has implications for newly developed bundled payment models. OBJECTIVE To examine the impact of a physical therapist-led clinical decision-making program on the risk of adverse events, function, visits used, or reaching knee range of motion (ROM) goals in patients after total knee arthroplasty. METHODS The decision-making program consisted of quarterly meetings and recommendations for early risk identification and evidence-based intervention. A retrospective review of electronic records included adult patients who underwent total knee arthroplasty postoperative rehabilitation in an 18-month baseline period from 2014 to 2015 and an intervention period from 2015 to 2018. Relative risk reduction (RRR) determined whether a reduction in risk had occurred. Discharge function was measured with the Lower Extremity Functional Scale. RESULTS A total of 160 patients were included, 69 from the 18-month baseline period and 91 from the 36-month intervention period. Mean (SD) age was 68 (9.2) years in the baseline period and 72 (9.7) years in the intervention period. There was an 8.4% (95% CI, 1.1%-64.9%) RRR in adverse events. The RRR for patients not reaching full knee extension was 70.5% (95% CI, 33.4%-87.0%) and the RRR for patients not reaching 120° of knee flexion was 65.5% (95% CI, 5.4%-87.4%). There was significant improvement in the discharge function score (P = 0.05), but not the number of visits used (P = 0.29). CONCLUSION The physical therapist-led clinical decision-making program reduced the risk of adverse events after total knee arthroplasty. The risk of not reaching ROM goals by discharge was also substantially reduced.
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Affiliation(s)
- Seth Peterson
- 42284Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA.,The Motive Physical Therapy Specialists, Oro Valley, AZ, USA
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27
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Paravlic AH, Meulenberg CJ, Drole K. The Time Course of Quadriceps Strength Recovery After Total Knee Arthroplasty Is Influenced by Body Mass Index, Sex, and Age of Patients: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:865412. [PMID: 35692543 PMCID: PMC9174520 DOI: 10.3389/fmed.2022.865412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction For patients with osteoarthritis who have undergone total knee arthroplasty (TKA), quadriceps strength is a major determinant of general physical function regardless of the parameters adopted for functional assessment. Understanding the time course of quadriceps strength recovery and effectiveness of different rehabilitation protocols is a must. Therefore, the aim of this study was to: (i) determine the magnitude of maximal voluntary strength (MVS) loss and the time course of recovery of the quadriceps muscle following TKA, (ii) identify potential moderators of strength outcomes, and (iii) investigate whether different rehabilitation practices can moderate the strength outcomes following TKA, respectively. Design General scientific databases and relevant journals in the field of orthopedics were searched, identifying prospective studies that investigated quadriceps’ MVS pre-to post-surgery. Results Seventeen studies with a total of 832 patients (39% males) were included. Results showed that in the early post-operative days, the involved quadriceps’ MVS markedly declined, after which it slowly recovered over time in a linear fashion. Thus, the greatest decline of the MVS was observed 3 days after TKA. When compared to pre-operative values, the MVS was still significantly lower 3 months after TKA and did not fully recover up to 6 months following TKA. Furthermore, a meta-regression analysis identified that the variables, time point of evaluation, patient age, sex, and BMI, significantly moderate the MVS of the quadriceps muscle. Conclusion The analyzed literature data showed that the decrease in strength of the involved quadriceps muscles following TKA is considerable and lasts for several months post-surgery. Therefore, we recommend to specifically target the strengthening of knee extensor muscles, preserve motor control, and apply appropriate nutrition to ensure a holistic quadriceps muscle recovery. Since age, sex, and BMI were found to be moderating factors in patients’ recovery, further research should include specific analyses considering these moderators.
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Affiliation(s)
- Armin H. Paravlic
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sport Studies, Masaryk University, Brno, Czechia
- *Correspondence: Armin H. Paravlic,
| | - Cécil J. Meulenberg
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
| | - Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
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28
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Capin JJ, Bade MJ, Jennings JM, Snyder-Mackler L, Stevens-Lapsley JE. Total Knee Arthroplasty Assessments Should Include Strength and Performance-Based Functional Tests to Complement Range-of-Motion and Patient-Reported Outcome Measures. Phys Ther 2022; 102:6556168. [PMID: 35358318 PMCID: PMC9393064 DOI: 10.1093/ptj/pzac033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/29/2021] [Accepted: 02/02/2022] [Indexed: 11/14/2022]
Abstract
Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to fully capture functional limitations after TKA; and (4) performance-based functional tests are critical to evaluate function objectively after TKA. This Perspective also addresses studies that question the need for or benefit of physical therapy after TKA because their conclusions focus only on ROM and PRO measures. Future research is needed to determine the optimal timing, delivery, intensity, and content of physical therapy.
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Affiliation(s)
- Jacob J Capin
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA,Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA,Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - Michael J Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA,Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado, USA,Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, Department of Biomedical Engineering, and Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA,Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA,Address all correspondence to Dr. Stevens-Lapsley at ; Follow the author(s): @JacobCapin, @PhysioBade, @DocLSmack, @JSLapsley
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29
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Rauzi MR, Foran JRH, Bade MJ. Multimodal conservative management of arthrofibrosis after total knee arthroplasty compared to manipulation under anesthesia: a feasibility study with retrospective cohort comparison. Pilot Feasibility Stud 2022; 8:71. [PMID: 35337388 PMCID: PMC8953056 DOI: 10.1186/s40814-022-01026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background The ideal treatment of early-stage arthrofibrosis after total knee arthroplasty is unclear. The purpose of this study was to determine the treatment effect, including variability, and feasibility of a multimodal physical therapy program as compared to manipulation under anesthesia. Methods This was a prospective feasibility study with a retrospective cohort comparison. Ten consecutive patients (aged 64 ± 9 years, 7 females) with early-stage arthrofibrosis were enrolled 6 weeks after primary total knee arthroplasty and participated in the multimodal physical therapy program. The multimodal physical therapy program consisted of manual therapy, therapeutic exercise, and static progressive splinting delivered over 4 weeks. The outcomes included knee range of motion (ROM), adherence, patient satisfaction, and safety. Data were compared to a retrospective cohort of 31 patients with arthrofibrosis (aged 65 ± 9 years, 20 females) who underwent manipulation under anesthesia followed by physical therapy. Results Overall, knee ROM outcomes were similar between multimodal physical therapy (110° ± 14) and manipulation under anesthesia (109° ± 11). Seven out of ten patients achieved functional ROM (≥ 110°) and avoided manipulation under anesthesia with the multimodal physical therapy program. Three out of 10 multimodal physical therapy patients required manipulation under anesthesia secondary to failure to demonstrate progress within 4 weeks of the multimodal physical therapy program. Adherence to the multimodal physical therapy program was 87 ± 9%. The median patient satisfaction with the multimodal physical therapy program was “very satisfied.” Safety concerns were minimal. Conclusion The use of the multimodal physical therapy program is feasible for treating early-stage arthrofibrosis after total knee arthroplasty, with 70% of patients avoiding manipulation under anesthesia. Randomized controlled trials are needed to determine the efficacy of the multimodal physical therapy program and to determine the optimal patient selection for the multimodal physical therapy program versus manipulation under anesthesia. Trial registration ClinicalTrials.gov, NCT04837872. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01026-y.
