Department of Health Sciences, Institute of Health and Society, University of Oslo , Oslo , Norway and.
Disabil Rehabil. 2013;35(23):2008-15. doi: 10.3109/09638288.2013.770084. Epub 2013 Apr 25.
PURPOSE: To examine the immediate and long-term effects of a walking-skill program compared with usual physiotherapy on physical function, pain and perceived self-efficacy in patients after total knee arthroplasty (TKA). METHOD: A single blind randomized controlled trial design was applied. Fifty-seven patients with primary TKA, mean age of 69 years (SD ± 9), were randomly assigned to a walking-skill program emphasizing weight-bearing exercises or usual physiotherapy. Outcomes were assessed before the interventions started at 6 weeks postoperatively (T1), directly after the interventions at 12-14 weeks (T2) and 9 months after the interventions (T3). Walking was the primary outcome, assessed by the 6 min walk test (6MWT). The secondary outcomes were timed stair climbing, timed stands, Figure-of-eight test, Index of muscle function, active knee range of motion, Knee Injury and Osteoarthritis Outcome Score and self-efficacy score. RESULTS: From T1 to T2, a better 6MWT score was found in favor of the walking-skill program of 39 m (2-76), p = 0.04. The difference between the groups in 6MWT persisted at T3, 44 m (8-80), p = 0.02. No differences in other outcome measures were found. CONCLUSION: The walking-skill program had better effect on walking than usual physiotherapy. Weight bearing was tolerated. Implications for Rehabilitation Weight-bearing exercises are tolerated by the patients in the early stage after TKA. Physiotherapy that focuses on learning different ways of walking through practice may be a plausible way to train patients after TKA.
目的:比较步行技能训练计划与常规物理治疗对全膝关节置换术后患者的身体功能、疼痛和自我效能的即时和长期影响。
方法:采用单盲随机对照试验设计。57 例初次全膝关节置换术患者,平均年龄 69 岁(SD±9),随机分为强调负重练习的步行技能训练计划组或常规物理治疗组。在干预前(T1)、术后 6 周(T2)、12-14 周(T2)和 9 个月(T3)直接进行评估。主要结局为 6 分钟步行测试(6MWT)评估的步行情况。次要结局包括计时上下楼梯、计时站立、八字测试、肌肉功能指数、主动膝关节活动度、膝关节损伤和骨关节炎结果评分和自我效能评分。
结果:从 T1 到 T2,步行技能训练计划组的 6MWT 评分提高了 39 米(2-76),p=0.04。T3 时,两组间 6MWT 的差异仍有统计学意义,为 44 米(8-80),p=0.02。其他结局指标无差异。
结论:步行技能训练计划在改善步行能力方面优于常规物理治疗。患者在 TKA 后早期能耐受负重。
康复意义:负重练习可被 TKA 后患者耐受。通过实践学习不同行走方式的物理治疗可能是训练 TKA 后患者的一种合理方法。
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