Dataset Information

Does free-living physical activity improve one-year following total knee arthroplasty in patients with osteoarthritis: A prospective study.

ABSTRACT:

Objective

Total knee arthroplasty (TKA) is the gold-standard treatment for end-stage knee osteoarthritis, and the primary expectations are reduced pain and improved function. However, there is conflicting evidence regarding functional changes post-TKA. Commonly, functional changes are measured using Oxford Knee Score (OKS). No previous study has investigated physical behaviour (PB) changes in terms of volume and patterns post-TKA. The aims of this study were to explore volume and pattern changes in PB following TKA using an objective tool and to assess the correlation between this and OKS.

Design

An activPAL measured the PB of individuals on a waiting list for TKA for a period of 7-8 days pre-TKA, and for the same length of time at 12 months post-TKA. OKS was completed at similar follow-up time points.

Results

Thirty-three individuals completed the study, where stepping time, the number of steps and the time spent on moderate to vigorous physical activity (MVPA) (>100 steps/minute) improved significantly post-TKA p = 0.0001. Steps at 12 months post-TKA improved by 45.6% (from 4240 to 6174) and stepping time increased by 38.8% (from 0.98 to 1.36 h). MVPA improved by 35 min at 12 months (from 6.6 to 41.7 min). There were no significant correlations between PB and OKS.

Conclusion

This is the first study to explore PB volumes and event-based patterns post-TKA. Activity improved in terms of volume and patterns. No correlation was found between OKS and ActivPAL, which emphasises the need to use objective methods in addition to patient-reported outcome measures.

SUBMITTER: Bin Sheeha B

PROVIDER: S-EPMC9718260 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Publications

Does free-living physical activity improve one-year following total knee arthroplasty in patients with osteoarthritis: A prospective study.

Bin Sheeha Bodor B Granat Malcolm M Williams Anita A Johnson David Sands DS Jones Richard R

Osteoarthritis and cartilage open 20200413 3

<h4>Objective</h4>Total knee arthroplasty (TKA) is the gold-standard treatment for end-stage knee osteoarthritis, and the primary expectations are reduced pain and improved function. However, there is conflicting evidence regarding functional changes post-TKA. Commonly, functional changes are measured using Oxford Knee Score (OKS). No previous study has investigated physical behaviour (PB) changes in terms of volume and patterns post-TKA. The aims of this study were to explore volume and pattern ...[more]

PMID: 36474675

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Project description:BackgroundFew instruments that measure physical activity (PA) can accurately quantify PA performed at light and moderate intensities, which is particularly relevant in older adults. The evidence of their reliability in free-living conditions is limited.ObjectiveThe study objectives were: (1) to determine the test-retest reliability of the Actigraph (ACT), SenseWear Armband (SWA), and Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire in assessing free-living PA at light and moderate intensities in people after total knee arthroplasty; (2) to compare the reliability of the 3 instruments relative to each other; and (3) to determine the reliability of commonly used monitoring time frames (24 hours, waking hours, and 10 hours from awakening).DesignA one-group, repeated-measures design was used.MethodsParticipants wore the activity monitors for 2 weeks, and the CHAMPS questionnaire was completed at the end of each week. Test-retest reliability was determined by using the intraclass correlation coefficient (ICC [2,k]) to compare PA measures from one week with those from the other week.ResultsData from 28 participants who reported similar PA during the 2 weeks were included in the analysis. The mean age of these participants was 69 years (SD=8), and 75% of them were women. Reliability ranged from moderate to excellent for the ACT (ICC=.75-.86) and was excellent for the SWA (ICC=.93-.95) and the CHAMPS questionnaire (ICC=.86-.92). The 95% confidence intervals (95% CI) of the ICCs from the SWA were the only ones within the excellent reliability range (.85-.98). The CHAMPS questionnaire showed systematic bias, with less PA being reported in week 2. The reliability of PA measures in the waking-hour time frame was comparable to that in the 24-hour time frame and reflected most PA performed during this period.LimitationsReliability may be lower for time intervals longer than 1 week.ConclusionsAll PA measures showed good reliability. The reliability of the ACT was lower than those of the SWA and the CHAMPS questionnaire. The SWA provided more precise reliability estimates. Wearing PA monitors during waking hours provided sufficiently reliable measures and can reduce the burden on people wearing them.