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Affiliation(s)
- Michelle R Rauzi
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, 13121 E 17th Ave, Aurora, CO, 80045, USA
| | - Jared R H Foran
- Panorama Orthopedics & Spine Center, 660 Golden Ridge Rd. #250, Golden, CO, 80401, USA
| | - Michael J Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, 13121 E 17th Ave, Aurora, CO, 80045, USA. .,Veterans Affairs Geriatric Research, Education and Clinical Center, VA Eastern Colorado Healthcare System, 13611 East Colfax, Aurora, CO, 80045, USA.
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30
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Komaris DS, Tarfali G, O'Flynn B, Tedesco S. Unsupervised IMU-based evaluation of at-home exercise programmes: a feasibility study. BMC Sports Sci Med Rehabil 2022; 14:28. [PMID: 35183244 PMCID: PMC8857882 DOI: 10.1186/s13102-022-00417-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The benefits to be obtained from home-based physical therapy programmes are dependent on the proper execution of physiotherapy exercises during unsupervised treatment. Wearable sensors and appropriate movement-related metrics may be used to determine at-home exercise performance and compliance to a physical therapy program. METHODS A total of thirty healthy volunteers (mean age of 31 years) had their movements captured using wearable inertial measurement units (IMUs), after video recordings of five different exercises with varying levels of complexity were demonstrated to them. Participants were then given wearable sensors to enable a second unsupervised data capture at home. Movement performance between the participants' recordings was assessed with metrics of movement smoothness, intensity, consistency and control. RESULTS In general, subjects executed all exercises similarly when recording at home and as compared with their performance in the lab. However, participants executed all movements faster compared to the physiotherapist's demonstrations, indicating the need of a wearable system with user feedback that will set the pace of movement. CONCLUSION In light of the Covid-19 pandemic and the imperative transition towards remote consultation and tele-rehabilitation, this work aims to promote new tools and methods for the assessment of adherence to home-based physical therapy programmes. The studied IMU-derived features have shown adequate sensitivity to evaluate home-based programmes in an unsupervised manner. Cost-effective wearables, such as the one presented in this study, can support therapeutic exercises that ought to be performed with appropriate speed, intensity, smoothness and range of motion.
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Affiliation(s)
- Dimitrios-Sokratis Komaris
- Tyndall National Institute, University College Cork, Lee Maltings Complex Dyke Parade, Cork, T12 R5CP, Ireland.
| | - Georgia Tarfali
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Brendan O'Flynn
- Tyndall National Institute, University College Cork, Lee Maltings Complex Dyke Parade, Cork, T12 R5CP, Ireland
| | - Salvatore Tedesco
- Tyndall National Institute, University College Cork, Lee Maltings Complex Dyke Parade, Cork, T12 R5CP, Ireland
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31
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King CA, Jordan M, Bradley AT, Wlodarski C, Tauchen A, Puri L. Transitioning a Practice to Robotic Total Knee Arthroplasty Is Correlated with Favorable Short-Term Clinical Outcomes-A Single Surgeon Experience. J Knee Surg 2022; 35:78-82. [PMID: 32544972 DOI: 10.1055/s-0040-1712984] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study sought to evaluate the patient experience and short-term clinical outcomes associated with the hospital stay of patients who underwent robotic arm-assisted total knee arthroplasty (TKA). These results were compared with a cohort of patients who underwent TKA without robotic assistance performed by the same surgeon prior to the introduction of this technology. MATERIALS AND METHODS A cohort of consecutive patients undergoing primary TKA for the diagnosis of osteoarthritis by a single fellowship trained orthopaedic surgeon over a 39-month period was identified. Patients who underwent TKA during the year that this surgeon transitioned his entire knee arthroplasty practice to robotic assistance were excluded to eliminate selection bias and control for the learning curve. All patients received the same prosthesis and postoperative pain protocol. Patients that required intubation for failed spinal anesthetic were excluded. A final population of 492 TKAs was identified. Of these, 290 underwent TKA without robotic assistance and 202 underwent robotic arm-assisted TKA. Patient demographic characteristics and short-term clinical data were analyzed. RESULTS Robotic arm-assisted TKA was associated with shorter length of stay (2.3 vs. 2.6 days, p < 0.001), a 50% reduction in morphine milligram equivalent utilization (from 214 to 103, p < 0.001), and a mean increase in procedure time of 9.3 minutes (p < 0.001). There was one superficial infection in the nonrobotic cohort and there were no deep postoperative infections in either cohort. There were no manipulations under anesthesia in the robotic cohort while there were six in the nonrobotic cohort. Additionally, there were no significant differences in emergency department visits, readmissions, or return to the operating room. CONCLUSION This analysis corroborates existing literature suggesting that robotic arm-assisted TKA can be correlated with improved short-term clinical outcomes. This study reports on a single surgeon's experience with regard to analgesic requirements, length of stay, pain scores, and procedure time following a complete transition to robotic arm-assisted TKA. These results underscore the importance of continued evaluation of clinical outcomes as robotic arthroplasty technology continues to grow.
