University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Eastern Colorado VA Geriatric Research, Education, and Clinical Center (GRECC), Aurora, CO, United States of America.
University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Eastern Colorado VA Geriatric Research, Education, and Clinical Center (GRECC), Aurora, CO, United States of America.
Contemp Clin Trials. 2020 Apr;91:105973. doi: 10.1016/j.cct.2020.105973. Epub 2020 Mar 12.
Total knee arthroplasty (TKA) reduces joint symptoms, but habitual movement compensations persist years after surgery. Preliminary research on movement training interventions have signaled initial efficacy for remediating movement compensations and restoring knee joint loading symmetry during dynamic functional tasks after TKA. The purpose of this clinical trial is to determine if physical rehabilitation that includes movement training restores healthy movement patterns after TKA and reduces the risk of osteoarthritis (OA) progression in the contralateral knee.
METHODS/DESIGN: 150 participants will be enrolled into this randomized controlled trial. Participants will be randomly allocated to one of two dose-equivalent treatment groups: standard rehabilitation plus movement training (MOVE) or standard rehabilitation without movement training (CONTROL). Movement training will promote between-limb symmetry and surgical knee loading during activity-based exercises. Movement training strategies will include real-time biofeedback using in-shoe pressure sensors and verbal, visual, and tactile cues from the physical therapist. The primary outcome will be change in peak knee extension moment in the surgical knee during walking, from before surgery to six months after surgery. Secondary outcomes will include lower extremity movement symmetry during functional tasks, physical function, quadriceps strength, range of motion, satisfaction, adherence, contralateral knee OA progression, and incidence of contralateral TKA.
This study will provide insights into the efficacy of movement training after unilateral TKA, along with mechanisms for optimizing long-term physical function and minimizing negative sequelae of compensatory movement patterns.
全膝关节置换术（TKA）可减轻关节症状，但术后多年仍存在习惯性运动代偿。初步研究表明，运动训练干预措施对于矫正运动代偿并在 TKA 后动态功能任务中恢复膝关节加载对称性具有初步疗效。本临床试验旨在确定包含运动训练的物理康复是否能在 TKA 后恢复健康的运动模式，并降低对侧膝关节骨关节炎（OA）进展的风险。
方法/设计：将招募 150 名参与者参加这项随机对照试验。参与者将被随机分配到两种等效剂量的治疗组之一：标准康复加运动训练（MOVE）或无运动训练的标准康复（CONTROL）。运动训练将在基于活动的锻炼中促进肢体间的对称性和手术膝关节的加载。运动训练策略将包括使用鞋内压力传感器进行实时生物反馈以及来自物理治疗师的口头、视觉和触觉提示。主要结局将是手术膝关节在行走过程中膝关节伸展峰值时刻的变化，从术前到术后 6 个月。次要结局将包括功能任务中下肢运动的对称性、身体功能、股四头肌力量、活动范围、满意度、依从性、对侧膝关节 OA 进展以及对侧 TKA 的发生率。
这项研究将深入了解单侧 TKA 后运动训练的疗效，以及优化长期身体功能和最小化代偿运动模式的负面后果的机制。
