Exercise- and education-based prehabilitation before total knee arthroplasty: a pilot study
DOI:
https://doi.org/10.2340/jrm.v56.18326Keywords:
Arthroplasty, Replacement, Knee, Exercise Therapy, Preoperative Exercise, Recovery of FunctionAbstract
Objective: To determine the feasibility and estimates of effects of a supervised exercise- and education-based prehabilitation programme aiming to improve knee functioning compared with usual care in patients awaiting total knee arthroplasty.
Design: A randomized controlled pilot study.
Subjects: Patients receiving primary, unilateral total knee arthroplasty.
Methods: Patients randomized to the intervention group participated in a personalized 4–8-week prehabilitation programme before surgery. Feasibility of the intervention and self-reported knee functioning, pain, physical performance and hospital stay were assessed at baseline, immediately preoperatively, 6 and 12 weeks after surgery.
Results: Twenty patients (mean age 72.7±5.95 years) were enrolled in this study. The personalized prehabilitation programme was found to be feasible and safe, with an exercise adherence of 90%. Significant medium interaction effects between groups and over time favouring prehabilitation were reported for the sport subscale of the Knee Osteoarthritis Outcome Score (F(3/54) = 2.895, p = 0.043, η² = 0.139) and Tegner Activity Scale (F(2.2/39.1) = 3.20, p = 0.048, η² = 0.151).
Conclusion: The absence of adverse events and high adherence to the programme, coupled with beneficial changes shown in the intervention group, support the conduct of a full-scale trial investigating the effectiveness of prehabilitation.
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Beck M, Christen B, Zdravkovic V, Brand C. Implantatregister SIRIS Hüfte und Knie: Kurzfassung - SIRIS Report 2022. Bern: SIRIS; 2022.
Ben-Shlomo Y, Blom A, Boulton C, et al. The National Joint Registry 19th Annual Report 2022 [Accessed November 30, 2023]. Lon-don: National Joint Registry. Available from: https://www.ncbi.nlm.nih.gov/books/NBK587525/.
Klem NR, Kent P, Smith A, Dowsey M, Fary R, Schutze R, et al. Satisfaction after total knee replacement for osteoarthritis is usu-ally high, but what are we measuring? A systematic review. Osteoarthr Cartil Open 2020; 2: 100032.
https://doi.org/10.1016/j.ocarto.2020.100032 DOI: https://doi.org/10.1016/j.ocarto.2020.100032
Mohammad HR, Gooberman-Hill R, Delmestri A, Broomfield J, Patel R, Huber J, et al. Risk factors associated with poor pain out-comes following primary knee replacement surgery: analysis of data from the clinical practice research datalink, hospital epi-sode statistics and patient reported outcomes as part of the STAR research programme. PLoS One 2021; 16: e0261850.
https://doi.org/10.1371/journal.pone.0261850 DOI: https://doi.org/10.1371/journal.pone.0261850
Olsen U, Lindberg MF, Rose C, Denison E, Gay C, Aamodt A, et al. Factors correlated with physical function 1 year after total knee arthroplasty in patients with knee osteoarthritis: a systematic review and meta-analysis. JAMA Netw Open 2022; 5: e2219636.
https://doi.org/10.1001/jamanetworkopen.2022.19636 DOI: https://doi.org/10.1001/jamanetworkopen.2022.19636
Desmeules F, Dionne CE, Belzile EL, Bourbonnais R, Fremont P. The impacts of pre-surgery wait for total knee replacement on pain, function and health-related quality of life six months after surgery. J Eval Clin Pract 2012; 18: 111-120.
https://doi.org/10.1111/j.1365-2753.2010.01541.x DOI: https://doi.org/10.1111/j.1365-2753.2010.01541.x
Zheng Y, Huang Z, Dai L, Liu Y, Chen Y, Zhang W, et al. The effect of preoperative rehabilitation training on the early recovery of joint function after artificial total knee arthroplasty and its effect evaluation. J Healthc Eng 2022; 2022: 3860991.
https://doi.org/10.1155/2022/3860991 DOI: https://doi.org/10.1155/2022/3860991
Gränicher P, Mulder L, Lenssen T, Scherr J, Swanenburg J, de Bie R. Prehabilitation improves knee functioning before and within the first year after total knee arthroplasty: a systematic review with meta-analysis. J Orthop Sports Phys Ther 2022; 52: 709-725.
https://doi.org/10.2519/jospt.2022.11160 DOI: https://doi.org/10.2519/jospt.2022.11160
Beaupre L, Lier, D, Davies, DM, Johnston, DB. The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol 2004; 31: 1166-1173.