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Affiliation(s)
- Connor A King
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Mark Jordan
- Department of Orthopaedic Surgery, NorthShore University Orthopaedic and Spine Institiute, Skokie, Illinois
| | - Alexander T Bradley
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Caroline Wlodarski
- Department of Orthopaedic Surgery, NorthShore University Orthopaedic and Spine Institiute, Skokie, Illinois
| | - Alexander Tauchen
- Department of Orthopaedic Surgery, NorthShore University Orthopaedic and Spine Institiute, Skokie, Illinois
| | - Lalit Puri
- Department of Orthopaedic Surgery, NorthShore University Orthopaedic and Spine Institiute, Skokie, Illinois
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32
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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Chapman RM, Moschetti WE, Van Citters DW. Is clinically measured knee range of motion after total knee arthroplasty ‘good enough?’: A feasibility study using wearable inertial measurement units to compare knee range of motion captured during physical therapy versus at home. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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King CA, Landy DC, Bradley AT, Scott B, Curran J, Devanagondi S, Balach T, Mica MC. Opioid Naive Surgeons and Opioid-Tolerant Patients: Can Education Alter Prescribing Patterns to Total Knee Arthroplasty Patients? J Knee Surg 2021; 34:1042-1047. [PMID: 32131101 DOI: 10.1055/s-0040-1701449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patterns of opioid overprescribing following arthroplasty likely developed given that poor pain control can diminish patient satisfaction, delay disposition, and lead to complications. Recently, interventions promoting responsible pain management have been described, however, most of the existing literature focuses on opioid naive patients. The aim of this study was to describe the effect of an educational intervention on opioid prescribing for opioid-tolerant patients undergoing primary total knee arthroplasty (TKA). As the start to a quality improvement initiative to reduce opioid overprescribing, a departmental grand rounds was conducted. Prescribing data, for the year before and after this intervention, were retrospectively collected for all opioid-tolerant patients undergoing primary TKA. Opioid prescribing data were standardized to mean morphine milligram equivalents (MME). Segmented time series regression was utilized to estimate the change in opioid prescribing associated with the intervention. A total of 508 opioid-tolerant patients underwent TKA at our institution during the study period. The intervention was associated with a statistically significant decrease of 468 mean MME (23%) from 2,062 to 1,594 (p = 0.005) in TKA patients. This study demonstrates that an educational intervention is associated with decreased opioid prescribing among opioid-tolerant TKA patients. While the effective management of these patients is challenging, surgeon education should be a key focus to optimizing their care.
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Affiliation(s)
- Connor A King
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | - David C Landy
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | | | - Bryan Scott
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | - John Curran
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Tessa Balach
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | - Megan Conti Mica
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
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Eymir M, Yuksel E, Unver B, Karatosun V. Hand-Held Dynamometry in the Inpatient Care Setting After Total Knee Arthroplasty: Reliability of Static Knee Strength Measurements. Am J Phys Med Rehabil 2021; 100:570-575. [PMID: 32932354 DOI: 10.1097/phm.0000000000001592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of the study was to determine intrarater and interrater reliabilities for static strength assessment of knee flexors and knee extensors in patients with total knee arthroplasty, during the acute postoperative rehabilitation. DESIGN Forty-five total knee arthroplasty patients were included in the study. Two physical therapists performed strength assessments by using hand-held dynamometry. Patients performed three trials and a 30-sec rest was provided between each trial. After this, a 5-min rest was provided, and then, a second investigator performed the same procedure for interrater reliability. Assessments for intrarater reliability were performed 1 hr later. RESULTS The intrarater reliability of knee extensors and knee flexors strength measurements were 0.96 and 0.94, respectively. The standard error of measurement and minimal detectable change 95% confidence level were 6.17 and 17.01 Nm for knee extensors and were 8.89 and 24.51 Nm for knee flexors, respectively. The interrater reliability of knee flexors and knee extensors strength measurement was 0.96 for both. The standard error of measurement and minimal detectable change values at 95% confidence level were 6.00 and 16.54 Nm for knee extensors and were 6.32 and 17.42 Nm for knee flexors, respectively. CONCLUSIONS Hand-held dynamometry is a reliable method to assess static knee strength. Hand-held dynamometry assessment can be implemented during acute postoperative rehabilitation. Our results may assist the clinicians in determining an accurate postoperative rehabilitation program after total knee arthroplasty surgery.
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Affiliation(s)
- Musa Eymir
- From the School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey (ME, BU); Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey (EY); and Department of Orthopedics and Traumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey (VK)
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Blevins Peratikos M, Weeks HL, Pisansky AJB, Yong RJ, Stringer EA. Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data. PAIN MEDICINE 2021; 21:521-531. [PMID: 31120529 PMCID: PMC7060398 DOI: 10.1093/pm/pnz083] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective Between 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes. Design Retrospective study of administrative medical and pharmaceutical claims data. Subjects Adults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014–2015. Methods A patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1–30 and 31–90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities, and utilization. Results Among 34,792 patients (38% hip, 58% knee, 4% shoulder), 6,043 (17.4%) were preoperative opioid users with a median morphine equivalent daily dose of 32 mg. Preoperative opioid users had increased length of stay (IRR = 1.03, 95% CI = 1.02 to 1.05), nonhome discharge (OR = 1.10, 95% CI = 1.00 to 1.21), and 30-day unplanned readmission (OR = 1.43, 95% CI = 1.17 to 1.74); experienced 35% higher surgical site infection (HR = 1.35, 95% CI = 1.14 to 1.59) and 44% higher surgical revision (HR = 1.44, 95% CI = 1.21 to 1.71); had a median $1,084 (95% CI = $833 to $1334) increase in medical spend during the 365 days after discharge; and had a 64% lower rate of opioid cessation (HR = 0.34, 95% CI = 0.33 to 0.35) compared with patients not filling two or more prescriptions across periods. Conclusions Preoperative opioid users had longer length of stay, increased revision rates, higher spend, and persistent opioid use, which worsened with dose. Adverse outcomes after elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.