Project description:ImportanceMore than 1 in 5 patients do not experience improved physical function after total knee arthroplasty (TKA). Identification of factors associated with physical function may be warranted to improve outcomes in these patients.ObjectiveTo identify preoperative and intraoperative factors associated with physical function at 12 months after TKA in a systematic review and meta-analysis.Data sourcesData from January 2000 to October 2021 were searched in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Physiotherapy Evidence Database (PEDro). No language restrictions were applied.Study selectionProspective observational studies or randomized clinical trials on factors associated with physical function after TKA in adult patients with osteoarthritis were selected. A prespecified peer-reviewed protocol was followed.Data extraction and synthesisFollowing the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline, 2 reviewers independently screened titles and abstracts and judged risk of bias using Quality in Prognosis Studies (QUIPS). Multivariate random-effects meta-analyses were performed to estimate mean correlations between factors and physical function with 95% CIs. Sensitivity analyses were conducted for each QUIPS domain. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO).Main outcomes and measuresThe primary outcome was physical function 12 months after TKA. Secondary outcomes were physical function 3 and 6 months after TKA. All estimates are mean correlations between factors and postoperative function. Positive correlations correspond to better function.ResultsAmong 12 052 articles, 20 studies (including 11 317 patients and 37 factors) were analyzed. Mean correlation with higher BMI was estimated to be -0.15 (95% CI, -0.24 to -0.05; P = .33; moderate-certainty evidence), while mean correlation with better physical function was estimated to be 0.14 (95% CI, 0.02 to 0.26; P = .03; low-certainty evidence) and mean correlation with more severe osteoarthritis was estimated to be 0.10 (95% CI, 0.01 to 0.19; P = .17; high-certainty evidence). In sensitivity analyses, mean correlation with better physical function was estimated to be 0.20 (95% CI, 0.04 to 0.36; P = .02), and so perhaps a larger coefficient than in the main analysis, while mean correlations were estimated to be similar for other factors (BMI: -0.17; 95% CI, -0.28 to -0.06; P < .001; osteoarthritis severity: 0.10; 95% CI, -0.01 to 0.20; P = .05).Conclusions and relevanceThis study found that higher presurgical BMI was correlated with worse physical function (with moderate certainty) and that better physical function (low certainty) and osteoarthritis severity (high certainty) were correlated with better physical function after TKA. These findings suggest that these factors should be included when testing predictive models of TKA outcomes.

Project description:BackgroundTo determine the effectiveness and therapeutic validity of physiotherapeutic exercise after total and unicompartmental knee arthroplasty for osteoarthritis. It was hypothesized that interventions of high therapeutic validity result in superior functional recovery after total and unicompartmental knee arthroplasty versus interventions of low therapeutic validity.MethodsA systematic review incorporating a comprehensive database search of five major databases relevant to the topic was conducted. Randomized controlled trials were reviewed if they included studies that compared postoperative physiotherapeutic exercise with usual care or compared two types of postoperative physiotherapeutic interventions. All included studies were assessed for risk of bias (using the Cochrane Collaboration's tool) and therapeutic validity (using the Consensus on Therapeutic Exercise Training scale). The characteristics of the included articles and their results on joint and muscle function, functional performance, and participation were extracted.ResultsOf the 4343 unique records retrieved, 37 articles were included. Six of them showed good therapeutic validity, suggesting low therapeutic validity in 31 studies. Three articles showed a low risk of bias, 15 studies scored some concerns for risk of bias and 19 studies scored high risk of bias. Only one article scored well on both methodological quality and therapeutic validity.ConclusionDue to heterogeneity of outcome measures and length of follow-up, as well as limited reporting of details of the physiotherapeutic exercises and control interventions, no clear evidence was found on effectiveness of physiotherapeutic exercises after total and unicompartmental knee arthroplasty. Homogeneity in intervention characteristics and outcome measures would enhance comparability of clinical outcomes between trials. Future studies should incorporate similar methodological approaches and outcome measures. Researchers are encouraged to use the Consensus on Therapeutic Exercise Training scale as a template to prevent insufficient reporting.

Project description:Arthrofibrosis is characterized by excessive extracellular matrix (ECM) deposition that results in restricted joint motion after total knee arthroplasty (TKA). Current surgical and pharmacologic treatment options are limited. Therefore, an in vitro model for joint myofibroblastogenesis is valuable to investigate the arthrofibrotic process and identify diagnostic biomarkers and treatment options. In this study, we obtained intraoperative posterior capsule (PC), quadriceps tendon (QT), and suprapatellar pouch (SP) tissue from knees of four patients undergoing primary TKA for osteoarthritis and characterized primary outgrowth cells from these tissues in the absence and presence of transforming growth factor beta 1 (TGFβ1), a pro-myofibroblastic cytokine. Light microscopy of knee outgrowth cells revealed spindle-shaped cells while immunofluorescence (IF) established staining for the fibroblast-specific antigen TE-7 and Vimentin, which are characteristics of fibroblasts. These fibroblasts differentiate readily into myofibroblasts as highlighted by enhanced alpha smooth muscle actin (ACTA2) mRNA and protein expression and increased collagen mRNA (i.e., collagen type 1 (COL1A1) and collagen type 3 (COL3A1)) expression and collagenous matrix deposition in the presence of TGFβ1. Of note, these studies also revealed that knee-derived fibroblasts are more sensitive to TGFβ1-mediated myofibroblastogenesis than adipose-derived mesenchymal stem cells. Importantly, while outgrowth fibroblasts isolated from four patients and three anatomical regions exhibit similar gene expression profiles, these knee fibroblasts form a unique gene expression cluster within the fibroblast niche as revealed by RNA-sequencing analysis. In conclusion, our study provides a fibroblast/myofibroblast model of outgrowth knee cells derived from patients undergoing primary TKA that can be employed to assess myofibroblast-related processes and test novel pharmacological strategies in vitro for arthrofibrosis.

Dataset Information

Does free-living physical activity improve one-year following total knee arthroplasty in patients with osteoarthritis: A prospective study.

Objective

Design

Results

Conclusion

Publications

Does free-living physical activity improve one-year following total knee arthroplasty in patients with osteoarthritis: A prospective study.

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