Outcomes Research, Burke Rehabilitation Hospital, 785 Mamaroneck Ave, White Plains, NY 10605, USA.
PM R. 2012 Oct;4(10):719-25. doi: 10.1016/j.pmrj.2012.07.004. Epub 2012 Sep 6.
To examine the use of continuous passive motion (CPM) as an adjunct to physical therapy after total knee replacement in patients who were transferred to an inpatient rehabilitation facility (IRF) and to compare the effectiveness of CPM on active range of motion (AROM), functional tasks, destination after discharge, the need for home care services, and the ambulation device at discharge.
Matched cohort study.
IRF.
Patients admitted to a rehabilitation setting after total knee replacement surgery with an initial AROM for knee flexion of less than 75° at admission to the IRF. From this initial population, a matched sample of 61 patient pairs was included in the analysis (61 who used the CPM and 61 who did not receive the adjunct therapy).
Use of CPM for 2 hours per day as an adjunct to the 3 hours of physical and occupational therapy customary in an IRF.
Primary outcomes were discharge active knee flexion ROM and flexion gain. Secondary outcomes were motor, cognitive, and total Functional Independence Measure scores; discharge ambulation device; destination after discharge; and the need for home care services after the inpatient stay.
The outcome variables of 61 matched pairs of CPM users and non-CPM users were reported. No statistically significant differences were found in any of the outcome variables that were compared in this matched case design, including AROM knee, flexion gain, discharge to the community, need for home care services after discharge, and discharge with cane/no device. No significant difference was found in all functional scores as measured by the Functional Independence Measure scale.
For this population, we determined at one facility that less than 30% are provided with a CPM as an adjunct to physical therapy. Using a matched cohort design, we compared CPM use with non-CPM use and determined that the application of CPM may not significantly influence ROM gain.
考察在转入住院康复机构（IRF）的全膝关节置换术后患者中，将持续被动运动（CPM）作为物理治疗的辅助手段的应用，并比较 CPM 对主动关节活动度（AROM）、功能任务、出院后去向、家庭护理服务需求以及出院时的助行器的影响。
匹配队列研究。
IRF。
接受康复治疗的全膝关节置换术后患者，入组时膝关节屈曲初始 AROM 小于 75°。在最初的患者人群中，有 61 对患者被纳入分析（61 例使用 CPM，61 例未接受辅助治疗）。
每天使用 CPM 2 小时，作为 IRF 中常规 3 小时物理治疗和职业治疗的辅助手段。
主要结局为出院时膝关节主动屈曲 ROM 和屈曲增加量。次要结局为运动、认知和总功能独立性测量评分；出院时的助行器；出院去向；以及住院期间后家庭护理服务的需求。
报告了 61 对 CPM 使用者和非 CPM 使用者的匹配对的结局变量。在这种匹配病例设计中比较的所有结局变量中，没有发现统计学上的显著差异，包括 AROM 膝关节、屈曲增加量、出院到社区、出院后家庭护理服务需求以及出院时使用手杖/无辅助器。使用功能独立性测量量表测量的所有功能评分也没有发现显著差异。
在我们的研究中，发现有不到 30%的患者在物理治疗中接受 CPM 作为辅助手段。使用匹配队列设计，我们比较了 CPM 与非 CPM 的使用，结果表明 CPM 的应用可能不会显著影响 ROM 增加量。