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Affiliation(s)
- Meridith Blevins Peratikos
- axialHealthcare Inc, Nashville, Tennessee.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hannah L Weeks
- axialHealthcare Inc, Nashville, Tennessee.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew J B Pisansky
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - R Jason Yong
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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37
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Zaghlol RS, Khalil SS, Attia AM, Dawa GA. Comparison of two different models of rehabilitation programs following total knee replacement operations. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Total knee replacement operation (TKR) is the treatment of choice in severe knee osteoarthritis (OA). Rehabilitation post-TKR is still not well studied. The aim of this study was to compare between the high-intensity (HI) rehabilitation program and the low-intensity (LI) rehabilitation program following TKR.
Results
At 1 month following the TKR operations, significant improvements were found in the first group compared to the second group in all the measured parameters except for the knee range of motion (ROM). At 3 and 12 months follow-up periods, there were statistically significant differences between both groups in all the evaluated parameters except for the numeric pain rating scale and the knee ROM.
Conclusions
Both high-intensity and low-intensity rehabilitation programs are effective; however, HI program had superior functional gain and patient-reported outcomes compared to the LI program. Moreover, HI group has a long-term functional gain.
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38
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Barker KL, Room J, Knight R, Dutton SJ, Toye F, Leal J, Kent S, Kenealy N, Schussel MM, Collins G, Beard DJ, Price A, Underwood M, Drummond A, Cook E, Lamb SE. Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT. Health Technol Assess 2020; 24:1-116. [PMID: 33250068 DOI: 10.3310/hta24650] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Over 100,000 primary knee arthroplasty operations are undertaken annually in the UK. Around 15-30% of patients do not report a good outcome. Better rehabilitation strategies may improve patient-reported outcomes. OBJECTIVES To compare the outcomes from a traditional outpatient physiotherapy model with those from a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty. DESIGN An individually randomised, two-arm controlled trial with a blinded outcome assessment, a parallel health economic evaluation and a nested qualitative study. SETTING The trial took place in 14 NHS physiotherapy departments. PARTICIPANTS People identified as being at high risk of a poor outcome after knee arthroplasty. INTERVENTIONS A multicomponent home-based rehabilitation package delivered by rehabilitation assistants with supervision from qualified therapists compared with usual-care outpatient physiotherapy. MAIN OUTCOME MEASURES The primary outcome was the Late Life Function and Disability Instrument at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function); Knee injury and Osteoarthritis Outcome Score; Quality of Life subscale; Physical Activity Scale for the Elderly; EuroQol-5 Dimensions, five-level version; and physical function assessed using the Figure-of-8 Walk Test, 30-Second Chair Stand Test and Single Leg Stance. Data on the use of health-care services, time off work and informal care were collected using participant diaries. RESULTS In total, 621 participants were randomised. A total of 309 participants were assigned to the COmmunity based Rehabilitation after Knee Arthroplasty (CORKA) home-based rehabilitation programme, receiving a median of five treatment sessions (interquartile range 4-7 sessions). A total of 312 participants were assigned to usual care, receiving a median of four sessions (interquartile range 2-6 sessions). The primary outcome, Late Life Function and Disability Instrument function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual-care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference 0.49 points, 95% confidence interval -0.89 to 1.88 points; p = 0.48). There were no statistically significant differences between the groups in any of the patient-reported or physical secondary outcome measures at 6 or 12 months post randomisation. The health economic analysis found that the CORKA intervention was cheaper to provide than usual care (£66 less per participant). Total societal costs (combining health-care costs and other costs) were lower for the CORKA intervention than usual care (£316 less per participant). Adopting a societal perspective, CORKA had a 75% probability of being cost-effective at a threshold of £30,000 per quality-adjusted life-year. Adopting the narrower health and social care perspective, CORKA had a 43% probability of being cost-effective at the same threshold. LIMITATIONS The interventions were of short duration and were set within current commissioning guidance for UK physiotherapy. Participants and treating therapists could not be blinded. CONCLUSIONS This randomised controlled trial found no important differences in outcomes when post-arthroplasty rehabilitation was delivered using a home-based, rehabilitation assistant-delivered rehabilitation package or a traditional outpatient model. However, the health economic evaluation found that when adopting a societal perspective, the CORKA home-based intervention was cost-saving and more effective than, and thus dominant over, usual care, owing to reduced time away from paid employment for this group. Further research could look at identifying the risk of poor outcome and further evaluation of a cost-effective treatment, including the workforce model to deliver it. TRIAL REGISTRATION Current Controlled Trials ISRCTN13517704. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jon Room
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Knight
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Fran Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicola Kenealy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael M Schussel
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Gary Collins
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,School of Medicine and Health, University of Exeter, Exeter, UK
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Paravlic AH, Maffulli N, Kovač S, Pisot R. Home-based motor imagery intervention improves functional performance following total knee arthroplasty in the short term: a randomized controlled trial. J Orthop Surg Res 2020; 15:451. [PMID: 33008432 PMCID: PMC7531130 DOI: 10.1186/s13018-020-01964-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/14/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Motor imagery (MI) is effective in improving motor performance in the healthy asymptomatic adult population. However, its possible effects among older orthopaedic patients are still poorly investigated. Therefore, this study explored whether the addition of motor imagery to routine physical therapy reduces the deterioration of quadriceps muscle strength and voluntary activation (VA) as well as other variables related to motor performance in patients after total knee arthroplasty (TKA). METHODS Twenty-six patients scheduled for TKA were randomized to either MI practice combined with routine physical therapy group (MIp) or to a control group receiving physical therapy alone (CON). MIp consisted of maximal voluntary isometric contraction (MViC) task: 15 min/day in the hospital, then 5 times/week in their homes for 4 weeks. MViC and VA of quadriceps muscle, knee flexion and extension range of motion, pain level, along with a Timed Up-and-Go Test (TUG) and self-reported measure of physical function (assessed using the Oxford Knee Score questionnaire [OKS]) were evaluated before (PRE) and 1 month after surgery (POST). RESULTS Significantly better rehabilitation outcomes were evident on the operated leg for the MIp group compared to CON: at POST, the MIp showed lower strength decrease (p = 0.012, η2 = 0.237) and unaltered VA, significantly greater than CON (p = 0.014, η2 = 0.227). There were no significant differences in knee flexion and extension range of motion and pain level (p > 0.05). Further, MIp patients performed better in TUG (p < 0.001, η2 = 0.471) and reported better OKS scores (p = 0.005, η2 = 0.280). The non-operated leg showed no significant differences in any outcomes at POST (all p > 0.05). In addition, multiple linear regression analysis showed that failure of voluntary activation explained 47% of the quadriceps muscle strength loss, with no significant difference in perceived level of pain. CONCLUSION MI practice, when added to physical therapy, improves both objective and subjective measures of patients' physical function after TKA, and facilitates transfer of MI strength task on functional mobility. TRIAL REGISTRATION Retrospectively registered on ClinicalTrials.gov NCT03684148.
