University of South Carolina, Department of Exercise Science, Technology Center to Promote Health Lifestyles, 915 Greene Street, Suite 403, Columbia, SC 29208, United States; Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States.
Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States.
Obes Res Clin Pract. 2018 Sep-Oct;12(5):472-478. doi: 10.1016/j.orcp.2018.06.009. Epub 2018 Jul 11.
Most patients risk gaining weight in the years after knee replacement, adding further concern to a population that is mostly overweight/obese prior to surgery.
Via a randomised pilot study, we assessed changes in weight during a Patient Centered Weight Loss Program (PACE) initiated either before or after knee replacement, while simultaneously examining the feasibility of recruiting and retaining participants over 26 weeks.
Recruitment outreach was made to 133 patients scheduled for knee replacement. Sixteen participants were randomised to a 14-session weight loss program that started either ≤6 weeks before surgery (PACE) or at 12 weeks post-op (Delayed PACE). Repeated measures ANOVAs were used to examine preliminary changes in weight, function, patient-reported outcomes, and physical activity across time (baseline/pre-op, 12 and 26 weeks after surgery) and group.
Retention was 75% and 69% at 12 and 26 weeks after surgery, respectively. Weight significantly decreased across the 26 weeks (P<0.001). A group by time interaction (P=0.03) demonstrated Delayed PACE [-7.6±5.9kg (-7.9±5.9%)] lost significantly more weight than PACE [-2.5±2.7kg (-2.6±2.6%)] participants at 26 weeks. Significant improvements across time were seen for all function and patient reported outcomes, however activity did not change.
Conducting a behavioural intervention was challenging but feasible in a knee replacement population, with preliminary evidence suggesting that initiating a program 12 weeks after surgery produces greater weight losses at 26 weeks compared to a program starting before knee replacement.
大多数患者在膝关节置换术后的几年内存在体重增加的风险，这给原本就超重/肥胖的患者群体带来了更大的担忧。
通过一项随机试点研究，我们评估了在膝关节置换术前或术后启动患者为中心的体重管理计划（PACE）时体重的变化情况，同时还检验了在 26 周内招募和保留参与者的可行性。
向 133 名计划接受膝关节置换的患者进行了招募推广。16 名参与者被随机分配到 14 节减肥课程中，这些课程要么在手术前≤6 周开始（PACE），要么在术后 12 周开始（延迟 PACE）。采用重复测量方差分析来检验体重、功能、患者报告的结果和身体活动在时间（基线/术前、术后 12 周和 26 周）和组内的初步变化。
术后 12 周和 26 周的保留率分别为 75%和 69%。体重在 26 周内显著下降（P<0.001）。组间时间交互作用（P=0.03）表明，延迟 PACE 组[-7.6±5.9kg（-7.9±5.9%）]在 26 周时比 PACE 组[-2.5±2.7kg（-2.6±2.6%）]的参与者减重更多。所有功能和患者报告的结果都显示出随时间的显著改善，然而活动量并没有变化。
在膝关节置换患者群体中进行行为干预具有挑战性，但可行，初步证据表明，与在膝关节置换前开始计划相比，在术后 12 周开始计划可在 26 周时产生更大的体重减轻。
