Moffet H.1,2, Bernard S.2,3, Choinière F.2, Tousignant M.4,5, Nadeau S.6,7, Mérette C.3, Boissy P.4,5, Corriveau H.4,5, Marquis F.8, Cabana F.9, Ranger P.10, Belzile E.8, Dimentberg R.11
1Laval University, Department of Rehabilitation, Quebec, Canada, 2Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada, 3Laval University, Faculty of Medicine, Quebec, Canada, 4University of Sherbrooke, Faculty of Medicine, Sherbrooke, Canada, 5Research Centre on Aging, Sherbrooke, Canada, 6University of Montreal, Montreal, Canada, 7CRIR, Montreal, Canada, 8CHUQ, Hôtel-Dieu de Québec, Quebec, Canada, 9CHUS, Sherbrooke, Canada, 10Hôpital Jean-Talon, Montreal, Canada, 11Ste-Mary's Hospital, Montreal, Canada
Background: Positive outcomes of total knee arthroplasty (TKA) in terms of pain reduction and functional gain is now widely recognised. However, data on these outcomes are scarce in the first two months post-TKA where most PT interventions take place. In a large-scale randomized clinical trial (RCT), comparing the clinical effectiveness and cost of a rehabilitation program delivered at home using videoconference technology (Telerehabilitation: TELE) or face-to-face visits (STD), our team collected data on pain and range of motion (ROM) at each treatment session in the first two months post-hospital discharge.
Purpose: The objective of this study is to present normative values for pain and knee ROM in the first 2 months after hospital discharge for a primary TKA in a large sample.
Methods: A total of 206 patients were initially randomized in our RCT. The intervention period began within 5-days after hospital discharge and lasted for 8-weeks (16 treatment sessions). Physiotherapists assessed pain and knee ROM at the beginning of each session using a standardized method. For pain intensity, a 10-cm visual analog scale was used. Knee ROM in flexion and extension was assessed using a goniometer. One-way ANOVAs with repeated measures were performed to determine means and confidence intervals (CI) of the data. Afterwards, calculations of the 50th, 85th and 95th percentiles (P) were conducted.
Results: Participants received a mean of 15.6±1.9 treatments (STD: 16.0 [0.2] and TELE 15.2 [2.7]). The number of days between sessions did not differ between groups. Only delay between hospital discharge and T1 differed significantly between groups (TELE: 5.5 [2.6] days, STD: 3.7 [2.0] days, p 0.0001). As no significant difference between groups were found for either pain or ROM from T1 to T16, normative values were established using the whole sample of patients (n=197). Pain intensity remained relatively low and diminished over time. Normative values of pain intensity for the 95th P varied from 6.9 cm at T1 to 4.4 cm at T16 (85th P: 5.4 to 2.8 cm; 50th P: 2.9 to 0 cm). For knee flexion, the 95th P varied from 55.4° in T1 to 93.1° in T16 (85th P: 66.7 to 96.8°; 50th P: 82.4 to 114.6°). For knee extension , values values of the 95th P varied from -25.7° at T1 to -12.4° at T16 (85th P: -18.6 to -9.1°; 50th P: -11.4 to -3.3°). The profiles of change in pain and knee ROM showed continuous improvements over the 16 treatment sessions.
Conclusion(s): The normative values obtained for this cohort could be used in comparable population and recovery time as benchmarks for on-going post TKA rehabilitation to easily identify at-risk patients and adjust treatment plans in a timely manner when needed.
Implications: These normative values could help identify laborious recoveries, inform patients about their level of recovery and select optimal modalities during rehabilitation. Patients who display delayed recovery in ROM following TKA may demonstrate persisting deficits. Clinicians should therefore seek to quickly identify patients with suboptimal progress in ROM.
Funding acknowledgements: This study was supported by a grant from the Canadian Institutes of Health Research (CIHR).
Topic: Musculoskeletal: lower limb
Ethics approval: The Ethics Committees of the CHUQ-LHôtel-Dieu de Québec and of 7 hospitals and 3 research centers approved the study.
All authors, affiliations and abstracts have been published as submitted.
