Desmeules François, Hall Jayne, Woodhouse Linda June
School of Rehabilitation, Faculty of Medicine ; University of Montreal Public Health Research Institute, University of Montreal ; Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal.
Hamilton Health Sciences Corporation, Hamilton, Ont.
Physiother Can. 2013 Spring;65(2):116-24. doi: 10.3138/ptc.2011-60.
To evaluate the effects of prehabilitation (enhancing physical capacity before total hip or knee joint arthroplasty) on pain and physical function of adults with severe hip and knee osteoarthritis (OA).
Consecutive patients (n=650) from 2006 to 2008 with hip or knee OA awaiting total joint arthroplasty (TJA) attended a hospital outpatient clinic for a prehabilitation assessment. All participants completed self-report (Lower Extremity Functional Scale [LEFS] and visual analogue scale for pain [VAS]) and functional performance measures (self-paced walk [SPW], timed stair, and timed up-and-go [TUG] tests). A subset of 28 participants with severe disability participated in a structured outpatient prehabilitation programme. Between-group differences were assessed via independent t-tests; paired Student's t-tests and Wilcoxon signed rank tests were used to compare changes in pain and function following the prehabilitation programme.
A total of 28 individuals (16 female) with mean age 67 (SD 10) years and BMI 33 (8) kg/m(2) awaiting TJA (10 hips, 18 knees) participated in a prehabilitation programme of 9 (6) weeks' duration. Relative to baseline, there was significant improvement in LEFS score (mean change 7.6; 95% CI, 1.7-13.5; p=0.013), SPW (mean change 0.17 m/s; 95% CI, 0.07-0.26; p=0.001), TUG (mean change 4.2 s; 95% CI, 2.0-6.4; p<0.001), and stair test performance (mean change 3.8 s [SD 14.6]; p=0.005) following prehabilitation.
This study presents preliminary evidence that prehabilitation improves physical function even in the most severely compromised patients with OA awaiting TJA.
评估术前康复（在全髋关节或膝关节置换术前增强身体机能）对患有严重髋膝关节骨关节炎（OA）的成年人疼痛和身体功能的影响。
2006年至2008年期间，连续650例等待全关节置换术（TJA）的髋或膝关节OA患者到医院门诊进行术前康复评估。所有参与者均完成了自我报告（下肢功能量表[LEFS]和疼痛视觉模拟量表[VAS]）以及功能表现测量（自定步速行走[SPW]、定时上下楼梯和定时起立行走[TUG]测试）。28名重度残疾参与者的子集参加了结构化门诊术前康复计划。通过独立t检验评估组间差异；配对t检验和Wilcoxon符号秩检验用于比较术前康复计划后疼痛和功能的变化。
共有28例（16例女性）平均年龄67（标准差10）岁、体重指数33（8）kg/m²且等待TJA（10例髋关节、18例膝关节）的患者参加了为期9（6）周的术前康复计划。与基线相比，术前康复后LEFS评分（平均变化7.6；95%置信区间，1.7 - 13.5；p = 0.013）、SPW（平均变化0.17 m/s；95%置信区间，0.07 - 0.26；p = 0.001）、TUG（平均变化4.2 s；95%置信区间，2.0 - 6.4；p < 0.001）以及楼梯测试表现（平均变化3.8 s[标准差14.6]；p = 0.005）均有显著改善。
本研究提供了初步证据，表明术前康复即使在等待TJA的OA最严重受损患者中也能改善身体功能。
