The effect of a 12 week prehabilitation program on pain and function for patients undergoing total knee arthroplasty: A prospective controlled study

Abstract

Background: The concept of preparing the body before a stressful event, such as surgery, has been termed "prehabilitation" (preoperative physiotherapy and exercise programs). Prehabilitation programs for people awaiting total knee arthroplasty (TKA) have positive effects on patients health status and may also lead to better postoperative outcomes. Aim: The purpose of this study was to examine effect of a prehabilitation program on knee pain, functional ability among patients with knee osteoarthritis after TKA surgery. Study Design: A Prospective Controlled Study. Patients and Methods: Subjects enrolled in this prospective controlled study who referred to our Orthopedics and Traumatology outpatient clinic between 2014 April-2015 May, had severe OA with pain not responsive to conservative treatment and scheduled for unilateral TKA. Subjects were assigned to a control or prehabilitation group. Patients of prehabilitation group were recruited from the orthopaedic waiting lists for primary unilateral TKA. Partipicants in the prehabilitation group were prescribed a training program that consisted of education and home-based exercise 12 weeks before the operation. After the TKA, all subjects partipicated in the same postoperative rehabilitation protocol. Evaluations were made before the surgery, with follow-up assessments at 3 and 6 months after surgery. Knee pain was assessed by the use of a 10-cm Visual Analog Scale (VAS) and function assesed by Knee injury and Osteoarthritis Outcome Score (KOOS) scale. Results: A statistically significant improvement was observed in the values of VAS and all subsclaes of KOOS in both groups at third and sixth month compared to baseline. The intergroup comparison of the improvement (pre-post scores at sixth month) did not show any statistically significant diffeferences in VAS and KOOS scores. Conclusion: Our results show that prehabilitation before TKA is not superior to surgical treatment alone but about 20% of the patients changed their operation decision. So it is important to be able to postpone this process especially in the early period.

The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review

“…A shorter hospital stay was also reported by Matassi et al (9.1 ± 2.1 vs. 9.9 ± 2.3 days) [14] and in the study by Williamson et al for those patients that underwent home-based [14] or supervised (6.5 vs. 7.7 days) [13] strengthening programs. The major difference registered, though not statistically significant, occurred in the study by Aytekin et al, where the average length of stay was longer in the intervention group (5.5 ± 2 vs. 7.9 ± 2.3 days; p > 0.05) [20]. A prospective case series by Twiggs et al [7] showed a poor positive correlation (rho = −0.114, p > 0.05) between preoperative step count and hospital length of stay.…”

“…Contrary to these results, the progressive strength training program advocated in the study by VanLeeuwen et al yielded comparable functional results between groups in terms of 6MWT and chair stand [12]. Similarly, in the paper by Aytekin et al [20], KOOS and VAS were comparable between intervention group (home-based strengthening and stretching exercises) and controls. In the case series by Twiggs et al [7], a significant correlation was found between preoperative step count and KOOS (activity of daily living subscore) immediately before surgery (rho = 0.282, p < 0.05).…”

“…Several studies retrieved were excluded for the following main reasons: average age of the cohort < 65 years [20,21], reviews or meta-analyses [22] and/or no surgery scheduled (assessment of physical activity as a conservative treatment).…”

“…The most relevant point concerning the activity program was supervision of the exercises by a trainer or a physical therapist. Some of the studies advocated a home-based program [9,14,15], while several other administered supervised training sessions [8,13,[16][17][18][19][20]. A slight modification of the exercise program did not yield significant differences in results, in fact in the trial by VanLeeuwen et al [12] no difference occurred between groups where progressive strength training was added to standard muscle strengthening.…”

Physical therapy prehabilitation on a reverse total shoulder replacement candidate: a case study

“…Holmgren et al found in individuals with subacrominal impingement that a strengthening program to the rotator cuff and scapular stabilizers improved pain and function, thus reducing the need for subacrominal decompression surgery 53) . In a 12-week total knee arthroplasty (TKA) prehab program, 19.4% of the participants elected to cancel surgery due to improved pain 54) .…”