Gränicher Pascale, Stöggl Thomas, Fucentese Sandro F, Adelsberger Rolf, Swanenburg Jaap
The University Center for Prevention and Sports Medicine (UCePS), Balgrist University Hospital, Forchstrasse 319, 8008 Zurich, Switzerland.
Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands.
Arch Physiother. 2020 Aug 5;10:13. doi: 10.1186/s40945-020-00085-9. eCollection 2020.
The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA).
20 patients (mean ± SD: age 67 ± 7 years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptive neuromuscular facilitation (PNF) techniques, endurance training and individually indicated interventions. Measurements were executed at baseline, preoperative and 3 months after TKA. The primary outcome measure was the Stair Climbing Test (SCT), secondary outcome measures were the knee range of motion (ROM) and the level of physical activity using Lysholm Score (LS) and Tegner Activity Scale (TAS). The subjective and socio-economic parameters were the Patients' Global Impression of Change (PGIC) scale, inpatient rehabilitation time, preoperative pain levels and metabolic equivalent (MET), postoperative intake of analgesics and overall costs.
No difference between IG and CG was found for SCT (F (2/36) = 0.016, = 0.984, η2 = 0.004). An interaction between group and time was shown for TAS (F (18/1) = 13.890) with an increase in the IG ( = 0.002, η2 = 0.536). The sub-item "pain" within the LS presented a higher pain-level in CG (F (18/1) = 4.490, = 0.048, η2 = 0.974), while IG showed a higher preoperative MET compared to CG ( = 0.035). There were no other significant changes. The CG produced 21.4% higher overall costs, took more analgesics and showed higher preoperative pain levels than the IG.
Findings show that preoperative therapy improved the level of physical activity before and after TKA and resulted in a clinically relevant gain in TAS.
ClinicalTrials.gov Identifier; NCT03160534. Registered 19 May 2017.
本研究旨在评估术前物理治疗（PT）对全膝关节置换术（TKA）后功能、主观及社会经济参数的影响。
2016年7月至2017年3月期间计划在巴尔格里斯特大学医院接受TKA的20例患者（平均±标准差：年龄67±7岁）被随机分配至对照组（CG）或干预组（IG）。手术前3至4周，IG组完成了5至9次包含本体感觉神经肌肉促进（PNF）技术、耐力训练及个体化干预措施的PT治疗。在基线、术前及TKA术后3个月进行测量。主要结局指标为爬楼梯试验（SCT），次要结局指标为膝关节活动范围（ROM）以及使用Lysholm评分（LS）和Tegner活动量表（TAS）评估的身体活动水平。主观及社会经济参数包括患者总体变化印象（PGIC）量表、住院康复时间、术前疼痛水平及代谢当量（MET）、术后镇痛药摄入量及总体费用。
SCT在IG组和CG组之间未发现差异（F(2/36)=0.016，P=0.984，η2=0.004）。TAS显示组与时间之间存在交互作用（F(18/1)=13.890），IG组有所增加（P=0.002，η2=0.536）。LS中的“疼痛”子项在CG组中疼痛水平更高（F(18/1)=4.490，P=0.048，η2=0.974），而IG组术前MET高于CG组（P=0.035）。未发现其他显著变化。CG组的总体费用比IG组高21.4%，服用更多镇痛药，且术前疼痛水平更高。
研究结果表明，术前治疗改善了TKA前后的身体活动水平，并在TAS方面取得了具有临床意义的提升。
ClinicalTrials.gov标识符；NCT03160534。于2017年5月19日注册。