Gränicher P, Stöggl T, Fucentese SF, Adelsberger R, Swanenburg J. Preoperative exercise in patients undergoing total knee arthro-plasty: a pilot randomized controlled trial. Arch Physiother 2020; 10: 13.
https://doi.org/10.1186/s40945-020-00085-9 DOI: https://doi.org/10.1186/s40945-020-00085-9
American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009; 41: 687-708.
https://doi.org/10.1249/MSS.0b013e3181915670 DOI: https://doi.org/10.1249/MSS.0b013e3181915670
Holden S, Barton CJ. 'What should I prescribe?': time to improve reporting of resistance training programmes to ensure accurate translation and implementation. Br J Sports Med 2019; 53: 264-265.
https://doi.org/10.1136/bjsports-2017-098664 DOI: https://doi.org/10.1136/bjsports-2017-098664
Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, et al. Defining feasibility and pilot studies in preparat-ion for randomised controlled trials: development of a conceptual framework. PLoS One 2016; 11: e0150205.
https://doi.org/10.1371/journal.pone.0150205 DOI: https://doi.org/10.1371/journal.pone.0150205
Clode NJ, Perry MA, Wulff L. Does physiotherapy prehabilitation improve pre-surgical outcomes and influence patient expectations prior to knee and hip joint arthroplasty? Int J Orthop Trauma Nurs 2018; 30: 14-19.
https://doi.org/10.1016/j.ijotn.2018.05.004 DOI: https://doi.org/10.1016/j.ijotn.2018.05.004
European Medicines Agency. Guideline for good clinical practice E6(R2) 2018; London: European Medicines Agency; 2018.
Jacques RM, Ahmed R, Harper J, Ranjan A, Saeed I, Simpson RM, Walters SJ. Recruitment, consent and retention of participants in randomised controlled trials: a review of trials published in the National Institute for Health Research (NIHR) Journals Library (1997-2020). BMJ Open 2022; 12: e059230.
https://doi.org/10.1136/bmjopen-2021-059230 DOI: https://doi.org/10.1136/bmjopen-2021-059230
Roos E, Lohmander, LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 3: 64.
https://doi.org/10.1186/1477-7525-1-64 DOI: https://doi.org/10.1186/1477-7525-1-64
Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res 2018; 11: 851-856.
https://doi.org/10.2147/JPR.S158847 DOI: https://doi.org/10.2147/JPR.S158847
Swanenburg J, Koch PP, Meier N, Wirth B. Function and activity in patients with knee arthroplasty: validity and reliability of a Ger-man version of the Lysholm Score and the Tegner Activity Scale. Swiss Med Wkly 2014; 144: w13976.
https://doi.org/10.4414/smw.2014.13976 DOI: https://doi.org/10.4414/smw.2014.13976
Geisser ME, Clauw DJ, Strand V, Gendreau RM, Palmer R, Williams DA. Contributions of change in clinical status parameters to Patient Global Impression of Change (PGIC) scores among persons with fibromyalgia treated with milnacipran. Pain 2010; 149: 373-378.
https://doi.org/10.1016/j.pain.2010.02.043 DOI: https://doi.org/10.1016/j.pain.2010.02.043
Swanenburg J, Gruber C, Brunner F, Wirth B. Patients' and therapists' perception of change following physiotherapy in an orthopedic hospital's outpatient clinic. Physiother Theory Pract 2015; 31: 293-298.
https://doi.org/10.3109/09593985.2014.994152 DOI: https://doi.org/10.3109/09593985.2014.994152
Medina-Mirapeix F, Vivo-Fernandez I, Lopez-Canizares J, Garcia-Vidal JA, Benitez-Martinez JC, Del Bano-Aledo ME. Five times sit-to-stand test in subjects with total knee replacement: Reliability and relationship with functional mobility tests. Gait Posture 2018; 59: 258-260.
https://doi.org/10.1016/j.gaitpost.2017.10.028 DOI: https://doi.org/10.1016/j.gaitpost.2017.10.028
Hashimoto S, Hatayama K, Terauchi M, Saito K, Higuchi H, Chikuda H. Preoperative hand-grip strength can be a predictor of stair ascent and descent ability after total knee arthroplasty in female patients. J Orthop Sci 2020; 25: 167-172.
https://doi.org/10.1016/j.jos.2019.03.003 DOI: https://doi.org/10.1016/j.jos.2019.03.003
Yuksel E, Kalkan S, Cekmece S, Unver B, Karatosun V. Assessing minimal detectable changes and test-retest reliability of the timed up and go test and the 2-minute walk test in patients with total knee arthroplasty. J Arthroplasty 2017; 32: 426-430.
https://doi.org/10.1016/j.arth.2016.07.031 DOI: https://doi.org/10.1016/j.arth.2016.07.031
Butland RJ PJ, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982; 284: 1607-1608.
https://doi.org/10.1136/bmj.284.6329.1607 DOI: https://doi.org/10.1136/bmj.284.6329.1607
Mizner RL, Petterson SC, Clements KE, Zeni JA, Jr, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthro-plasty 2011; 26: 728-737.
https://doi.org/10.1016/j.arth.2010.06.004 DOI: https://doi.org/10.1016/j.arth.2010.06.004
Cibere J, Bellamy N, Thorne A, Esdaile JM, McGorm KJ, Chalmers A, et al. Reliability of the knee examination in osteoarthritis: effect of standardization. Arthritis Rheum 2004; 50: 458-468.
https://doi.org/10.1002/art.20025 DOI: https://doi.org/10.1002/art.20025
Wirth B, Meier N, Koch PP, Swanenburg J. Development and evaluation of a German version of the Tegner activity scale for measuring outcome after anterior cruciate ligament injury. Sportverletz Sportschaden 2013; 27: 21-27.
