Preop progressive resistance training improves function but not PROMs after TKA

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
59 patients scheduled for total knee arthroplasty were randomized to participate or not participate in a preoperative progressive resistance training program. The purpose of this study was to determine if preoperative resistance training led to significantly increased preoperative and short-term postoperative functional performance and muscle strength. Patients allocated to Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Aarhus University and Aarhus University Hospital, the Bevica Foundation, the Danish Rheumatism Association, the Danish Physiotherapy Research Foundation, the Orthopaedic Surgery Research Foundation, the Aase and Ejnar Danielsen Foundation, the Hede Nielsen Foundation, and the Oda and Hans Svenningsens Foundation
Conflicts: None disclosed
Why was this study needed now?
Prehabilitation methods have been a popular topic of research in the management of patients scheduled for total knee arthroplasty following identification of knee extension strength as a possible factor in postoperative functional recovery. Various programs have been proposed previously, though many have failed to demonstrate any clinically important benefit in postoperative strength or recovery. Progressive resistance training has been explored as an intervention to manage symptomatic osteoarthritis, and extrapolation of the same working hypothesis for improvement in strength and function may be applicable to patients undergoing total knee arthroplasty. However, a randomized controlled trial is still needed to test this hypothesis.
What was the principal research question?
Prior to total knee arthroplasty, does a 4-week preoperative progressive resistance training program lead to significantly greater preoperative and 6&12-week postoperative functional performance, muscle strength, and patient-reported outcomes?
Population: 59 patients, 18 years of age or older, scheduled for primary unilateral total knee arthroplasty due to knee osteoarthritis. At the time of surgery, patient care was standardized, with procedures performed under spinal anesthesia through a medial parapatellar approach, and fast-track rehabilitation including mobilization on the first postoperative day, immediate full weight bearing allowed, and discharge planned within the first two postoperative days. A 4-week postoperative progressive resistance training program (as described below) was provided in both groups
Intervention: Preop PRT: Participants were allocated to 4 weeks of preoperative, supervised progressive resistance training. Three 6-minute sessions were completed each week for 4 weeks. Intensity was initially 12-repetition maximum for 3 sets, with progression to 8-repetition maximum for 3 sets. Exercises included leg press, knee extension, knee flexion, hip extension, hip abduction, and hip adduction. Sessions ended with stretching of the knee extensors, knee flexors, and ankle flexors.
Comparison: Control group: Participants only received postoperative progressive resistance training and were instructed preoperatively to live as usual.
Outcomes: The primary outcome was the performance on the 30-second chair stand test. Secondary outcomes included performance on the timed up-and-go (TUG), 10-meter walk, and 6-minute walk (6MW) tests, isokinetic and isometric strength in flexion and extension, active and passive knee range of motion, knee joint circumference, patient-reported outcome through the Knee Injury and Osteoarthritis Outcomes Score (KOOS) and a numeric rating scale for current, worst, and average pain, and consumption of analgesic medications.
Methods: RCT; assessor-blind, single-center
Time: Patients were assessed at baseline, 1 week preoperatively, and at 1, 6 and 12 weeks postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
February 27, 2017
February 27, 2017
me too
February 27, 2017
why so?