Prehabilitation Improves Physical Function of Individuals with Severe Disability from Hip or Knee Osteoarthritis

Abstract

Purpose: To evaluate the effects of prehabilitation (enhancing physical capacity before total hip or knee joint arthroplasty) on pain and physical function of adults with severe hip and knee osteoarthritis (OA). Methods: Consecutive patients (n ¼ 650) from 2006 to 2008 with hip or knee OA awaiting total joint arthroplasty (TJA) attended a hospital outpatient clinic for a prehabilitation assessment. All participants completed self-report (Lower Extremity Functional Scale [LEFS] and visual analogue scale for pain [VAS]) and functional performance measures (self-paced walk [SPW], timed stair, and timed up-and-go [TUG] tests). A subset of 28 participants with severe disability participated in a structured outpatient prehabilitation programme. Between-group differences were assessed via independent t-tests; paired Student's t-tests and Wilcoxon signed rank tests were used to compare changes in pain and function following the prehabilitation programme. Results: A total of 28 individuals (16 female) with mean age 67 (SD 10) years and BMI 33 (8) kg /m 2 awaiting TJA (10 hips, 18 knees) participated in a prehabilitation programme of 9 (6) weeks' duration. Relative to baseline, there was significant improvement in LEFS score (mean change 7.6; 95% CI, 1.7-13.5; p ¼ 0.013), SPW (mean change 0.17 m/s; 95% CI, 0.07-0.26; p ¼ 0.001), TUG (mean change 4.2 s; 95% CI, 2.0-6.4; p < 0.001), and stair test performance (mean change 3.8 s [SD 14.6]; p ¼ 0.005) following prehabilitation. Conclusion: This study presents preliminary evidence that prehabilitation improves physical function even in the most severely compromised patients with OA awaiting TJA.Key Words: arthroplasty; exercise; osteoarthritis; physical therapy specialty; rehabilitation. RÉ SUMÉ 116From the

Frailty and perioperative outcomes: a narrative review

“…44 In an orthopedic study, preoperative exercise programs prior to total joint arthroplasty improved physical function testing postoperatively compared with baseline. 45 Preoperative exercise programs address the physical components of frailty and sarcopenia and would seem to be beneficial. Research is beginning to emerge on the effects of prehabilitation in a variety of patients.…”

“…Research is beginning to emerge on the effects of prehabilitation in a variety of patients. 45,46 A randomized controlled trial, termed the PREHAB (Preoperative REhabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery -NCT02219815) study is currently underway and looking at the effects of prehabilitation on frail patients undergoing cardiac surgery.…”

Digital Measurement of Individual Motor and Proprioceptive Skills in Patients with Osteoarthritis of the Knee Prior to Total Knee Replacement

“…Patienten wären gezielter trainierbar und damit besser auf die Operation vorbereitet. Entsprechende Studien haben den positiven Effekt von präoperativer Physiotherapie bereits gezeigt [5,6]. Ob Patienten mit hoher Leistungsfähigkeit und dementsprechend hohem Score trotzdem von einer individuell intensivierten Therapie profitieren könnten, muss in zukünftigen Studien untersucht werden.…”

“…Propriozeption könnte deshalb im perioperativen Rehabilitationsmanagement detaillierter beachtet werden und sich positiv auf das OP-Ergebnis auswirken. Außerdem ließen sich durch eine auf den jeweiligen Leistungszustand und die Schmerzsymptomatik abgestimmte präoperative Trainingstherapie gezielt Defizite behandeln [5,6] [10]. Insgesamt existieren hinsichtlich der Propriozeptionsmessung für den praktischen klinischen Einsatz wenige Messverfahren [9].…”

An e-Prehabilitation System of Care for Teenagers and Young Adults Diagnosed With Cancer: Protocol for a Qualitative Co-Design Study (Preprint)

“…Typically delivered in the intervening period between a patient receiving a diagnosis and their treatment initiation, strategies tend to be implemented to maximise people's fitness, adjustment and to ultimately have a positive impact on survival and associated patient reported outcomes and coping [23][24][25][26][27][28][29][30]. The application of prehabilitation strategies are becoming more evident within healthcare, with a growing evidence base for their benefits for patients receiving surgery [29,31] [22].…”