Effect of a rehabilitation protocol on the functionality and quality of life in patients with total knee replacement. a cross sectional study
DOI:
https://doi.org/10.1016/j.rccot.2021.09.002Keywords:
Total knee replacement, Physical rehabilitation, Functionality, Quality of lifeAbstract
Introduction: Total knee replacement (TKR) has one of the highest success rates, and functionality and quality of life depend largely on appropriate physical rehabilitation. There is no physical rehabilitation guideline registered with the Ministry of Health in Colombia. Therefore, the general objective of this study was to determine the effect of physiotherapy intervention on functionality and quality of life in patients undergoing TKR.
Materials & methods: A cross-sectional cohort study, comprising three assessments (preoperative, at 3 and at 6 months) using the WOMAC and SF12 questionnaires, physiotherapy assessment, and 36 sessions of home physiotherapy in 10 adults over 65 years of age. The sample was taken from the participating surgeon’s waiting list between November 2017 and June 2018. Results. Stiffness and pain obtained p-values of .00 and .01 respectively from the WOMAC questionnaire. A significance level of .009 was found in functional ability between the 1st and 3rd assessments.
The SF12 questionnaire results reflected a better state of health, with little limitation on moderate effort or climbing stairs. Strength went from 3- to 4+ in 80% of the population. Functional ranges exceeding 90◦ of flexion were achieved in joint range of motion.
Discussion: Outcomes in terms of functionality and quality of life are in line with those reported in the international literature.
Level of evidence: III
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References
WHO. Dispositivos médicos: la gestión de la discordancia. 2012. Disponible en: http://whqlibdoc.who.int/publications/2012/9789243564043spa.pdf.
Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA. Artritis reum. 2008;58:15-25.
Burillo R, Reyna Y, Herrero F. Artritis en el anciano. Rev Colomb Reumatol. 2007;14:66-84.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg. 2007;89:780-5.
Mercado Y. Análisis del mercadeo de prótesis articulares en la ciudad de Medellin. Tesis Maestria. Universidad CES;. 2012.
Ministerio de Salud y Protección Social. Guía de práctica clínica para detección temprana, diagnóstico y tratamiento de la artritis reumatoide. Bogotá: Ministerio de Salud y Protección Social; 2014.
Healy WL, Della Valle CJ, Iorio R. Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clin Orthop Relat Res. 2012;471:215-20.
Song J, Causes. Risk Factors, and Trends in Failures After TKA in Korea Over the Past 5 Years: A Multicenter Study. Clin Orthop Relat Res. 2013;472:327-8.
Lorio R, Della Valle CJ, Healy WL. Stratification of standardized TKA complications and adverse events: a brief communication. Clin Orthop Relat Res. 2013;472:194-205.
Kendall E, Kendall F, Provance P. Músculos y pruebas, funciones y dolor postural. 5a ed. México: MARBAN; 2007.
Gerstner J, Gerstner JB. Semiología del aparato locomotor. 13th ed, Colombia. Celsus;. 2013.
Batlle E, EsteveJ, Piera MC, Hargreaves CJ. Adaptación transcultural del cuestionario WOMAC específico para artrosis de rodilla y cadera. Rev Esp Reum. 1999;26:38-45.
Alonso J. Versión española del Cuestionario de la Salud SF-12 adaptado. Med clin Barc. 1998.
Alonso J, Regidor E, Berrio G, Prieto L, Rodríguez C, De la Fuente L. Valores poblacionales de referencia de versión española del Cuestionario de Salud SF-36. Med clin Barc. 1998;111:410-6.
Sardi L, Suárez O. Protocolo de movilización temprana en reemplazo total de rodilla. Rev Colomb Ortop y Traumatol. 2013;34:1-11.
Hernandez N, Alvarez G, Bravo F, Vieira JC, Reina EA, Herrera- Arbelaez JM. Validación de la prueba de Romberg Modificada para la determinación del tiempo de propiocepción inconciente en adultos sanos. Rev Col Or Tra. 2018;32:93-9, http://dx.doi.org/10.1016/j.rccot.2017.11.001.
McDonough CM, Stoiber E, Tomek IM, Kim YJ, Tian JA. Sensitivity to Change of a Computer Adaptive Testing Instrument for Outcome Measurement After Hip and Knee Arthroplasty and Periacetabular Osteotomy. JOSPT. 2016;46:75.
Christensen JC, Paxton RJ, Baym C, Forster JE, Dayton MR, Hogan CA. Benefits of direct patient discharge to outpatient physical therapy after total knee arthroplasty. Disabil Rehabil. 2019;7:1-7.
Liu SC, Hou ZL, Tang QX, Qiao XF, Yang JH, Ji QH. Effect of knee joint function training on joint functional rehabilitation after knee replacement. Medicine (Baltimore). 2018;97:11270.
Bernard-Pineda M, Heras-Sotos J, Garcés-Puentes M. Quality of life in patients with knee and hip osteoarthritis. Rev Esp Cir Ortop Traumatol. 2014;58:283-9.
Serra-Sutton V, Allepuz A. Factores relacionados con la calidad de vida al año de la artroplastia total de cadera y rodilla: estudio multicéntrico en Cataluña. Rev Esp Cir Ortop Traumatol. 2013;57:254-62.
Jirón D. Resultado Funcional en pacientes operados de Artroplastia total de rodilla secundario a osteoartritis degenerativa en el servicio de ortopedia del Hospital escuela Antonio Lenin Fonseca periodo de Enero 2012 junio 2013. [Especialista en ortopedia y traumatología]. UNIVERSIDAD NACIONAL AUTONOMA DE NICARAGUA;. 2015.
Choi YJ, Ra HJ. Patient Satisfaction after Total Knee Arthroplasty. Knee Surg Relat Res. 2016;28:1-15.
Davis A, Ibrahim S, Hogg-Johnson S, Wong R, Beaton D. Achieving important improvement in WOMAC pain and function by three months post-surgery influences satisfaction 1 year following total knee replacement. Osteoarthritis and Cartilage. 2019;26:278-9.
Pivec R, Issa K, Given K, Harwin S, Greene K, Hitt k. A Prospective, Longitudinal Study of Patient Satisfaction Following Total Knee Arthroplasty Using the Short-Form 36 (SF-36) Survey Stratified by Various Demographic and Comorbid Factors. Artroplastia J. 2015;30:374-8.
Ramírez R, Agredo RA, Jerez AM. Confiabilidad y valores normativos preliminares del cuestionario de salud SF-12 (Short Form 12 Health Survey) en adultos Colombianos. Rev salud pública. 2010;12:807-19.
Mozo AP, Palacios J. Comparación de dos programas de rehabilitación tras artroplastia total de rodilla. Traumatol. 2008;19:218-24.
Ramon S. Función y calidad de vida de los pacientes con gonartrosis antes y después de la artroplastia de sustitución, Coste de la gonartrosis según la esperanza de vida y de la cirugía. [dissertation]. Universitat Autònoma de Barcelona. Departament de Cirurgia Universitat Autònoma de Barcelona. Departament de Cirurgia;. 2001.
Pozzi F, Snyder JZ. Physical Exercise After Knee Arthroplasty: A Systematic Review Of Controlled Trials. Eur J Phys Rehabil Med. 2013;49:887-92.
Schache MB, Mcclelland JA, Webster KE. Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty ? A study protocol for a randomized trial. BMC Musculoskelet Disord. 2016;17:259, http://dx.doi.org/10.1186/s12891-016-1104-x.
Rajesh N. To Use or Not to Use Continuous Passive Motion Post-Total Knee Arthroplasty. Artroplastia J. 2011;27: 193-201.