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Affiliation(s)
- Armin H Paravlic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK.
| | - Simon Kovač
- Orthopaedic Hospital Valdoltra, Ankaran, Slovenia
| | - Rado Pisot
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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Hsieh CJ, DeJong G, Vita M, Zeymo A, Desale S. Effect of Outpatient Rehabilitation on Functional Mobility After Single Total Knee Arthroplasty: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2016571. [PMID: 32940679 PMCID: PMC7499127 DOI: 10.1001/jamanetworkopen.2020.16571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/26/2020] [Indexed: 11/16/2022] Open
Abstract
Importance Even without evidence, rehabilitation practitioners continue to introduce new interventions to enhance the mobility outcomes for the increasing population with a recent total knee arthroplasty (TKA). Objective To compare post-TKA functional mobility outcomes among 3 newly developed physical therapy protocols with a standard-of-care post-TKA rehabilitation protocol. Design, Setting, and Participants This randomized clinical trial included 4 study arms implemented in 15 outpatient clinics within a single health system in the Baltimore, Maryland, and Washington, District of Columbia, region from October 2013 to April 2017. Participants included patients who underwent elective unilateral TKA, were aged 40 years and older, and began outpatient physical therapy within 24 days after TKA. A total of 505 patients were screened and 386 participants were enrolled. Patients provided informed consent and were randomly assigned to 1 of 4 groups. Blinding patients and treating therapists was not feasible owing to the nature of the intervention. Analysis was conducted under the modified intent-to-treat principle from October 2017 to May 2019. Interventions The control group used a standard recumbent bike for 15 to 20 minutes each session. Interventions used 1 of 3 modalities for 15 to 20 minutes each session: (1) a body weight-adjustable treadmill, (2) a patterned electrical neuromuscular stimulation device, or (3) a combination of the treadmill and electrical neuromuscular stimulation. Main Outcomes and Measures Outcomes included the Activity Measure for Post-acute Care basic mobility score, a patient-reported outcome measure, and the 6-minute walk test. Outcomes were measured at baseline, monthly, and on discharge from outpatient therapy. Results Data from 363 patients (mean [SD] age, 63.4 [7.9] years; 222 [61.2%] women) were included in the final analysis, including 92 participants randomized to the control group, 91 participants randomized to the treadmill group, 90 participants randomized to the neuromuscular stimulation device group, and 90 participants randomized to the combination intervention group. Activity Measure for Post-acute Care scores at discharge were similar across groups, ranging from 61.1 to 61.3 (P = .99) with at least 9.0 points improvement (P = .80) since baseline. The distances as measured by the 6-minute walking test were not statistically different across groups (range, 382.9-404.5 m; P = .60). Conclusions and Relevance This randomized clinical trial found no statistically or clinically significant differences in outcomes across the 4 arms. Because outcomes were similar among arms, clinicians should instead consider relative cost in tailoring TKA rehabilitation. Trial Registration ClinicalTrials.gov Identifier: NCT02426190.
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Affiliation(s)
- Chinghui Jean Hsieh
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Maryland
| | - Gerben DeJong
- MedStar National Rehabilitation Hospital, Washington, District of Columbia
- Department of Rehabilitation Medicine, Georgetown University School of Medicine, Washington, District of Columbia
| | - Michele Vita
- MedStar National Rehabilitation Network, Washington, District of Columbia
| | | | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, Maryland
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Nakamura M, Kise C, Hasegawa S, Misaki S. Effectiveness of early high-intensity balance training for early home life independence after total knee arthroplasty: a pseudo-randomized controlled trial. Phys Ther Res 2020; 23:79-86. [PMID: 32850283 DOI: 10.1298/ptr.e9995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In Japan, the number of elderly individuals living alone is increasing, leading to an increase in hospital medical expenses attributed to total knee arthroplasty (TKA). Improvement in balance and functional performance is a priority in the early postoperative stages after TKA. However, there are no reports on the effectiveness of balance training (BT) for inpatients in the early postoperative period. Thus, we aimed to evaluate the effectiveness of early high-intensity BT for early home-life independence after TKA. METHOD This pseudo-randomized controlled trial included 49 inpatients who underwent TKA and had osteoarthritis. Inpatients were categorized into the BT or typical training (TT) group. The BT program began on post-TKA day 4, with 12-14 sessions between day 7 and 10 (i.e., 1-2 sessions per day). The effect of the intervention was assessed using balance ability as the main outcome. Sub-outcomes included evaluation of motion function. The differences in each variable before and after intervention were compared, including covariance analysis adjusted for age and sex. RESULTS The mean (standard deviation) balance ability indexes in the left and right directions were BT, pre 4.5 (0.8) and post 4.4 (0.8); TT, pre 4.8 (0.9) and post 4.4 (0.8), and those in the forward and backward directions were BT, pre 4.7 (1.7) and post 5.1 (2.1); TT, pre 6.3 (2.6) and post 5.9 (2.0). No significant differences were found between the preoperative and postintervention scores in the two groups for any measured outcome. CONCLUSION BT did not appear to improve balance ability or functional performance.
