PNF Stretching for TKA on ROM

The Effects of PNF Stretching on Knee Motion Following TKA

To investigate immediate and short term effects on angle of knee flexion, intensity of pain, strength of the knee extensor, and function of the lower extremity by using PNF stretching technique in patients with total knee arthroplasty.

hypothesis:TKA patients may increase ROM after PNF stretching

Study Overview

• Status: Unknown
• Conditions: Total Knee Arthroplasty
• Intervention / Treatment: Procedure: PNF stretching; Procedure: passive stretching

Detailed Description

Proprioceptive neuromuscular facilitation（PNF） is defined as a treatment method that promotes or hastens the response of the neuromuscular mechanism through stimulation of proprioceptors within the related muscles or joints. PNF stretching technique is a therapeutic technique using the PNF concept to the related muslces either to increase neuro-inhibition mechanism for releasing muscle spasm and elongating muscle length, or to increase neuro-excitation mechanism for enhancing muscle strength. Improvement in range of motion using PNF stretching technique has been reported superior to other techniques in previous literature, but those studies have only been done in healthy adults. Less is known in the effect of PNF stretching on improvement in joint restriction. Range of motion limitation usually disturbed the patients with total knee arthroplasty. PNF stretching techniques has been used frequently for patients with total knee arthroplasty in clinical practice to increase range of motion effectively and reduced knee pain during exercise. However there is no evidence-based research in such a technique for patients with total knee arthroplasty. This research project, therefore, will explore application of PNF stretch in changes of knee flexion, pain, muscle strength, and function of the lower extremity following total knee arthroplasty.

Purposes： To investigate immediate and short term effects on angle of knee flexion, intensity of pain, strength of the knee extensor, and function of the lower extremity by using PNF stretching technique in patients with total knee arthroplasty.

Method： Sixty patients who received total knee arthroplasty in National Taiwan University Hospital will be recruited in this study. They will be allocated randomly into either experimental or control groups. Conventional physical therapy will be given to all participants. Besides, the experimental group will assume PNF stretching technique from the third post-operative day to the day of discharge. This technique will be executed by the same physical therapist, including 5 trials of isometric knee extension for 6 s, followed by active knee flexion to the maximum range immediately, and holding for 10s. The rest interval will be 10 s. For the control group, passive stretch technique with the same treatment time will be given, instead. All participants will be asked to do home exercises after discharged from the hospital. The outcome measures will be given before and after the first session treatment on the same day, on the day of discharge, and one month after the operation. The variables measured will be (1) knee flexion angle measured with a universal goniometer, (2) maximum voluntary isometric strength of the knee extensor measured with a hand-held dynamometer, (3) pain score using pain visual analog scale, (4) function performance of the lower extremity measured with timed up and go test, (5) Knee Injury and Osteoarthritis Outcome Score (KOOS) to record 5 dimensions including the symptoms, stiffness, pain, difficulties in knee functions and/or daily activities, limitations in sports or recreational participation, and quality of life.

• Study Type: Interventional
• Enrollment (Anticipated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Shiun-Jeng Lin; Phone Number: 0939803219; Email: seanjeng2000@yahoo.com.tw

Study Locations

• Taiwan
  • Taipei, Taiwan, 100
    • National Taiwan University Hospital
    • Contact: Huei-Ming Chai, PHD; Phone Number: 02-33228140; Email: hmchai@ntu.edu.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• OA knee
• primary unilateral TKA

Exclusion Criteria:

• knee flexion>110 or thigh girth > 55 cm
• poor cognition
• CNS or PNS neuromuscular disease
• received operation in recent 3 months
• joint infection and loosening
• revision total knee arthroplasty
• complication during follow up

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; PNF stretching x 5 repetitions for 3 days	Procedure: PNF stretching; PNF stretching x 5 repetitions and continue 3 days
Active Comparator: 2; passive stretching	Procedure: passive stretching; passive stretching x 5 repetitions continue 3 days

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
knee flexion angle	baseline and follow up

Secondary Outcome Measures

Outcome Measure	Time Frame
VAS pain score	baseline and follow up
knee extensor strength	baseline and follow up
time up and go test time	baseline and follow up
KOOS score	baseline and follow up

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Investigators: Principal Investigator: Huei-Ming Chai, PHD, Nation Taiwan University Hospital

Study record dates

Study Major Dates

• Study Start: December 1, 2008
• Primary Completion (Anticipated): December 1, 2008
• Study Completion (Anticipated): December 1, 2008

Study Registration Dates

• First Submitted: November 24, 2008
• First Submitted That Met QC Criteria: November 24, 2008
• First Posted (Estimate): November 25, 2008

Study Record Updates

• Last Update Posted (Estimate): November 25, 2008
• Last Update Submitted That Met QC Criteria: November 24, 2008
• Last Verified: November 1, 2008

More Information

Terms related to this study

• Keywords: proprioceptive neuromuscular facilitation stretching technique, total knee arthroplasty, range of motion
• Other Study ID Numbers: 200803064R