Liao Chun-De, Chiu Yen-Shuo, Ku Jan-Wen, Huang Shih-Wei, Liou Tsan-Hon
Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
J Clin Med. 2020 Jul 11;9(7):2194. doi: 10.3390/jcm9072194.
(1) Background: Knee osteoarthritis (KOA) and aging are associated with high sarcopenia risk; sarcopenia may further affect outcomes after total knee replacement (TKR). Elastic resistance exercise training (RET) limits muscle attenuation in older adults. We aimed to identify the effects of post-TKR elastic RET on lean mass (LM) and functional outcomes in overweight and obese older women with KOA by using the brief International Classification of Functioning, Disability and Health Core Set for osteoarthritis (Brief-ICF-OA). (2) Methods: Eligible women aged ≥60 years who had received unilateral primary TKR were randomly divided into an experimental group (EG), which received postoperative RET twice weekly for 12 weeks, and a control group (CG), which received standard care. The primary and secondary outcome measures were LM and physical capacity, respectively, and were linked to the Brief-ICF-OA. The assessment time points were 2 weeks prior to surgery (T) and postoperative at 1 month (T; before RET) and 4 months (T; upon completion of RET) of follow-up. An independent t test with an intention-to-treat analysis was conducted to determine the between-group differences in changes of outcome measures at T and T from T. (3) Results: Forty patients (age: 70.9 ± 7.3 years) were randomly assigned to the EG ( = 20) or CG ( = 20). At T, the EG exhibited significantly greater improvements in leg LM (mean difference (MD) = 0.86 kg, = 0.004) and gait speed (MD = 0.26 m/s, = 0.005) compared with the CG. Furthermore, the EG generally obtained significantly higher odds ratios than the CG for treatment success for most Brief-ICF-OA categories (all < 0.001). Conclusions: Early intervention of elastic RET after TKR yielded positive postoperative outcomes based on the Brief-ICF-OA. The findings of this study may facilitate clinical decision-making regarding the optimal post-TKR rehabilitation strategy for older women with KOA.
(1) 背景：膝关节骨关节炎（KOA）和衰老与肌肉减少症风险较高相关；肌肉减少症可能会进一步影响全膝关节置换术（TKR）后的结果。弹性阻力运动训练（RET）可限制老年人的肌肉衰减。我们旨在通过使用骨关节炎功能、残疾和健康国际分类简表（Brief-ICF-OA），确定TKR后弹性RET对超重和肥胖的KOA老年女性瘦体重（LM）和功能结局的影响。(2) 方法：年龄≥60岁且接受单侧初次TKR的符合条件女性被随机分为实验组（EG）和对照组（CG），EG每周接受两次术后RET，共12周，CG接受标准护理。主要和次要结局指标分别为LM和身体能力，并与Brief-ICF-OA相关联。评估时间点为手术前2周（T0）以及术后1个月（T1；RET前）和4个月（T2；RET完成时）的随访。进行意向性分析的独立t检验，以确定T1和T2相对于T0时结局指标变化的组间差异。(3) 结果：40例患者（年龄：70.9±7.3岁）被随机分配至EG（n = 20）或CG（n = 20）。在T1时，与CG相比，EG的腿部LM改善更为显著（平均差异（MD）= 0.86 kg，P = 0.004），步态速度改善也更为显著（MD = 0.26 m/s，P = 0.005）。此外，对于大多数Brief-ICF-OA类别，EG获得治疗成功的优势比总体上显著高于CG（所有P < 0.001）。结论：基于Brief-ICF-OA，TKR后早期进行弹性RET干预可产生积极的术后结局。本研究结果可能有助于临床决策制定关于KOA老年女性TKR后最佳康复策略。
