Restoring physical function after knee replacement: a cross sectional comparison of progressive strengthening vs standard physical therapy.
Federico Pozzi, Daniel K White, Lynn Snyder-Mackler and 1 others
PMID 29877749WHAT IT FOUND
At 12 months after knee replacement, both therapy groups were worse than healthy adults on average.
Progressive outpatient strengthening, with or without electrical stimulation, was linked to more patients reaching normal knee extension, quadriceps strength, and stair-climbing times.
Key findings
01Twelve months after knee replacement, participants in both rehabilitation groups had worse self-reported knee function, active knee range of motion, quadriceps strength, and performance than healthy older adults.
02The group labelled progressive strengthening included progressive strengthening with or without neuromuscular electrical stimulation; a higher proportion reached the healthy-control cutoff for knee extension range of motion, 30% versus 15%, quadriceps strength, 18% versus 5%, and stair-climbing time, 34% versus 18%, than the standard care group.
03Participants in the progressive group reached the healthy-control cutoff in at least one of the seven measures more often than standard care participants, 67% versus 47.5%.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The analysis was cross-sectional, so it cannot show whether the differences at 12 months were present before surgery. The standard care group was not randomly assigned; it included participants who could not travel to the university clinic or had other non-condition-related issues. The progressive group combined two original trial arms, progressive strengthening alone and progressive strengthening plus neuromuscular electrical stimulation, so the effect of electrical stimulation cannot be separated from progressive strengthening. Both knee replacement groups were heavier and had higher body mass index than the healthy controls. Sex distribution was unequal between groups, although a sensitivity analysis was performed. Data were missing for some performance tests: one stair-climbing result was missing, and 27 participants in the progressive group did not complete the 6-minute walk. The 6-minute walk was not a primary measure of the original trial and had a high number of missing data in the progressive group. The results apply only to participants who had tri-compartmental cemented total knee replacement.
Declared interests
The authors reported no conflict of interest.
The easy way to misread this
Do not read this as proof that progressive strengthening alone restores normal function after knee replacement. The progressive group included some patients who also received neuromuscular electrical stimulation, the standard-care group was not randomly assigned, and only a subset reached healthy-control cutoffs.