Moutzouri M1,2, Gleeson N3, Coutts F3, Billis E4, Tsepis E4, Gliatis J5
1Queen Margaret University Edinburgh, Physiotherapy, Edinburgh, United Kingdom, 2University of West Attica, Physiotherapy, Athens, Greece, 3Queen Margaret University Edinburgh, Health Sciences, Edinburgh, United Kingdom, 4Technological Educational Institute (TEI) of Western Greece, Physiotherapy, Patras, Greece, 5University of Patras, Orthopedic, Patras, Greece
Background: Both patient-reported and objective outcome measures are commonly used following total knee replacement (TKR) to assess knee function and they are key indicators of when patients' physical performance is restored. Objective measures can be over-burdening and expensive in terms of equipment and assessor time.Therefore, if a robust and significant relationship exists even between an easily-delivered objective functional, balance or neuromuscular tasks and inexpensive patient-reported outcome measures (PROMs), the aforementioned objective measures could be made redundant. Potential relationships over time between changes in outcomes of physical performance capabilities, and neuromuscular indices during focal sensori-motor training (SMT) might help identify mechanisms of change in functional capacity.
Purpose: To explore the inter-relationships amongst the PROMs and objective measures of functional, balance and neuromuscular performance during a focal SMT programme in patients following knee replacement.
Methods: In order to assess the inter-relationships between PROMS and objective measures, participants undergoing knee replacement were recruited and evaluated. Fifty-two adults (females, n=38), [age (years); mean ± SD: 72.2 ± 5.5, height (m) 1.66 ± 0.7, body mass (kg) 82.5 ± 9.5] participated in the study.Timed Up and Go Test (TUG), single-limb standing balance in Biodex Stability System, quadriceps peak force (PF) and patient-reported measures (NPRS, KOOS, KOS-ADL, SF-12) were analysed for association, using Pearson product-moment correlation coefficients.
Results: A few weak to moderate statistically significant correlations were confirmed between objective (TUG)and PROMs [KOOS, KOS-ADL, SF-12] (ranging from r = -0.34 to -0.41; p 0.05). Correlations of TUG and balance performance during a focal SMT programme were scarce and weak in strength. Modest correlations (ranging from r = -0.39 to -0.60; p 0.05) were confirmed between objective (TUG) and neuromuscular indices.
Conclusion(s): The TUG objective functional evaluation score was not robustly correlated with PROMs.As no clinically-meaningful relationships were identified between TUG and indices of balance performance, it can be concluded that in order to fully assess and describe the effectiveness of a focal SMT programme implemented post-TKR, all the aforementioned indices need to be assessed. The modest relationships of TUG with quadriceps PF demonstrated that the observed improvement in functional performance during the focal SMT may be attributed mechanistically to improved aspects of neuromuscular performance.
Implications: Findings clinically support the notion that current practice when evaluating post-surgical TKR outcomes during SMT, should continue to use a battery of PROMs and performance-based indices. All functional and balance indices are needed to establish a comprehensive description of the physical performance, dynamic stability, confidence and capabilities associated with the surgically reconstructed knee. However, the numerous moderate relationships of functional and neuromuscular performance' indices offer a potential mechanistic explanation of how a focal SMT programme may have improved functional performance, using a neurophysiological pathway.
Keywords: Knee replacement, rehabilitation, sensori-motor training
Funding acknowledgements: Partial Funding was obtained from the MACP for this study.
Purpose: To explore the inter-relationships amongst the PROMs and objective measures of functional, balance and neuromuscular performance during a focal SMT programme in patients following knee replacement.
Methods: In order to assess the inter-relationships between PROMS and objective measures, participants undergoing knee replacement were recruited and evaluated. Fifty-two adults (females, n=38), [age (years); mean ± SD: 72.2 ± 5.5, height (m) 1.66 ± 0.7, body mass (kg) 82.5 ± 9.5] participated in the study.Timed Up and Go Test (TUG), single-limb standing balance in Biodex Stability System, quadriceps peak force (PF) and patient-reported measures (NPRS, KOOS, KOS-ADL, SF-12) were analysed for association, using Pearson product-moment correlation coefficients.
Results: A few weak to moderate statistically significant correlations were confirmed between objective (TUG)and PROMs [KOOS, KOS-ADL, SF-12] (ranging from r = -0.34 to -0.41; p 0.05). Correlations of TUG and balance performance during a focal SMT programme were scarce and weak in strength. Modest correlations (ranging from r = -0.39 to -0.60; p 0.05) were confirmed between objective (TUG) and neuromuscular indices.
Conclusion(s): The TUG objective functional evaluation score was not robustly correlated with PROMs.As no clinically-meaningful relationships were identified between TUG and indices of balance performance, it can be concluded that in order to fully assess and describe the effectiveness of a focal SMT programme implemented post-TKR, all the aforementioned indices need to be assessed. The modest relationships of TUG with quadriceps PF demonstrated that the observed improvement in functional performance during the focal SMT may be attributed mechanistically to improved aspects of neuromuscular performance.
Implications: Findings clinically support the notion that current practice when evaluating post-surgical TKR outcomes during SMT, should continue to use a battery of PROMs and performance-based indices. All functional and balance indices are needed to establish a comprehensive description of the physical performance, dynamic stability, confidence and capabilities associated with the surgically reconstructed knee. However, the numerous moderate relationships of functional and neuromuscular performance' indices offer a potential mechanistic explanation of how a focal SMT programme may have improved functional performance, using a neurophysiological pathway.
Keywords: Knee replacement, rehabilitation, sensori-motor training
Funding acknowledgements: Partial Funding was obtained from the MACP for this study.
Topic: Orthopaedics; Musculoskeletal: lower limb; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: Queen Margaret University, Uk
Ethics committee: Queen Margaret University Divisional Ethics Committee
Ethics number: 7052/4-7-2011
All authors, affiliations and abstracts have been published as submitted.
