Orthopedics. 2020 Sep 1;43(5):e364-e368. doi: 10.3928/01477447-20200619-04. Epub 2020 Jul 7.
Whether preoperative physical therapy actually leads to improved clinical outcomes after total joint arthroplasty (TJA) remains unclear. The authors sought to use participation in a preoperative online exercise and education program as a marker for patient engagement. They hypothesized that increased preoperative participation with the program would predict shorter length of stay (LOS) and gait independence. Forty consecutive patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) by a single surgeon were given access to the PrimePrehab Prehabilitation Exercise Program (NextPT, Boulder, Colorado). Patients were guided through questionnaires, and the program generated educational readings and exercise modules directed toward initial ability. Preoperative completion of readings, completion of exercise modules, and improvement in exercise difficulty were tracked. Patients received a standardized postoperative protocol, including physical therapy on the day of surgery and subsequent hospital days. Length of stay and gait aid use at 90 days postoperatively were recorded. Analyses were simple or multiple regression with a significance of P≤.05. Patients completed a mean of 7 exercise modules with 30% improvement in difficulty. Controlling for demographic variables, the frequency of program completion correlated with shorter LOS (P=.037). This finding was not different between THA and TKA (P=.387). No association was found between the frequency of program completion and gait aid use at 90 days (P=.213), although there was a decrease in gait aid use at 90 days with improvement in exercise difficulty (P=.034). A preoperative education and exercise program can predict patient engagement, which correlates with a shorter LOS and suggests that increasing exercise difficulty is associated with gait independence after TJA. [Orthopedics. 2020;43(5):e364-e368.].
术前物理治疗是否确实能改善全关节置换术（TJA）后的临床结果尚不清楚。作者试图将参与术前在线锻炼和教育计划作为患者参与的标志。他们假设，该计划的术前参与度增加将预测住院时间（LOS）更短和步态独立。一位外科医生对 40 例连续进行初次全髋关节置换术（THA）或全膝关节置换术（TKA）的患者进行了 PrimePrehab 康复锻炼计划（NextPT，博尔德，科罗拉多州）。患者接受了问卷调查，并根据初始能力生成了教育阅读材料和锻炼模块。跟踪阅读完成情况、锻炼模块完成情况和锻炼难度提高情况。患者接受了标准化的术后方案，包括手术当天的物理治疗和随后的住院天数。术后 90 天记录住院时间和步态辅助工具使用情况。分析采用简单或多元回归，P≤.05 为有统计学意义。患者平均完成了 7 个锻炼模块，难度提高了 30%。在控制人口统计学变量的情况下，计划完成频率与 LOS 更短相关（P=.037）。THA 和 TKA 之间没有差异（P=.387）。在术后 90 天，计划完成频率与步态辅助工具使用之间没有相关性（P=.213），尽管随着锻炼难度的提高，步态辅助工具的使用在术后 90 天减少（P=.034）。术前教育和锻炼计划可以预测患者的参与度，与 LOS 更短相关，表明增加锻炼难度与 TJA 后步态独立相关。[骨科。2020；43(5)：e364-e368.]。