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Affiliation(s)
- Mutsumi Nakamura
- Tohto University Faculty of Human Care at Makuhari Department of Physical Therapy
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Wang XF, Ma ZH, Teng XR. Isokinetic Strength Test of Muscle Strength and Motor Function in Total Knee Arthroplasty. Orthop Surg 2020; 12:878-889. [PMID: 32436619 PMCID: PMC7307260 DOI: 10.1111/os.12699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/20/2020] [Accepted: 04/20/2020] [Indexed: 01/17/2023] Open
Abstract
Objective To use isokinetic strength testing system to test and analyze the relationship between changes in muscle strength before and after knee replacement in patients undergoing total knee arthroplasty (TKA). Methods A total of 200 patients with advanced knee osteoarthritis treated from June 2018 to June 2019 were selected for TKA. The patient's isokinetic muscle strength test was performed in the first, third, and the sixth month before and after the operation. The knee hamstring peak torque (PT value), quadriceps peak torque (PT value), and total work were mainly measured. The knee joint was evaluated at the hospital for special surgery score, range of motion and other knee function standards, and then healthy limbs and normal people were tested with the same method. Statistical data was used to analyze and deal with the data, evaluate the muscle strength and motor function changes with time progressing, then compare the differences to the healthy limb. From P < 0.05, we can see that the differences have some statistical significance. The influences that TKA has on motor function changes of lower limbs were also observed. Results Among the 200 subjects, 162 completed all follow‐up tests, and the remaining 38 were lost to follow‐up for various reasons. The rate of loss of follow‐up was approximately 19%. The isokinetic muscle strength test system and the knee joint function scoring standard were used to record the knee joint muscle strength and function changes before and after knee joint replacement. Statistical analysis was performed to show the knee joint hamstring muscle force and quadriceps muscle strength and joint mobility in the first month after the surgery. The knee joint muscle strength and joint mobility were significantly improved after the third month after the surgery, but there were still some differences compared with normal people. The knee function index was significantly improved in the sixth month after operation (P < 0.05), and there were no significant differences compared with normal people. Conclusions Knee joint strength and knee function after TKA are significantly improved compared with preoperative function, which is of great significance for the treatment of knee osteoarthritis. The constant velocity muscle strength test system has the advantages of safety, accuracy, repeatability and easy operation. It is a good method to evaluate the knee joint's muscle strength and function after the knee joint replacement.
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Affiliation(s)
| | - Zhen-Hua Ma
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xue-Ren Teng
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
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Liao Y, Vakanski A, Xian M, Paul D, Baker R. A review of computational approaches for evaluation of rehabilitation exercises. Comput Biol Med 2020; 119:103687. [PMID: 32339122 PMCID: PMC7189627 DOI: 10.1016/j.compbiomed.2020.103687] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/27/2022]
Abstract
Recent advances in data analytics and computer-aided diagnostics stimulate the vision of patient-centric precision healthcare, where treatment plans are customized based on the health records and needs of every patient. In physical rehabilitation, the progress in machine learning and the advent of affordable and reliable motion capture sensors have been conducive to the development of approaches for automated assessment of patient performance and progress toward functional recovery. The presented study reviews computational approaches for evaluating patient performance in rehabilitation programs using motion capture systems. Such approaches will play an important role in supplementing traditional rehabilitation assessment performed by trained clinicians, and in assisting patients participating in home-based rehabilitation. The reviewed computational methods for exercise evaluation are grouped into three main categories: discrete movement score, rule-based, and template-based approaches. The review places an emphasis on the application of machine learning methods for movement evaluation in rehabilitation. Related work in the literature on data representation, feature engineering, movement segmentation, and scoring functions is presented. The study also reviews existing sensors for capturing rehabilitation movements and provides an informative listing of pertinent benchmark datasets. The significance of this paper is in being the first to provide a comprehensive review of computational methods for evaluation of patient performance in rehabilitation programs.
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Affiliation(s)
- Yalin Liao
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | | | - Min Xian
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | - David Paul
- Department of Movement Sciences, University of Idaho, Moscow, USA
| | - Russell Baker
- Department of Movement Sciences, University of Idaho, Moscow, USA
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Paravlic AH, Kovač S, Pisot R, Marusic U. Neurostructural correlates of strength decrease following total knee arthroplasty: A systematic review of the literature with meta-analysis. Bosn J Basic Med Sci 2020; 20:1-12. [PMID: 30640590 PMCID: PMC7029198 DOI: 10.17305/bjbms.2019.3814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022] Open
Abstract
Recent literature suggests that alterations in both neural and structural components of the neuromuscular system are major determinants of knee extensor muscle weakness after total knee arthroplasty (TKA). Therefore, the goal of this study was to investigate the maximal voluntary strength (MVS), voluntary muscle activation (VMA), and the cross-sectional area (CSA) of the muscle, up to 33 months after the TKA. We searched relevant scientific databases and literature for outcomes of interest, including quadriceps MVS, VMA, and CSA. Ten studies met the inclusion criteria and involved a total of 289 patients. The quality of the studies was evaluated by Methodological Index for Non-Randomized Studies (MINORS). Results showed that quadriceps MVS markedly declines in the early postoperative period, after which it slowly and linearly recovers over time. However, the same phenomenon was not observed for VMA and CSA, which were not significantly altered after the TKA. Furthermore, a meta-regression analysis revealed that the change in VMA accounted for 39% of the relative change in quadriceps strength (R2=0.39; p=0.015) in the early postoperative period. Patients treated with TKA had considerable weakness of the quadriceps muscle, which was detectable up to 3 months after surgery. Although the change in VMA largely explains quadriceps weakness, this change and CSA differences were not significant, suggesting that other neural correlates, such as hamstrings coactivation, might alter quadriceps muscle function. Thus, more attention should be paid to address VMA failure and coactivation of antagonist muscles. More comprehensive rehabilitation approaches may be required to target the whole neural circuit controlling the motor action.
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Affiliation(s)
- Armin H Paravlic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Simon Kovač
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | - Rado Pisot
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Uros Marusic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, and Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia.
