Exericise and Health Psychology Laboratory, School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.
PM R. 2012 Sep;4(9):647-56. doi: 10.1016/j.pmrj.2012.04.012. Epub 2012 Jun 13.
To examine the effect of a 6-week prehabilitation exercise training program on presurgical quadriceps strength for patients undergoing total knee arthroplasty (TKA).
Two-arm, parallel, randomized, controlled pilot trial.
Private exercise space in a research facility.
Twenty-two patients scheduled for primary TKA.
Participants completed a series of baseline questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Short Form 36, and Arthritis Self-efficacy Scale) and functional testing (isometric quadriceps strength assessment, flat-surface walk test, and stair ascent-descent test). The participants were randomized to a lower-body strength training program or to a nonspecific upper-body strength training program. The participants exercised 3 times per week for 6 weeks before TKA. Postintervention assessment occurred immediately before TKA, with follow-up assessments at 6 and 12 weeks after surgery.
The primary outcome was isometric quadriceps strength. Secondary outcomes were mobility, pain, self-reported function, health-related quality of life, and arthritis self-efficacy.
There was no significant treatment condition-by-time effect on quadriceps strength, but the effect size was large (F(3,18) = 0.89, P = .47, η(2) = 0.13). Similar findings were shown for walking speed (F(3,18) = 1.47, P = .26, η(2) = 0.20). There was a significant treatment-by-time effect for the Short Form 36 mental component score (F(3,18) = 0.41, P = .02, η(2) = 0.41), with differences emerging before surgery but not at either postoperative assessment. For all other secondary outcome measures, the treatment-by-time effect was nonsignificant and small.
The intervention elicited clinically meaningful increases in quadriceps strength, walking speed, and mental health immediately before TKA. It did not impart lasting benefits to patients in the 12 weeks after surgery. Analysis of the results suggests that quadriceps strength may not drive functional improvements after surgery. These findings need to be replicated in larger trials before clinical recommendations are made about including strength training prehabilitation in everyday practice.
研究 6 周术前康复锻炼计划对全膝关节置换术（TKA）患者术前股四头肌力量的影响。
双臂、平行、随机、对照试验。
研究设施的私人锻炼空间。
22 名计划接受初次 TKA 的患者。
参与者完成了一系列基线问卷（西安大略和麦克马斯特大学骨关节炎指数[WOMAC]、简短表格 36、关节炎自我效能量表）和功能测试（等长股四头肌力量评估、平地行走测试和楼梯上下测试）。参与者被随机分配到下半身力量训练计划或非特定的上半身力量训练计划。参与者在 TKA 前每周进行 3 次，持续 6 周。干预后评估在 TKA 前即刻进行，术后 6 周和 12 周进行随访评估。
主要结局是等长股四头肌力量。次要结局是移动性、疼痛、自我报告功能、健康相关生活质量和关节炎自我效能。
股四头肌力量无显著的治疗条件与时间效应，但效应量较大（F(3,18) = 0.89, P =.47, η(2) = 0.13）。步行速度也显示出类似的发现（F(3,18) = 0.89, P =.47, η(2) = 0.13）。简短表格 36 精神成分评分的治疗与时间效应显著（F(3,18) = 0.41, P =.02, η(2) = 0.41），术前出现差异，但术后评估均无差异。对于所有其他次要结局测量，治疗与时间的效应均不显著且较小。
干预措施在 TKA 前即刻引起了股四头肌力量、步行速度和心理健康的显著临床改善。它在术后 12 周内没有给患者带来持久的益处。对结果的分析表明，股四头肌力量可能不会促进术后的功能改善。在提出关于将力量训练作为术前康复纳入日常实践的临床建议之前，需要在更大的试验中复制这些发现。
