Hiyama Yoshinori, Kamitani Tsukasa, Wada Osamu, Mizuno Kiyonori, Yamada Minoru
J Orthop Sports Phys Ther. 2016 Sep;46(9):742-8. doi: 10.2519/jospt.2016.6409. Epub 2016 Aug 5.
Study Design Prospective observational study including a historical control group. Background The extent to which group-based exercise (G-EXE) improves knee range of motion (ROM), quadriceps strength, and gait ability is similar to that of individualized exercise (I-EXE) at 6 weeks and 8 months after total knee arthroplasty (TKA). However, the benefits of G-EXE for patients during the acute recovery phase after TKA remain unclear. Objective To determine the effects of G-EXE during the acute recovery phase after TKA on knee ROM, quadriceps strength, functional ability, and knee pain. Methods Two hundred thirty-one patients participated in G-EXE in addition to regular ambulation and activities-of-daily-living exercises twice daily during the hospital stay. Outcomes were compared to those of a retrospectively identified, historical control group (I-EXE group [n = 206]) that included patients who performed exercises identical to those performed by the G-EXE group. The outcomes included knee ROM, quadriceps strength, pain intensity, and timed up-and-go test score at 1 month before surgery and at discharge. Analyses were adjusted for age, body mass index, sex, length of hospital stay, and preoperative values. Results Changes in ROM of knee flexion and extension (P<.001) and quadriceps strength (P<.001) were significantly better in the G-EXE group than those in the I-EXE group at discharge. The pain intensity improved more in the G-EXE group than in the I-EXE group at discharge (P<.001). However, the changes in the timed up-and-go scores were not significantly different. Conclusion Patients performing G-EXE in addition to regular ambulation and activities-of-daily-living exercises demonstrated greater changes in knee ROM, quadriceps strength, and knee pain than those performing I-EXE in addition to regular ambulation and activities-of-daily-living exercises. The nonrandomized, asynchronous design decreases certainty of these findings. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2016;46(9):742-748. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6409.
前瞻性观察性研究，包括一个历史对照组。背景：全膝关节置换术（TKA）后6周和8个月时，基于小组的运动（G-EXE）改善膝关节活动范围（ROM）、股四头肌力量和步态能力的程度与个体化运动（I-EXE）相似。然而，G-EXE对TKA后急性恢复阶段患者的益处仍不明确。目的：确定TKA后急性恢复阶段G-EXE对膝关节ROM、股四头肌力量、功能能力和膝关节疼痛的影响。方法：231例患者在住院期间除每天进行两次常规步行和日常生活活动锻炼外，还参加G-EXE。将结果与一个回顾性确定的历史对照组（I-EXE组[n = 206]）进行比较，该组患者进行与G-EXE组相同的锻炼。结果包括术前1个月和出院时的膝关节ROM、股四头肌力量、疼痛强度和计时起立行走测试得分。分析对年龄、体重指数、性别、住院时间和术前值进行了校正。结果：出院时，G-EXE组膝关节屈伸ROM（P <.001）和股四头肌力量（P <.001）的改善明显优于I-EXE组。出院时，G-EXE组的疼痛强度改善比I-EXE组更大（P <.001）。然而，计时起立行走得分的变化没有显著差异。结论：除常规步行和日常生活活动锻炼外还进行G-EXE的患者，与除常规步行和日常生活活动锻炼外还进行I-EXE的患者相比，膝关节ROM、股四头肌力量和膝关节疼痛的变化更大。非随机、不同步的设计降低了这些结果的确定性。证据水平：治疗，2b级。《矫形与运动物理治疗杂志》2016年；46(9):742 - 748。2016年8月5日在线发表。doi:10.2519/jospt.2016.6409。
