Pilot Study of Methods to Document Quantity and Variation of Independent Patient Exercise and Activity After Total Knee Arthroplasty

Article (PDF Available)inThe Journal of Arthroplasty 21(6 Suppl 2):157-63 · October 2006with11 Reads
DOI: 10.1016/j.arth.2006.05.007 · Source: PubMed
Variation in patients' independent exercise and activity after total knee arthroplasty (TKA) surgery may contribute to variable functional gains but have never been quantified. We pilot tested daily exercise logs and step activity monitors to quantify exercise and general home activity post-TKA. Patients successfully maintained logs and wore activity monitors. Logs documented significant variation in quantity of daily exercises. Women with poor emotional health recorded fewer repetitions and greater variation. More daily exercise repetitions correlated with larger 6-month functional improvement. Activity peaks on step monitors correlated with logged exercise sessions. However, most step activity was in addition to exercise sessions. Further research is needed to validate these findings and to clarify the relationship among post-TKA exercise, activity, and functional gain.

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Available from: Wenjun Li, Jan 19, 2016
    • "We have examined these associations in our pilot research and our data support a direct relationship between quantity of post-TKR exercise and activity and functional gain after TKR. This relationship was mediated by the patient's emotional health (SF36, MCS) and MCS was directly correlated with self-efficacy for arthritis self-care [9]. Based on the existing evidence, we hypothesize that a Patient Self-Management Support intervention that targets self-efficacy for physical activity and independent activity and exercise during the peri-operative TKR period will improve actual adherence to independent exercise and activity and, thus, maximize 6 and 12 month functional outcomes among post-TKR patients. "
    [Show abstract] [Hide abstract] ABSTRACT: Total knee replacement (TKR) is a common and effective surgical procedure to relieve advanced knee arthritis that persists despite comprehensive medical treatment. Although TKR has excellent technical outcomes, significant variation in patient-reported functional improvement post-TKR exists. Evidence suggests that consistent post-TKR exercise and physical activity is associated with functional gain, and that this relationship is influenced by emotional health. The increasing use of TKR in the aging US population makes it critical to find strategies that maximize functional outcomes. This randomized clinical trial (RCT) will test the efficacy of a theory-based telephone-delivered Patient Self-Management Support intervention that seeks to enhance adherence to independent exercise and activity among post- TKR patients. The intervention consists of 12 sessions, which begin prior to surgery and continue for approximately 9 weeks post-TKR. The intervention condition will be compared to a usual care control condition using a randomized design and a probabilistic sample of men and women. Assessments are conducted at baseline, eight weeks, and six- and twelve- months. The project is being conducted at a large healthcare system in Massachusetts. The study was designed to provide greater than 80% power for detecting a difference of 4 points in physical function (SF36/Physical Component Score) between conditions (standard deviation of 10) at six months with secondary outcomes collected at one year, assuming a loss to follow up rate of no more than 15%. As TKR use expands, it is important to develop methods to identify patients at risk for sub-optimal functional outcome and to effectively intervene with the goal of optimizing functional outcomes. If shown efficacious, this peri-TKR intervention has the potential to change the paradigm for successful post-TKR care. We hypothesize that Patient Self-Management Support to enhance adherence to independent activity and exercise will enhance uniform, optimal improvement in post-TKR function and patient autonomy, the ultimate goals of TKR.
    Full-text · Article · Oct 2011
    • "An estimated 15% to 30% of patients report minimal functional improvement at 12 months, while another 10% report functional gains up to three times the national average [1, 2, 13]. This post-TKR functional variation is not explained by persistent knee pain or poor preoperative function [8]. The 2003 NIH Consensus Panel called for research to evaluate ''patient-level factors affecting outcomes after surgery, including medical and sociodemographic characteristics ,'' such as age, gender, BMI, and emotional health at time of TKR and the contribution of these attributes to the variation in functional improvement 12 months after surgery. "
    [Show abstract] [Hide abstract] ABSTRACT: Total knee replacement effectively relieves arthritis pain but improvement in physical function varies. A clearer understanding of the patient attributes associated with differing levels of functional gain after TKR is critical to surgical decision making. We reviewed 8050 primary, unilateral TKR patients enrolled in a prospective registry between 2000 and 2005 who had complete data. We evaluated associations between 12-month function (SF12/PCS) and preoperative gender, age, BMI, emotional health (MCS), knee diagnosis, quadriceps strength, and physical function (PCS). More than 98% of patients reported pain relief (KS pain score). At 12 months, mean PCS gain was 13.6 points, but the distribution was bimodal. The mean gain in PCS in the 63% of patients with greater improvement was 21 (SD = 7), and 4.1 (SD = 7) in the remaining 37%. Increased likelihood of poor functional gain was associated with older age, body mass index (BMI) over 40, lower MCS, and poor quadriceps strength. While two-thirds of patients reported functional gain well above national average at 12 months post-TKR, 37% reported limited functional improvement. Further understanding of the patient attributes associated with limited improvement will guide the design of innovative strategies to improve functional outcomes. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
    Full-text · Article · Oct 2008
  • [Show abstract] [Hide abstract] ABSTRACT: The objective of this cross-sectional investigation is to describe a cohort of 275 status post joint replacement patients who received home health services from an orthopedic home health agency in St. Louis, Missouri. This study also aims to determine if these patients achieved statistically significant improvements in their functional mobility skills, pain, and emotional status. Demographic data were collected together with functional mobility elements from the Outcome and Assessment Information Set pertinent to the rehabilitation of status post joint replacement patients on admission and discharge from home care. Because of the limited nature of participant selection and convenience sampling, no correlations or trends were established among the data collected. However, this cross-sectional analysis validated the incidence of a patient subpopulation that is admitted directly to home care after undergoing joint replacement surgery and demonstrated that these patients achieved significant positive outcomes in functional measures.
    Article · Feb 2008
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