Department of Physical Therapy, College of Nursing and Health Sciences, Florida International University, University Park, Miami, 33199, USA.
Am J Phys Med Rehabil. 2013 Jan;92(1):53-60. doi: 10.1097/PHM.0b013e318269d8d0.
The aims of this study were to evaluate weight bearing during standing and 30- and 60-degree squats approximately 1 wk and 2 mos after surgery and determine whether weight bearing during squatting could be a better clinical marker than standing for identifying perceived functional limitation approximately 1 wk after surgery. A further objective was to determine whether age, body mass index, and number of outpatient visits over the course of rehabilitation predicted weight bearing during a squat approximately 2 mos after surgery.
The percentage of body weight placed over both limbs during stand and 30- and 60-degree squats in 38 patients (25 women and 13 men) who had primary unilateral knee arthroplasty was determined. An asymmetry index would be used as a marker that could discriminate between those who perceived at least moderate difficulty with functional tasks and those who perceived only slight or no difficulty with functional activities based on the physical function dimension of the Western Ontario McMaster Universities Osteoarthritis index approximately 1 wk after surgery. Stepwise regression was conducted to determine whether clinical characteristics predicted weight-bearing asymmetry at discharge.
At initial visit (first observation), and compared with the uninvolved side, individuals placed significantly less body weight over the involved or operated limb for stand and 30- and 60-degree squats (P < 0.0001). Results were similar at last rehabilitation visit (second observation). Identifying at least moderate self-reported difficulty with functional tasks based on the receiver operator characteristic curve for the asymmetry index for the stand position was 0.64, whereas for the 30- and 60-degree squats, the area under the curve was 0.81 and 0.89, respectively. At discharge from rehabilitation, there was a moderate to good direct relationship (r = 0.70) between the number of rehabilitation visits completed and the weight-bearing asymmetry index for the 60-degree squat.
On the first outpatient visit, individuals who had primary unilateral knee arthroplasty placed more body weight over the uninvolved side for the three weight-bearing positions. With high probability, the asymmetry index for both squatting angles identified perceived functional difficulty. As rehabilitation visits increased, there was a direct association to improved interlimb weight-bearing symmetry when squatting to 60 degrees.
本研究旨在评估术后 1 周和 2 个月时站立和 30 度及 60 度深蹲时的承重情况，并确定深蹲时的承重是否比站立时更能作为术后 1 周时识别功能受限的临床标志物。进一步的目的是确定年龄、体重指数和康复过程中的门诊就诊次数是否可以预测术后 2 个月时深蹲时的承重。
确定了 38 例（25 名女性和 13 名男性）初次单侧膝关节置换患者在站立和 30 度及 60 度深蹲时双侧肢体的承重百分比。使用不对称指数作为标志物，可以根据术后 1 周时基于 Western Ontario McMaster Universities Osteoarthritis 指数的身体功能维度，将那些认为功能活动存在中度以上困难的人与那些仅认为存在轻微或无困难的人区分开来。进行逐步回归分析，以确定临床特征是否可以预测出院时的承重不对称性。
在初次就诊（第一次观察）时，与未受累侧相比，个体在站立和 30 度及 60 度深蹲时，受累或手术侧肢体承重明显减少（P<0.0001）。最后一次康复就诊（第二次观察）时结果相似。根据站立位不对称指数的受试者工作特征曲线，识别出至少存在中度自我报告的功能障碍的比例为 0.64，而对于 30 度和 60 度深蹲，曲线下面积分别为 0.81 和 0.89。从康复出院时，完成的康复就诊次数与 60 度深蹲时的承重不对称指数之间存在中度至高度的直接关系（r=0.70）。
在初次门诊就诊时，初次单侧膝关节置换患者在三种承重姿势下，会将更多的体重放在未受累侧。高概率情况下，两种深蹲角度的不对称指数都可以识别出功能障碍。随着康复就诊次数的增加，当深蹲至 60 度时，承重的双侧对称性有直接的改善。
