Lenssen Anton F, Crijns Yvonne H F, Waltjé Eddie M H, Roox George M, van Steyn Mike J A, Geesink Ruud J T, van den Brandt Piet A, de Bie Rob A
University Hospital Maastricht, Department of Physical Therapy, Maastricht, The Netherlands.
BMC Musculoskelet Disord. 2006 Feb 23;7:15. doi: 10.1186/1471-2474-7-15.
Adequate and intensive rehabilitation is an important requirement for successful Total Knee Arthroplasty. The primary focus of early rehabilitation is ambulation of patients and regaining range of motion in the knee. Although research suggests that Continuous Passive Motion should be implemented in the first rehabilitation phase following surgery, there is substantial debate about the duration of each session and the total period of CPM application and. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered.
In a randomised controlled trial we intend to investigate the efficacy of prolonged use of a continuous passive motion (CPM) device in the home situation as an adjunct to standardised physical therapy. The experimental treatment is compared to standardised physical therapy, in patients with osteoarthritis of the knee undergoing Total Knee Arthroplasty (TKA). Efficacy will be assessed in terms of faster improvements in range of motion and functional recovery. Seventy patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment (less than 80 degrees of knee flexion at the time of discharge) will be randomised over two treatment groups, a usual care group and an experimental group. The experimental group will receive CPM + physiotherapy for 17 consecutive days after surgery, whereas the usual care group will receive the same treatment during the in-hospital phase (i.e. about four days), followed by physical therapy alone (usual care) in the first two weeks after hospital discharge. From 18 days to three months after discharge, both groups will receive standardised PT. The primary focus of rehabilitation will be functional recovery (e.g. ambulation) and regaining range of motion (ROM) in the knee.
Because restricted knee ROM affects functional activities, knee ROM and knee function are regarded as the primary indicators of successful TKA. Potential effects of the intervention under study include rapid return of knee flexion accompanied by earlier return to functional activities of daily life. If patients benefit significantly from prolonged CPM use, this treatment should be added to the standard PT treatment at home. We expect the additional home CPM programme to be more effective than the usual physiotherapy programme, resulting in a difference in ROM of at least 5 degrees , 17 days after surgery. This clinically important difference, with a possible flexion ROM of about 100 degrees , is expected to lead to better functioning in activities of daily life, like walking, and earlier ability to cycle. These advantages should result in earlier and increasing independence.
充分且强化的康复治疗是全膝关节置换术成功的一项重要要求。早期康复的主要重点是患者的行走能力以及恢复膝关节的活动范围。尽管研究表明，在术后首个康复阶段应实施持续被动运动（CPM），但对于每次治疗的时长以及CPM应用的总时长仍存在大量争议。一项关于该主题的Cochrane综述得出结论，短期使用CPM可带来更大的短期活动范围。然而，该综述也建议，未来的研究应聚焦于CPM的治疗时长。
在一项随机对照试验中，我们打算研究在家庭环境中延长使用持续被动运动（CPM）设备作为标准化物理治疗辅助手段的疗效。将接受全膝关节置换术（TKA）的膝骨关节炎患者的实验性治疗与标准化物理治疗进行比较。疗效将根据活动范围和功能恢复的更快改善情况进行评估。70例接受TKA且术后早期存在屈曲障碍（出院时膝关节屈曲小于80度）的膝骨关节炎患者将被随机分为两个治疗组，即常规护理组和实验组。实验组将在术后连续17天接受CPM + 物理治疗，而常规护理组将在住院期间（即约4天）接受相同治疗，随后在出院后的前两周仅接受物理治疗（常规护理）。出院后18天至3个月，两组都将接受标准化物理治疗。康复的主要重点将是功能恢复（如行走）以及恢复膝关节的活动范围（ROM）。
由于膝关节ROM受限会影响功能活动，膝关节ROM和膝关节功能被视为TKA成功的主要指标。所研究干预措施的潜在效果包括膝关节屈曲的快速恢复以及更早恢复日常生活功能活动。如果患者从延长使用CPM中显著获益，这种治疗应添加到家庭中的标准物理治疗中。我们预计额外的家庭CPM方案比常规物理治疗方案更有效，在术后17天导致ROM差异至少5度。这种具有临床重要意义的差异，可能的屈曲ROM约为100度，预计会使日常生活活动（如行走）功能更好，并更早具备骑自行车的能力。这些优势应会带来更早且不断增强的独立性。
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