Characteristics of Usual Physical Therapy Post‐Total Knee Replacement and Their Associations With Functional Outcomes (original) (raw)
Related papers
Arthritis Care & Research, 2017
Objective. To evaluate the long-term benefit of providing a post-acute, outpatient group exercise program for patients following primary total knee replacement (TKR) surgery for osteoarthritis. Methods. A multicenter randomized clinical trial was conducted in 12 Australian public and private hospital centers. A total of 422 participants, ages 45-75 years, were randomly allocated prior to hospital discharge to the post-acute group exercise program or to usual care and were assessed at 6 weeks, 6 months, and 12 months after surgery. The main outcomes were operated knee pain and activity limitations at 12 months using the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Secondary outcomes included health-related quality of life (Short Form 12 health survey), knee extension and flexion strength, stair-climb power, 50-foot walk speed, and active knee range of motion. Results. While both allocation groups achieved significant improvements in knee pain and activity limitations over the 12month followup period, there were no significant differences in these main outcomes, or in the secondary physical performance measures, between the 2 treatment allocations. Twelve months after TKR, 69% and 72% of participants allocated to post-acute exercise and usual acute care, respectively, were considered to be treatment-responders. While population normative values for self-report measures of pain, activity limitation, and health-related quality of life were attained 12 months after TKR, marked deficits in physical performance measures remained. Conclusion. Providing access to a post-acute group exercise program did not result in greater reductions in long-term knee pain or activity limitations than usual care. Patients undergoing primary TKR retain marked physical performance deficits 12 months after surgery.
Effectiveness of structured exercise program on the functional outcomes in total knee replacement
Background: Total knee replacement (TKR) surgery has become the most successful surgery for patients with severe debilitating arthritis. Numerous factors influence the outcomes in TKR Post-operative physiotherapy and rehabilitation greatly influences the outcome of TKR. Despite the high incidence of TKR in recent years there is no post-operative rehabilitation approach being incorporated correctly to address the muscular and functional deficits following surgery. Objective: The main objective of the study is to analyze the effectiveness of structured rehabilitation program on the functional outcome of patients following total knee replacement. Materials & Methods: All patients who were planned to undergo elective primary TKR were recruited. Subjects posted for revision TKR, rheumatoid arthritis posted for TKR, immediate post-operative complications like deep vein thrombosis, signs of infection, TKR for Post-fracture cases were excluded. Eighty subjects enrolled for the study were randomly allocated to control and experimental group using simple random sampling. The control group receives standard care and experimental group receive structured exercise program comprising range of motion, staged training of quadriceps, vastus medialis strengthening exercises, early balance training and functional retraining. Outcomes including pain severity, knee joint mobility, isometric muscle strength, six minute walk test and functional outcome using KOOS scale were measured post-surgery and after 3 months follow up. Results: In experimental group, follow up measures of pain severity (p-.0001), knee joint extension range (p-.0016), isometric strength of hamstrings (p-0008) shows statistically significant results than control group. Whereas, in experimental group, follow up measures of knee flexion range (p-< .0001), isometric strength of quadriceps (p-<.0001), six minute walk test (p-< .0001), functional outcome subscale of KOOS-symptoms and quality of life (< .0001) shows statistical highly significant results than control group. Conclusion: The structured exercise program was effective in improving the primary and secondary outcomes following primary total knee replacement.
BMC musculoskeletal disorders, 2015
Although the outcome of total knee replacement (TKR) is favorable, surgery alone fails to resolve the functional limitations and physical inactivity that existed prior to surgery. Exercise is likely the only intervention capable of improving these persistent limitations, but exercises have to be performed with intensity sufficient to promote significant changes, at levels that cannot be tolerated until later stages post TKR. The current evidence is limited regarding the effectiveness of exercise at a later stage post TKR. To that end, this study aims to compare the outcomes of physical function and physical activity between 3 treatment groups: clinic-based individual outpatient rehabilitative exercise during 12 weeks, community-based group exercise classes during 12 weeks, and usual medical care (wait-listed control group). The secondary aim is to identify baseline predictors of functional recovery for the exercise groups. This protocol paper describes a comparative effectiveness st...
Physical therapy, 2018
The definitive treatment for knee osteoarthritis is a total knee replacement, which results in a clinically meaningful improvement in pain and physical function. However, evidence suggests that physical activity (PA) remains unchanged after total knee replacement (TKR). The objective of this study is to investigate the efficacy, fidelity, and safety of a physical therapist-administered PA intervention for people after TKR. This study will be a randomized controlled trial. The setting is an outpatient physical therapy clinic. The participants are 125 individuals who are over the age of 45 and are seeking outpatient physical therapy following a unilateral TKR. In addition to standardized physical therapy after TKR, the intervention group will receive, during physical therapy, a weekly PA intervention that includes a wearable activity tracking device, individualized step goals, and face-to-face feedback provided by a physical therapist. The control group will receive standardized physi...