https://doi.org/10.1055/s-0032-1330752 DOI: https://doi.org/10.1055/s-0032-1330752
Almeida GJ, Schroeder CA, Gil AB, Fitzgerald GK, Piva SR. Interrater reliability and validity of the stair ascend/descend test in subjects with total knee arthroplasty. Arch Phys Med Rehabil 2010; 91: 932-938.
https://doi.org/10.1016/j.apmr.2010.02.003 DOI: https://doi.org/10.1016/j.apmr.2010.02.003
Doiron-Cadrin P, Kairy D, Vendittoli PA, Lowry V, Poitras S, Desmeules F. Feasibility and preliminary effects of a tele-prehabilitation program and an in-person prehablitation program compared to usual care for total hip or knee arthroplasty candidates: a pilot randomized controlled trial. Disabil Rehabil 2020; 42: 989-998.
https://doi.org/10.1080/09638288.2018.1515992 DOI: https://doi.org/10.1080/09638288.2018.1515992
Banerjee A, Pluddemann A, O'Sullivan J, Nunan D. Performance Bias Catalogue of Bias: Nuffield Department of Primary Care Health Sciences; 2019 [acessed 2023 Nov 30]. Available from: https://catalogofbias.org/biases/performance-bias/.
Sipers WM, Verdijk LB, Sipers SJ, Schols JM, van Loon LJ. The Martin Vigorimeter represents a reliable and more practical tool than the Jamar dynamometer to assess handgrip strength in the geriatric patient. J Am Med Dir Assoc 2016; 17: 466.e461-466.e467.
https://doi.org/10.1016/j.jamda.2016.02.026 DOI: https://doi.org/10.1016/j.jamda.2016.02.026
Janssen ER, Osong B, van Soest J, Dekker A, van Meeteren NL, Willems PC, et al. Exploring associations of preoperative physical performance with postoperative outcomes after lumbar spinal fusion: a machine learning approach. Arch Phys Med Rehabil 2021; 102: 1324-1330.
https://doi.org/10.1016/j.apmr.2021.02.013 DOI: https://doi.org/10.1016/j.apmr.2021.02.013
Ohno C, Ogawa T, Taniguchi T, Kinoshita T, Fujita Y, Nishimura Y, et al. Effect of 3-week preoperative rehabilitation on pain and daily physical activities in patients with severe osteoarthritis undergoing total knee arthroplasty. Br J Pain 2022; 16: 472-480.
https://doi.org/10.1177/20494637221084190 DOI: https://doi.org/10.1177/20494637221084190
Hashizaki T, Nishimura Y, Ogawa T, Ohno C, Kouda K, Umemoto Y, et al. Effectiveness of a 3-week rehabilitation program combining muscle strengthening and endurance exercises prior to total knee arthroplasty: a non-randomized controlled trial. J Clin Med 2023; 12: 1523.
https://doi.org/10.3390/jcm12041523 DOI: https://doi.org/10.3390/jcm12041523
Ponzio DY, Chiu YF, Salvatore A, Lee YY, Lyman S, Windsor RE. An analysis of the influence of physical activity level on total knee arthroplasty expectations, satisfaction, and outcomes: increased revision in active patients at five to ten years. J Bone Joint Surg Am 2018; 100: 1539-1548.
https://doi.org/10.2106/JBJS.17.00920 DOI: https://doi.org/10.2106/JBJS.17.00920
Carli F, Zavorsky, G.S. Optimizing functional exercise capacity in the elderly surgical population. Curr Opin Clin Nutr Metab Care 2005; 8: 23-32.
https://doi.org/10.1097/00075197-200501000-00005 DOI: https://doi.org/10.1097/00075197-200501000-00005
Durrand J, Singh, SJ, Danjoux, G. Prehabilitation. Clin Med (Lond) 2019; 19: 458-464.
https://doi.org/10.7861/clinmed.2019-0257 DOI: https://doi.org/10.7861/clinmed.2019-0257
Berghmans DDP, Lenssen AF, Emans PJ, de Bie RA. Functions, disabilities and perceived health in the first year after total knee arthroplasty; a prospective cohort study. BMC Musculoskelet Disord 2018; 19: 250.
https://doi.org/10.1186/s12891-018-2159-7 DOI: https://doi.org/10.1186/s12891-018-2159-7
Warner D. Surgery as a teachable moment: lost opportunities to improve public health. Arch Surg 2009; 144: 1106-1107.
https://doi.org/10.1001/archsurg.2009.205 DOI: https://doi.org/10.1001/archsurg.2009.205
Akhavan NS, Ormsbee L, Johnson SA, George KS, Foley EM, Elam ML, et al. Functionality in middle-aged and older overweight and obese individuals with knee osteoarthritis. Healthcare (Basel) 2018; 6: 74.
https://doi.org/10.3390/healthcare6030074 DOI: https://doi.org/10.3390/healthcare6030074
Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009; 338: b2393.
https://doi.org/10.1136/bmj.b2393 DOI: https://doi.org/10.1136/bmj.b2393
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