File
Gränicher P1, Stöggl T2, Fucentese SF3, Adelsberger R4, Swanenburg J5,6
1University Hospital Balgrist, Balgrist Move>Med, Zurich, Switzerland, 2University of Salzburg, Department of Sport Science and Kinesiology, Hallein/Rif, Austria, 3University Hospital Balgrist, Department of Orthopaedic Surgery, Zurich, Switzerland, 4ETH Zurich, Wearable Computing Lab Zurich, Zurich, Switzerland, 5Balgrist University Hospital, Integrative Spinal Research ISR, Department of Chiropractic Medicine, Zurich, Switzerland, 6University Hospital Zurich, Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, Zurich, Switzerland
Background: Total knee arthroplasty (TKA) is the elective surgical procedure in patients suffering from advanced knee osteoarthritis (OA) accompanied by limited knee functionality and pain. Although pain levels and joint function often improve after surgery, up to 20% of the patients are not satisfied with the result. Patients' expectations of improved health-related quality of life, reduced pain symptoms and better knee function, often remain unachieved after TKA.
Purpose: The purpose of this pilot study was to assess whether preoperative physical therapy (PT) prior to TKA enhances postoperative outcomes in terms of functional, subjective and socio-economic parameters.
Methods: A total of 20 patients (mean±SD: age 67±7 years) awaiting TKA at an Orthopaedic University Hospital were randomly assigned to a control (CG) or intervention (IG) group. Three weeks prior to surgery the IG completed one prescription à 7-9 sessions of PT, containing Proprioceptive Neuromuscular Facilitation (PNF)-techniques, endurance training, and individual indicated interventions. The CG kept its activity level unchanged. Primary outcome measure was the Stair Climbing Test (SCT), secondary knee ROM and the activity level by Lysholm Score (LS) and Tegner Activity Scale (TAS). Measurements were executed at baseline (three weeks before surgery), preoperative and three-months postoperative. Additionally, the Patient's Global Impression of Change (PGIC) scale was evaluated. The risk of discharge to a rehabilitation facility and the resulting length of stay were assessed. All patients were provided with diaries obtaining questions about preoperative pain levels, Metabolic Equivalent (MET), postoperative intake of analgesics, and overall costs.
Results: The repeated measures ANOVA showed of the SCT no interaction between group and time (F (2/36) = 0.016, p = 0.984, η2 = 0.004, sphericity assumed).
Only the TAS revealed a significant increase within the IG (F (18/1) = 13.890, p = 0.002, η2 = 0.536). No other significant change was found. Preoperative pain levels were reduced by 30% in IG and by 6.5% in CG, compared to baseline. MET declined in both groups from baseline to surgery, in IG by 5% and in CG by 43% on average. CG produced 21.4% higher overall costs than IG.
Conclusion(s): Preoperative PT facilitated the activity level before surgery in patients awaiting TKA. There were tendencies of improvements in functional, pain-related and socio-economic parameters. Sample size might have been too small to present clearly the effect of preoperative PT with the tests used. Patients who received preoperative PT benefitted from low postoperative costs. These results should be confirmed with future studies with larger sample size.
Implications: The results of this study indicate a possible reduction of post-surgery costs. This can underline the importance of PT before and after a TKA.
Keywords: physical therapy, prehabilitation, total knee arthroplasty
Funding acknowledgements: No funding.
Purpose: The purpose of this pilot study was to assess whether preoperative physical therapy (PT) prior to TKA enhances postoperative outcomes in terms of functional, subjective and socio-economic parameters.
Methods: A total of 20 patients (mean±SD: age 67±7 years) awaiting TKA at an Orthopaedic University Hospital were randomly assigned to a control (CG) or intervention (IG) group. Three weeks prior to surgery the IG completed one prescription à 7-9 sessions of PT, containing Proprioceptive Neuromuscular Facilitation (PNF)-techniques, endurance training, and individual indicated interventions. The CG kept its activity level unchanged. Primary outcome measure was the Stair Climbing Test (SCT), secondary knee ROM and the activity level by Lysholm Score (LS) and Tegner Activity Scale (TAS). Measurements were executed at baseline (three weeks before surgery), preoperative and three-months postoperative. Additionally, the Patient's Global Impression of Change (PGIC) scale was evaluated. The risk of discharge to a rehabilitation facility and the resulting length of stay were assessed. All patients were provided with diaries obtaining questions about preoperative pain levels, Metabolic Equivalent (MET), postoperative intake of analgesics, and overall costs.
Results: The repeated measures ANOVA showed of the SCT no interaction between group and time (F (2/36) = 0.016, p = 0.984, η2 = 0.004, sphericity assumed).
Only the TAS revealed a significant increase within the IG (F (18/1) = 13.890, p = 0.002, η2 = 0.536). No other significant change was found. Preoperative pain levels were reduced by 30% in IG and by 6.5% in CG, compared to baseline. MET declined in both groups from baseline to surgery, in IG by 5% and in CG by 43% on average. CG produced 21.4% higher overall costs than IG.
Conclusion(s): Preoperative PT facilitated the activity level before surgery in patients awaiting TKA. There were tendencies of improvements in functional, pain-related and socio-economic parameters. Sample size might have been too small to present clearly the effect of preoperative PT with the tests used. Patients who received preoperative PT benefitted from low postoperative costs. These results should be confirmed with future studies with larger sample size.
Implications: The results of this study indicate a possible reduction of post-surgery costs. This can underline the importance of PT before and after a TKA.
Keywords: physical therapy, prehabilitation, total knee arthroplasty
Funding acknowledgements: No funding.
Topic: Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: Swissmedic
Ethics committee: Ethics Committee of the Canton of Zurich
Ethics number: BASEC 2016-00258
All authors, affiliations and abstracts have been published as submitted.