Outcomes of Physiotherapy Exercises After Total Knee Replacement Surgery
IJSR, Vol (2), No (11), November 2023, 2023
Introduction: Total knee replacement (TKR) surgery is a common procedure for severe knee osteoarthritis, improving the quality of life for many patients. Despite surgical success, optimal recovery heavily relies on effective post-operative rehabilitation. This systematic review aimed to evaluate the effectiveness of various physiotherapy exercises in enhancing recovery outcomes following TKR, focusing on knee function, pain reduction, and patient satisfaction. Methods: A comprehensive search of PubMed, Scopus, Cochrane Library, and Web of Science was conducted, focusing on interventional studies and clinical trials published in the last five years up to 2022. Studies included were those evaluating physiotherapy interventions post-TKR, with clear measures on efficacy regarding patient outcomes. Exclusion criteria encompassed non-exercise-based rehabilitations, observational studies, and non-English publications. Data extraction focused on intervention types, sample sizes, and outcome measures. Results: Twelve studies were included, with sample sizes ranging from 30 to over 200 participants. Interventions varied from in-person physiotherapy, home-based exercises, high-intensity training, to tele-rehabilitation. High-intensity physiotherapy programs were associated with a 40% greater improvement in knee function compared to standard care. Tele-rehabilitation provided comparable outcomes in terms of pain management and mobility improvements, with patient satisfaction exceeding 80% in some studies. However, adherence and exercise intensity were noted challenges in remote settings. Conclusions: The review highlights physiotherapy's pivotal role in post-TKR recovery, with high-intensity programs showing significant benefits in knee function. Tele-rehabilitation emerges as a promising alternative, potentially increasing access to care. These findings support the integration of structured physiotherapy into rehabilitation protocols to maximize recovery outcomes. Future research should explore strategies to enhance adherence and effectiveness of tele-rehabilitation services.
Arthritis Care & Research, 2015
To determine, at 6 weeks postsurgery, if a monitored home exercise program (HEP) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement (TKR) surgery for osteoarthritis. Methods. We conducted a multicenter, randomized clinical trial. Patients ages 45-75 years were allocated at the time of hospital discharge to usual care rehabilitation (n ؍ 196) or the HEP (n ؍ 194). Outcomes assessed 6 weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales, knee range of motion, and the 50-foot walk time. The upper bound of the 95% confidence interval (95% CI) mean difference favoring usual care was used to determine noninferiority. Results. At 6 weeks after surgery there were no significant differences between usual care and HEP, respectively, for pain (7.4 and 7.2; 95% CI mean difference [MD] ؊0.7, 0.9), physical function (22.5 and 22.4; 95% CI MD ؊2.5, 2.6), knee flexion (96°and 97°; 95% CI MD ؊4°, 2°), knee extension (؊7°and ؊6°; 95% CI MD ؊2°, 1°), or the 50-foot walk time (12.9 and 12.9 seconds; 95% CI MD ؊0.8, 0.7 seconds). At 6 weeks, 18 patients (9%) allocated to usual care and 11 (6%) to the HEP did not achieve 80°knee flexion. There was no difference between the treatment allocations in the number of hospital readmissions. Conclusion. The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR
Arthritis care & research, 2017
To test the feasibility of a comprehensive behavioral intervention (CBI) program that combines intense exercises with an education program to be implemented at a later stage (3 months) post total knee replacement (TKR), and to get a first impression of the effects of the CBI as compared to a standard of care exercise (SCE) program on the outcomes of physical function and physical activity. 44 subjects participated in a 3-month program of either CBI or SCE followed by 3 months of home exercise program. Outcomes of physical function and physical activity were measured at baseline and at 6-month follow-up. ANOVA was used to compare statistical differences between groups whereas responder analyses was used for clinically important differences. The CBI was found to be safe and well tolerated. As compared to the SCE group, the CBI group had less pain (p= .035) and better physical function based on the RAND questionnaire (p=.017) and the single-leg stance test (p=.037). The other outcome m...
2020
Objective: The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation. Design: Scoping review Literature search: A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library. Study selection criteria: All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included. Data synthesis: The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool. Results: There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88-99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT. Conclusion: The RCTs included in this study poorly reported exercise adherence, as well as description of the postoperative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER).
2019
Purpose: The aims of this study to investigate the level of physical activity and physical function three months post-surgery in patients > 55 years old who had received knee arthroplasty. A second aim was to examine the relationship between objectively measured physical activity level and physical function. Methods: A consecutive sample of 43 participants, 28 (65%) men, 15 (35%) women with a mean age of 70.7 years three months after total knee arthroplasty were included. Outcome measures were levels of physical activity (steps and total energy expenditure) registered with accelerometer worn for seven days. Physical function was measured with the Short Physical Performance Battery. Results: Participants walked on average 6068 steps per day, and the mean total energy expenditure was 2494 kcal per day three months after surgery. Walking speed was low. The correlation values between the number of steps per day and walking speed indicated that those more physical active had better ph...
International Journal of Environmental Research and Public Health, 2021
Total hip replacement (THR) and total knee replacement (TKR) are among the most common elective surgical procedures. There is a large consensus on the importance of physical activity promotion for an active lifestyle in persons who underwent THR or TKR to prevent or mitigate disability and improve the quality of life (QoL) in the long term. However, there is no best practice in exercise and physical activity specifically designed for these persons. The present protocol aims to evaluate the efficacy and safety of an exercise program (6 month duration) designed for improving quality of life in people who had undergone THR or TKR. This paper describes a randomized controlled trial protocol that involves persons with THR or TKR. The participant will be randomly assigned to an intervention group or a control group. The intervention group will perform post-rehabilitation supervised training; the control group will be requested to follow the usual care. The primary outcome is QoL, measured...