Department of Physical Therapy, University of Delaware, Newark, DE.
J Orthop Sports Phys Ther. 2013 Oct;43(10):715-26. doi: 10.2519/jospt.2013.4657. Epub 2013 Aug 30.
Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point.
To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA).
TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes.
Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean ± SD age, 61.4 ± 5.8 years; body mass index, 33.1 ± 5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean ± SD age, 61.8 ± 5 years; body mass index, 34.3 ± 5.1 kg/m2), that did not receive specialized symmetry retraining.
Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol.
Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared to rehabilitation protocols that focus on range of motion, strength, and return to independence.
Therapy, level 4.
单时间点的前瞻性分析，包括一个纵向队列和一个嵌入式对照组。
确定一种门诊康复方案的可行性和有效性，该方案包括全膝关节置换术（TKA）后功能和生物力学结果的运动对称性生物反馈。
TKA 可减轻疼痛并改善功能能力，但许多患者在接受门诊康复后仍存在患肢力量不足和运动异常。这些不对称性会增加非手术肢体的负荷，并且更大的不对称性与更差的功能结果相关。
在 TKA 前 2 至 3 周、门诊物理治疗出院时以及 TKA 后 6 个月，对 11 名患者（9 名男性，2 名女性；平均 ± 标准差年龄 61.4 ± 5.8 岁；体重指数 33.1 ± 5.4 kg/m2）进行了生物力学和功能测量，这些患者接受了 6 至 8 周的门诊物理治疗，包括专门的对称性训练。将 6 个月的结果与对照组进行比较，对照组按年龄、体重指数和性别进行匹配（9 名男性，2 名女性；平均 ± 标准差年龄 61.8 ± 5 岁；体重指数 34.3 ± 5.1 kg/m2），对照组未接受专门的对称性再训练。
在接受附加对称性训练的 11 名患者中，有 9 名患者在 TKA 后 6 个月的所有基于性能的功能测试中表现出了有临床意义的改善，超过了最小可检测变化。与 TKA 前相比，在 TKA 后 6 个月患者在行走时，接受对称性再训练的患者在中足期有更大的膝关节伸展，并且矢状面膝关节力矩更对称、双相且更能代表正常膝关节动力学。没有患者因方案而出现不良事件。
与专注于运动范围、力量和恢复独立性的康复方案相比，将对称性再训练添加到术后方案中在临床上是可行的、安全的，并且可能具有额外的益处。
治疗，4 级。
