L. Sattler1, W. Hing1, A. Kan2, A. Walker1, C. Vertullo3
1Bond University, Robina, Australia, 2Gold Coast Knee Group, Robina, Australia, 3Knee Research Australia, Benowa, Australia
Background: For most individuals with symptomatic, end-stage knee osteoarthritis, total knee arthroplasty (TKA) is associated with decreased pain and enhanced quality of life. However, a proportion of patients, reportedly up to twenty percent, experience what they perceive as an unfavourable outcome. Physiotherapy is a commonly proposed therapeutic intervention for TKA patients, however, post-discharge referral to a physiotherapist can be based on a number of different variables. Despite the common notion that physiotherapy can be valuable to TKA patients, there is currently little guidance on which individuals would benefit most from physiotherapy or the optimal duration for physiotherapy intervention.
Purpose: Therefore, the two primary aims of this trial are (1) to determine if pre-operative variables predict suboptimal results at two-weeks post-TKA and (2) do patients who are identified as having suboptimal results at two weeks post-surgery improve upon these outcomes after undergoing supervised-physiotherapy when assessed for the same outcomes at six-weeks and four-months.
Methods: Forty participants enrolled in this trial were initially allocated to a self-directed bike pedalling-based physiotherapy group. Baseline demographics, along with functional and self-reported outcomes, were assessed pre-operatively, and at the patients first post-operative review, two-weeks following TKA. At the two-week assessment, patients were referred to the supervised-physiotherapy group if
1) their knee extension range of motion (ROM) was lacking by ten degrees or more,
2) knee flexion ROM was less than ninety degrees, or
3) they were dissatisfied with the progress of their rehabilitation.
Subsequent assessment of these variables, along with the number of supervised physiotherapy sessions attended, were recorded at follow-up timepoints of six-weeks and four-months. Normally distributed continuous data were reported using descriptive statistics and analysed via an independent samples t-test with statistical significance considered as p = <0.05. Categorical variables were summarized using counts and percentages and a nonparametric test, the Mann-Whitney U test, was used when data were not normally distributed.
1) their knee extension range of motion (ROM) was lacking by ten degrees or more,
2) knee flexion ROM was less than ninety degrees, or
3) they were dissatisfied with the progress of their rehabilitation.
Subsequent assessment of these variables, along with the number of supervised physiotherapy sessions attended, were recorded at follow-up timepoints of six-weeks and four-months. Normally distributed continuous data were reported using descriptive statistics and analysed via an independent samples t-test with statistical significance considered as p = <0.05. Categorical variables were summarized using counts and percentages and a nonparametric test, the Mann-Whitney U test, was used when data were not normally distributed.
Results: Of the forty participants, twenty-two (55%) did not require supervised-physiotherapy based on the criterion set in this trial. Eighteen (45%) participants met the inclusion criteria for supervised physiotherapy when assessed at two weeks post-TKA, for the reasons of knee flexion lack n=9 (50%); knee extension lack n=8 (44%); and dissatisfaction n=1 (0.1%). The average number of supervised-physiotherapy sessions was four, with an average duration of thirty minutes each, utilizing a 1:1 physiotherapist-to-patient ratio. The average number of years of practice of the treating physiotherapist was twenty-eight. There were no preoperative differences in any demographic variable or outcome assessed between the two groups. At six weeks, five (28%) of the eighteen participants still met the criteria for supervised physiotherapy and at four months, there were no participants who met the criteria to continue with supervised-physiotherapy.
Conclusions: The results of this study demonstrate that patients with suboptimal results assessed at two-weeks following TKA can improve these outcomes with four supervised physiotherapy sessions. Interestingly, there were no differences between the outcomes assessed preoperatively between the two groups.
Implications: Not all individuals require supervised physiotherapy after TKA, however, in select patients with suboptimal results, a referral at two-weeks post-surgery improves outcomes.
Funding acknowledgements: This research was supported by a Bond University Early Career Researcher grant, to the value of $5000.00 AUD.
Keywords:
Total knee arthroplasty
Outpatient physiotherapy
Total knee arthroplasty
Outpatient physiotherapy
Topics:
Orthopaedics
Musculoskeletal: lower limb
Orthopaedics
Musculoskeletal: lower limb
Did this work require ethics approval? Yes
Institution: Bond University
Committee: Human Research Ethics Committee
Ethics number: LS00163
All authors, affiliations and abstracts have been published as submitted.