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Kim JH, Kim BR, Kim SR, Han EY, Nam KW, Lee SY, Kim WB. Functional Outcomes After Critical Pathway for Inpatient Rehabilitation of Total Knee Arthroplasty. Ann Rehabil Med 2019; 43:650-661. [PMID: 31918528 PMCID: PMC6960081 DOI: 10.5535/arm.2019.43.6.650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/02/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate functional outcomes after the application of a critical pathway for inpatient rehabilitation of total knee arthroplasty (TKA). METHODS A total of 184 patients (57 males and 127 females; average age, 71.5±5.9 years) who underwent unilateral or bilateral TKA were included. The critical pathway included early, intensive individualized rehabilitation exercises. Patients completed the following performance-based physical function tests: the stair climbing test (SCT), 6-minute walk test (6MWT), and Timed Up and Go test (TUG) as well as measurement of isometric knee flexor and extensor strength of the operated knee, gait speed, and range of knee flexion and extension. Self-reported physical function and pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), respectively, and self-reported quality of life was measured using the EuroQoL 5 dimension (EQ-5D) questionnaire. These evaluations were performed preoperatively and at 1 month and 3 months postoperatively. RESULTS Performance-based and self-reported physical function and quality of life measures improved nonlinearly over time. Specifically, the 6WMT, TUG, gait speed, WOMAC-pain, WOMAC-function, VAS, and EQ-5D scores showed a significant improvement at 1-month post-TKA, whereas SCT, peak torque of the knee extensors and flexors, and WOMAC-stiffness scores showed gradual, but substantial, improvements over 3 months. There were between-group differences (unilateral and bilateral TKA groups) in the time course of the SCT, 6MWT, TUG, VAS, WOAMC-stiffness, and WOMAC-function results. CONCLUSION Patients who underwent critical pathway rehabilitation after TKA showed significant improvements in functional measurements during the first 3 months post-surgery.
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Affiliation(s)
- Jong Hyun Kim
- Department of Rehabilitation Medicine, Jeju National University College of Medicine—Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University College of Medicine—Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Sang Rim Kim
- Department of Orthopedic Surgery, Jeju National University College of Medicine—Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University College of Medicine—Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Kwang Woo Nam
- Department of Orthopedic Surgery, Jeju National University College of Medicine—Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University College of Medicine—Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
| | - Won Bin Kim
- Department of Rehabilitation Medicine, Jeju National University College of Medicine—Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea
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Harmelink K, Nijhuis-van der Sanden R, Zeegers E, Hullegie W, Van der Wees P, Staal B. Reasons for continuing physiotherapy treatment after a high-intensity physyiotherapy program in patients after total knee arthroplasty: a mixed-methods study. Physiother Theory Pract 2019; 37:1321-1336. [PMID: 31760847 DOI: 10.1080/09593985.2019.1693675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Patients after total knee arthroplasty treated with a 10-day high-intensity physiotherapy program in a resort were expected to recover fast without need for a longer physiotherapy treatment period.Objective: To explore the expectations and experiences of patients with total knee arthroplasty following the high-intensity physiotherapy program, including the perceived recovery level at discharge, and reasons for (not) adhering to the given advice at discharge (being either continuing with or refraining from further physiotherapy treatment).Design: A mixed-methods approach: semi-structured interviews were held and were then used to develop items and answer categories for a survey.Methods: Fifteen patients participated in semi-structured interviews, which focused on expectations and experiences related to the total knee arthroplasty and physiotherapy program, the perceived recovery level at the moment of discharge, and the reasons for the advice at discharge (continuing with or refraining from physiotherapy treatment) being followed. A deductive thematic analysis of those interviews was used to develop a survey, which was sent to the total cohort of 60 patients. Logistic regression models were estimated to determine which factors were associated with the continuation of physiotherapy treatment and (not) following the advice. Results: Four themes were identified: (1) confidence of independent recovery; (2) experiencing residual complaints; (3) expecting further improvement of physical fitness; and (4) preferring to be supervised by a healthcare professional. These themes were covered by 14 items in the survey. In total, 55 out of 60 patients completed the survey. Out of 36 patients, 23 continued with physiotherapy treatment despite an adequate level of recovery. Five out of 19 patients, who were advised to continue with physiotherapy treatment, decided to refrain. Advice to continue with physiotherapy treatment was followed more often than advice to refrain from physiotherapy treatment (OR 0.09; 95%CI 0.01-0.85). Reasons for continuing with physiotherapy treatment were residual complaints, the expectation that their physical fitness could be improved and preferring to be supervised by a healthcare professional. In contrast, patients who refrained from physiotherapy, despite being advised to continue, were self-confident that they could do exercises by themselves.Conclusions: A substantial proportion of patients continued with physiotherapy treatment because they expected that a higher level of recovery could be reached. The level of self-confidence to recover on their own seemed to be an important factor in deciding to continue with or refrain from physiotherapy treatment. It would be helpful to focus on self-management skills during the high-intensity physiotherapy program following total knee arthroplasty.
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Affiliation(s)
- Karen Harmelink
- FysioHolland Twente, Enschede, Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ria Nijhuis-van der Sanden
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elgun Zeegers
- Department of Orthopedic Surgery, Medisch Spectrum Twente (MST), Enschede, Netherlands
| | - Wim Hullegie
- Fysiotherapie Hullegie and Richter, Enschede, Netherlands
| | - Philip Van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart Staal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands.,HAN University of Applied Sciences, Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, Nijmegen, Netherlands
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Antony-Leo AP, Arun-Maiya G, Mohan-Kumar M, Vijayaraghavan PV. Structured Total Knee Replacement Rehabilitation Programme and Quality of Life following Two Different Surgical Approaches - A Randomised Controlled Trial. Malays Orthop J 2019; 13:20-27. [PMID: 31467647 PMCID: PMC6702978 DOI: 10.5704/moj.1907.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The key important factor influencing the outcomes following rehabilitation is the surgical approach involved in Total Knee Replacement (TKR). Most studies have analysed the functional outcome in comparing the approaches on surgical perspective rather on post-operative therapeutic interventions. The current study was to analyse the effects of structured TKR rehabilitation programme on the quality of life and joint specific outcomes between two different surgical approaches. Materials and Methods: In this double-blind randomised controlled trial, participants were randomly allocated to one of two groups: Group 1- those who underwent medial parapatellar approach and Group 2- those who underwent mid-vastus approach. Both groups received three-phase structured rehabilitation protocol for 12 weeks. The outcome measures of SF-36, knee mobility, isometric knee musculature strength and six-minute walk distance were measured at baseline, on discharge and at review after three months. Results: The quality of life and joint specific outcome scores were better in mid-vastus approach than the popular medial parapatellar approach. The outcomes of knee flexion mobility (p=0.04), knee extension mobility (p=0.03), isometric muscle strength of quadriceps (p=0.001), isometric muscle strength of hamstrings (p=0.03), six-minute walk distance (p=0.001) and Physical Cumulative Scores (PCS) (p=0.03) were found to exhibit significant improvements at three months follow up. Conclusion: The mid-vastus approach was found to exhibit better improvements following structured rehabilitation care, in physical summary scores of quality of life and joint specific outcomes than medial parapatellar approach.
