PATIENT INFORMATION > NEWS > CURRENT REHAB CONCEPTS
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CURRENT REHAB CONCEPTS
Outcomes Before and After Total Knee Arthroplasty Compared to Healthy Adults.
Bade, M., Kohrt, W. and Stevens-Lapsley, J. 2010. J Orthop Sports Phys Ther.40(9):559-56. The objective of this study was to investigate functional measures in patients undergoing total knee joint replacement one month prior to, two weeks post, one month post, three months post and six months post surgery. These measures were compared with matched controls with healthy knees. Functional outcome measures were chosen to avoid the bias created with self reporting due to the diminished pain post joint replacement. All participants undertook a standard rehab program post surgery involving range of motion exercises, exercycle and strength exercises. These were supervised for the initial two week period twice weekly in an outpatients setting after which the patients continued unsupervised. Outcome measures investigated were Timed Up and Go, Stair Climbing Test, 6 Minute Walk Test and Single Limb Stand. Knee range of motion and quadriceps strength were also measured. At each of the time points the TKJR patients displayed deficits when compared to matched controls except for the Single Limb Stance when tested at six months. This compares well to what we are seeing anecdotally when patients undertake a preoperative strength and range of motion program involving the exercycle, rowing ergometer and restricted range strength exercises. It seems that with this prehabilitation the post surgery deficit is diminished. The failure of patients to restore normal strength is particularly important as a high correlation exists between quadriceps strength and functional performance. Although these patients recovered to preoperative strength levels at the six month mark they continued to display deficits when compared to controls. The more positive outcome I believe comes from this paper is the improvement in Single Limb Stance time and how this reflects on proprioception and control. Somewhere in the order of 24% of patients will fall in the first year after TKJR. With improvements in Single Limb Stance Time it would seem reasonable to expect this figure would decrease as patients control and stability of the lower limb should be better as reflected in greater stance times. In this study the stance times had reached the level of controls by the six month mark. It was demonstrated that patients undergoing a TKJR do not recover to normal functional levels by six months post surgery. Currently utilised protocols of rehabilitation do not effectively return patients to the level of healthy peers. Six months could be considered an early time point to measure the return of function when the decay time with osteoarthritis is extended but early rehabilitation may well limit this loss. I believe this gives some support to pre surgery strength and range of motion programs and a more formal progression of post TKJR rehabilitation to address the strength component particularly. This could easily be undertaken by the patient in the home environment with intermittent assessment and progression but undertaken on a more regular basis. Exercycle program after total hip replacement improves quality of life. Patients who exercise on a stationery cycle after hip replacement report better health-related quality of life and greater satisfaction, according to a study in the April issue of the Journal of Bone and Joint Surgery. Altogether, the researchers randomized 362 patients to a 3-week program of stationary cycling, 3 times per week starting 2 weeks after total hip replacement surgery, or to a control group. The main outcome was self-reported physical function at 3, 6, 12, and 24 months after surgery. After total hip replacement, patients in the cycling group reported not only better physical functioning but less pain and stiffness than patients in the control group and were "very satisfied" at the follow-up intervals compared with those in the control group. Physical function -- the primary outcome -- was significantly better in hip replacement patients in the cycling group at 3 months. Home based exercise program beneficial in avoiding recurrance of ankle sprains. In a recent study in the British Medical Journal (Hupperets et al, 2009) a home based proprioception (balance) program has been shown to provide benefit in avoiding the occurance of repeat ankle sprains. Patients with lateral ankle sprains received normal treatment following injury and an intervention group were put on a home based exercise program. The program prescribed three training sessions a week, with a maximum duration of 30 minutes a session. Athletes were encouraged to perform the exercises as part of their normal warm up. Exercises gradually increased in difficulty and training load during the eight week programme. At one year follow up the group who had completed the balance exercises had a 35% less risk of further ankle sprain over that time. What does this mean for you as a patient? Completion of a rehab program following ankle injury does not stop with return to play. The recovery of normal balance sensation through the joint is important in prevention of further injury and in regaining full control of the ankle again. Proprioception programs form an important part of our Physiotherapy rehab and we encourage you to undertake these programs. |