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Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial.

ABSTRACT: Background:The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA). Methods:20 patients (mean?±?SD: age 67?±?7?years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptive neuromuscular facilitation (PNF) techniques, endurance training and individually indicated interventions. Measurements were executed at baseline, preoperative and 3 months after TKA. The primary outcome measure was the Stair Climbing Test (SCT), secondary outcome measures were the knee range of motion (ROM) and the level of physical activity using Lysholm Score (LS) and Tegner Activity Scale (TAS). The subjective and socio-economic parameters were the Patients' Global Impression of Change (PGIC) scale, inpatient rehabilitation time, preoperative pain levels and metabolic equivalent (MET), postoperative intake of analgesics and overall costs. Results:No difference between IG and CG was found for SCT (F (2/36)?=?0.016, p =?0.984, ?2?=?0.004). An interaction between group and time was shown for TAS (F (18/1)?=?13.890) with an increase in the IG (p =?0.002, ?2?=?0.536). The sub-item "pain" within the LS presented a higher pain-level in CG (F (18/1)?=?4.490, p =?0.048, ?2?=?0.974), while IG showed a higher preoperative MET compared to CG (p =?0.035). There were no other significant changes. The CG produced 21.4% higher overall costs, took more analgesics and showed higher preoperative pain levels than the IG. Conclusions:Findings show that preoperative therapy improved the level of physical activity before and after TKA and resulted in a clinically relevant gain in TAS. Trial registration:ClinicalTrials.gov Identifier; NCT03160534. Registered 19 May 2017.

SUBMITTER: Granicher P

PROVIDER: S-EPMC7405420 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial.

Gränicher Pascale P Stöggl Thomas T Fucentese Sandro F SF Adelsberger Rolf R Swanenburg Jaap J

Archives of physiotherapy 20200805

<h4>Background</h4>The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA).<h4>Methods</h4>20 patients (mean ± SD: age 67 ± 7 years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptiv ...[more]

PMID: 32774889

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Project description:To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement.A prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients' clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality.Of 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001).Recruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery.ClinicalTrials.Gov NCT00743951.

Dataset Information

Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial.

Publications

Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial.

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