Orthopedic and Arthritis Center for Outcomes Research and the Policy and Innovation Evaluation in Orthopedic Treatments Center, Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts.
Orthopedic and Arthritis Center for Outcomes Research and the Policy and Innovation Evaluation in Orthopedic Treatments Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2018 May;70(5):732-740. doi: 10.1002/acr.23324. Epub 2018 Apr 12.
Most persons who undergo total knee replacement (TKR) do not increase their physical activity following surgery. We assessed whether financial incentives and health coaching would improve physical activity in persons undergoing TKR.
We designed a factorial randomized controlled trial among persons undergoing TKR for osteoarthritis. Subjects underwent normal perioperative procedures, including postoperative physical therapy, and were assigned to 1 of 4 arms: attention control, telephonic health coaching (THC), financial incentives (FI), or THC + FI. We objectively measured step counts and minutes of physical activity using a commercial accelerometer (Fitbit Zip) and compared the changes from pre-TKR to 6 months post-TKR across the 4 study arms.
Of the 202 randomized subjects, 150 (74%) provided both pre-TKR and 6 months post-TKR accelerometer data. Among completers, the mean ± SE daily step count at 6 months ranged from 5,619 ± 381 in the THC arm to 7,152 ± 407 in the THC + FI arm (adjusting for baseline values). Daily step count 6 months post-TKR increased by 680 (95% confidence interval [95% CI] -94, 1,454) in the control arm, 274 (95% CI -473, 1,021) in the THC arm, 826 (95% CI 89, 1,563) in the FI arm, and 1,808 (95% CI 1,010, 2,606) in the THC + FI arm. Weekly physical activity increased by mean ± SE 14 ± 10, 14 ± 10, 16 ± 10, and 39 ± 11 minutes in the control, THC, FI, and THC + FI arms, respectively.
A dual THC + FI intervention led to substantial improvements in step count and physical activity following TKR.
大多数接受全膝关节置换术（TKR）的患者在手术后不会增加身体活动量。我们评估了经济激励和健康指导是否会提高接受 TKR 的患者的身体活动量。
我们在接受 TKR 治疗骨关节炎的患者中设计了一项基于因素的随机对照试验。受试者接受了常规围手术期治疗，包括术后物理治疗，并被分配到 4 个治疗组之一：对照组、电话健康指导（THC）组、经济激励（FI）组或 THC+FI 组。我们使用商业加速度计（Fitbit Zip）客观测量步幅数和身体活动分钟数，并比较了 4 个研究组在术前和术后 6 个月的变化。
在 202 名随机受试者中，有 150 名（74%）提供了术前和术后 6 个月的加速度计数据。在完成者中，6 个月时 THC 组的平均每日步数为 5619±381，THC+FI 组为 7152±407（根据基线值调整）。对照组术后 6 个月的每日步数增加了 680（95%置信区间[95%CI]-94，1454），THC 组增加了 274（95%CI-473，1021），FI 组增加了 826（95%CI 89，1563），THC+FI 组增加了 1808（95%CI 1010，2606）。每周身体活动量分别增加了 14±10、14±10、16±10 和 39±11 分钟。
THC+FI 双重干预可显著提高 TKR 术后的步数和身体活动量。