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Affiliation(s)
- A P Antony-Leo
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.,Department of Physiotherapy, Manipal Academy of Higher Education, Manipal, India.,Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - G Arun-Maiya
- Department of Physiotherapy, Manipal Academy of Higher Education, Manipal, India
| | - M Mohan-Kumar
- Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - P V Vijayaraghavan
- Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Ilfeld BM, Ball ST, Cohen SP, Hanling SR, Fowler IM, Wongsarnpigoon A, Boggs JW. Percutaneous Peripheral Nerve Stimulation to Control Postoperative Pain, Decrease Opioid Use, and Accelerate Functional Recovery Following Orthopedic Trauma. Mil Med 2019; 184:557-564. [PMID: 30901395 DOI: 10.1093/milmed/usy378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
Orthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy-percutaneous peripheral nerve stimulation (PNS) - and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.
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Affiliation(s)
- Brian M Ilfeld
- University of California San Diego, 200 W Arbor Drive, San Diego, CA
| | - Scott T Ball
- University of California San Diego, 200 W Arbor Drive, San Diego, CA
| | - Steven P Cohen
- Johns Hopkins School of Medicine, Department of Anesthesiology and Critical Care Medicine, 1800 Orleans Street, Baltimore, MD
| | - Steven R Hanling
- Medical College of Georgia, Department of Anesthesiology & Perioperative Medicine, BIW-2144 1120 15th Street, Augusta, GA
| | - Ian M Fowler
- Naval Medical Center San Diego, Department of Anesthesiology, 34800 Bob Wilson Dr, San Diego, CA
| | | | - Joseph W Boggs
- SPR Therapeutics, 22901 Millcreek Boulevard, Suite 110, Cleveland, OH
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Jakobsen TL, Jakobsen MD, Andersen LL, Husted H, Kehlet H, Bandholm T. Quadriceps muscle activity during commonly used strength training exercises shortly after total knee arthroplasty: implications for home-based exercise-selection. J Exp Orthop 2019; 6:29. [PMID: 31267365 PMCID: PMC6606685 DOI: 10.1186/s40634-019-0193-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background In the early phase after a total knee arthroplasty (TKA), patients experience multi-level weakness in the operated leg, which is caused primarily by reduced central nervous system (CNS) activation failure of the muscles - especially the knee extensors (quadriceps muscle). Whether similar levels of neuromuscular activity of the muscles in the operated leg, elicited during strength training exercises in machines, can be reached during strength training exercises in more simple forms is unknown. Many clinicians are faced with the problem of not having strength training equipment at their institution or having to prescribe simple strength training exercises for home-based training. Therefore, the purpose of this study was to determine which strength training exercises that activated the muscles in the operated leg the most after TKA. The hypothesis was that strength training exercises performed in machines would elicit higher levels of voluntary peak quadriceps and hamstring muscle activity than strength training exercises performed in more simple forms, using elastic bands or the patients’ own body weight. Methods A cross-sectional electromyographic study investigated voluntary peak muscle activity in the operated leg during 6 different strength training exercises. Twenty-four patients, who received a TKA 4 to 8 weeks earlier, performed the exercises in a randomized order, using a pre-determined loading of 10 RM (repetition maximum). Voluntary peak muscle activity (%EMGmax) was calculated for the quadriceps and hamstring muscles for each exercise. Results Knee extensions with elastic band showed significantly higher voluntary peak quadriceps muscle activity than knee extensions in machine (93.3 vs. 74.9; mean difference, 18.3 %EMGmax [95% confidence interval (CI), 11.7 to 24.9]; P < 0.0001). Similarly, one-legged squat (and sit to stand) elicited higher voluntary peak quadriceps muscle activity than leg press in machine (86.7 vs. 66.8; mean difference, 19.9 %EMGmax [95% CI, 14.8 to 25.0]; P < 0.0001). Conclusions Strength training exercises in more simple forms elicited higher voluntary peak quadriceps muscle activity than strength training exercises in machines early after TKA. Consequently, simple home-based strength training exercises using e.g. elastic bands or the patients’ own bodyweight should be considered to alleviate muscle strength losses early after TKA. Trial registration ClinicalTrials.gov identifier: NCT01708980. Electronic supplementary material The online version of this article (10.1186/s40634-019-0193-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Linding Jakobsen
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark. .,Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Hvidovre, Denmark. .,Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark. .,Section for Orthopaedic and Sports Rehabilitation (SOS-R), Health Centre Nørrebro, City of Copenhagen, Copenhagen, Denmark.
| | | | - Lars Louis Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Sport Sciences, Department of Health Science and Technology, Aalborg University, Copenhagen, Denmark
| | - Henrik Husted
- Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Kehlet
- Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Hvidovre, Denmark.,Section for Surgical Pathophysiology 7621, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
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50
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Room J, Batting M, Barker KL. Development of a functional rehabilitation intervention for post knee arthroplasty patients: COmmunity based Rehabilitation post Knee Arthroplasty (CORKA) trial. Physiotherapy 2019; 106:52-64. [PMID: 32026846 DOI: 10.1016/j.physio.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 06/17/2019] [Indexed: 11/27/2022]
Abstract
Knee osteoarthritis is a common cause of disability in older people and knee arthroplasty surgery in the UK is increasing. The CORKA trial is a randomised controlled trial of rehabilitation targeted at patients identified as being at risk of a poor outcome after knee arthroplasty. This paper describes the development and delivery of the CORKA intervention. It was informed by current evidence, relevant guidelines, expert and patient opinion, practical considerations and a pilot study. The intervention is a multicomponent rehabilitation programme with the main component being an exercise programme delivered to participants in their own home. It includes functional task practice, strategies to improve adherence and where appropriate the provision of appropriate aids and equipment.
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Affiliation(s)
- J Room
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS FT, Oxford, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - M Batting
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS FT, Oxford, United Kingdom
| | - K L Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS FT, Oxford, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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