Amano Tetsuya, Tamari Kotaro, Tanaka Shigeharu, Uchida Shigehiro, Ito Hideyuki, Morikawa Shinya, Kawamura Kenji
Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Shizuoka, Japan.
Graduate School of Health Science, KIBI International University, Takahashi, Okayama, Japan.
PLoS One. 2016 Jul 13;11(7):e0159172. doi: 10.1371/journal.pone.0159172. eCollection 2016.
The effectiveness of current rehabilitation programs is supported by high-level evidence from the results of randomized controlled trials, but an increasing number of patients are not discharged from the hospital because of the schedule of the critical path (CP). The present study aimed to determine which factors can be used to assess the effectiveness of early rehabilitation. We enrolled 123 patients with medial knee osteoarthritis (OA) who had undergone unilateral minimally invasive total knee arthroplasty for the first time. The following factors were assessed preoperatively: the maximum isometric muscle strength of the knee extensors and flexors, maximum knee and hip joint angle, pain, 5-m maximum walking speed, sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side (bilateral or unilateral knee OA), and functional independence measure. We re-evaluated physical function (i.e., muscle strength, joint angle, and pain) and motor function (5-m maximum walking speed) 14 days postoperatively. Changes in physical function, motor function (5-m maximum walking speed), and number of days to independent walking were used as explanatory variables. The postoperative duration of hospitalization (in days) was used as the dependent variable in multivariate analyses. These analyses were adjusted for sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side, and functional independence measure. The duration of hospitalization was significantly affected by the number of days to independent walking (p < 0.001, β = 0.507) and a change in the 5-m maximum walking speed (p = 0.016, β = -0.262). Multiple regression analysis showed that the radiographic knee grade (p = 0.029, β = 0.239) was a significant confounding factor. Independent walking and walking speed recovery were considered to reduce the duration of hospitalization. Therefore, these indices can be used to assess the effectiveness of early rehabilitation.
随机对照试验结果的高级证据支持了当前康复计划的有效性，但由于关键路径（CP）的安排，越来越多的患者无法出院。本研究旨在确定哪些因素可用于评估早期康复的有效性。我们纳入了123例首次接受单侧微创全膝关节置换术的内侧膝关节骨关节炎（OA）患者。术前评估了以下因素：膝关节伸肌和屈肌的最大等长肌力、最大膝关节和髋关节角度、疼痛、5米最大步行速度、性别、年龄、体重指数、运动习惯、Kellgren-Lawrence分级、股胫角、患侧（双侧或单侧膝关节OA）以及功能独立性测量。术后14天我们重新评估了身体功能（即肌力、关节角度和疼痛）和运动功能（5米最大步行速度）。身体功能、运动功能（5米最大步行速度）的变化以及独立行走天数用作解释变量。在多变量分析中，术后住院天数（以天为单位）用作因变量。这些分析对性别、年龄、体重指数、运动习惯、Kellgren-Lawrence分级、股胫角、患侧和功能独立性测量进行了校正。住院时间受独立行走天数（p < 0.001，β = 0.507）和5米最大步行速度变化（p = 0.016，β = -0.262）的显著影响。多元回归分析表明，膝关节影像学分级（p = 0.029，β = 0.239）是一个显著的混杂因素。独立行走和步行速度恢复被认为可缩短住院时间。因此，这些指标可用于评估早期康复的有效性。
