Effect of pre-operative neuromuscular training on functional outcome after total knee replacement: a randomized-controlled trial

Erika O Huber, Rob A de Bie, Ewa M Roos, Heike A Bischoff-Ferrari, Erika O Huber, Rob A de Bie, Ewa M Roos, Heike A Bischoff-Ferrari

Abstract

Background: Total Knee Replacement (TKR) is the standard treatment for patients with severe knee osteoarthritis (OA). Significant improvement in pain and function are seen after TKR and approximately 80% of patients are very satisfied with the outcome. Functional status prior to TKR is a major predictor of outcome after the intervention. Thus, improving functional status prior to surgery through exercise may improve after surgery outcome. However, results from several previous trials testing the concept have been inconclusive after surgery.

Methods/design: In a randomized controlled trial (RCT) we will test the effect of a pre-operative neuromuscular training program versus an attention control program on lower extremity function - before and after surgery. We will enroll 80 participants, aged between 55-90 years, who are scheduled for TKR. In this single-blinded RCT, the intervention group will receive a minimum of 8 and a maximum of 24 training sessions plus 3 educational sessions of the knee school. The control group will receive the 3 educational sessions only. Assessments are performed immediately before and after the intervention (before surgery), at 6 weeks, 3 months and 12 months (after surgery). The primary outcome will include the Chair Stand Test as a measure of leg strength and reaction time. Secondary outcomes are knee function and pain assessed with the self-reported Knee Injury and Osteoarthritis Outcome Score (KOOS). All measurements will be carried out by a specially trained physical therapist, blinded to group allocation.

Discussion: To our knowledge this is the first single-blinded RCT to test the effect of pre-operative neuromuscular training plus knee school against knee school alone--on knee function and pain, assessed immediately after the interventions prior to surgery and repeatedly after surgery.

Trial registration: Clinical Trials NCT00913575.

Figures

Figure 1
Figure 1
Flow chart of research design.

References

    1. Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol. 2006;20(1):3–25. doi: 10.1016/j.berh.2005.09.007.
    1. Harris WH, Sledge CB. Total hip and total knee replacement (2) N Engl J Med. 1990;323(12):801–807. doi: 10.1056/NEJM199009203231206.
    1. Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, Kelly-Hayes M, Wolf PA, Kreger BE, Kannel WB. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994;84(3):351–358. doi: 10.2105/AJPH.84.3.351.
    1. Harris WH, Sledge CB. Total hip and total knee replacement (1) N Engl J Med. 1990;323(11):725–731. doi: 10.1056/NEJM199009133231106.
    1. Schweizerisches Gesundheitsobservatorium. Gesundheit in der Schweiz. Nationaler Gesundheitsbericht. 2008. .
    1. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) Ann Rheum Dis. 2003;62(12):1145–1155. doi: 10.1136/ard.2003.011742.
    1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil. 2010;18(4):476–499. doi: 10.1016/j.joca.2010.01.013.
    1. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86-A(5):963–974.
    1. Bischoff-Ferrari HA, Lingard EA, Losina E, Baron JA, Roos EM, Phillips CB, Mahomed NN, Barrett J, Katz JN. Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis Rheum. 2004;51(5):829–835. doi: 10.1002/art.20691.
    1. Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS. Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis. 2003;62(10):923–930. doi: 10.1136/ard.62.10.923.
    1. Karlson EW, Mandl LA, Aweh GN, Sangha O, Liang MH, Grodstein F. Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors. Am J Med. 2003;114(2):93–98. doi: 10.1016/S0002-9343(02)01447-X.
    1. Wallis JA, Taylor NF. Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee osteoarthritis awaiting joint replacement surgery–a systematic review and meta-analysis. Osteoarthr Cartil. 2011;19(12):1381–1395. doi: 10.1016/j.joca.2011.09.001.
    1. Coudeyre E, Jardin C, Givron P, Ribinik P, Revel M, Rannou F. Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines. Ann Readapt Med Phys. 2007;50(3):189–197. doi: 10.1016/j.annrmp.2007.02.002.
    1. Ackerman IN, Bennell KL. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review. Aust J Physiother. 2004;50(1):25–30.
    1. Dauty M, Genty M, Ribinik P. Physical training in rehabilitation programs before and after total hip and knee arthroplasty. Ann Readapt Med Phys. 2007;50(6):462–468. doi: 10.1016/j.annrmp.2007.04.011. 455–461.
    1. Weidenhielm L, Mattsson E, Brostrom LA, Wersall-Robertsson E. Effect of preoperative physiotherapy in unicompartmental prosthetic knee replacement. Scand J Rehabil Med. 1993;25(1):33–39.
    1. D’Lima DD, Colwell CW Jr, Morris BA, Hardwick ME, Kozin F. The effect of preoperative exercise on total knee replacement outcomes. Clin Orthop Relat Res. 1996;326:174–182.
    1. Rodgers JA, Garvin KL, Walker CW, Morford D, Urban J, Bedard J. Preoperative physical therapy in primary total knee arthroplasty. J Arthroplasty. 1998;13(4):414–421. doi: 10.1016/S0883-5403(98)90007-9.
    1. Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, Alpert S, Iversen MD, Katz JN. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum. 2006;55(5):700–708. doi: 10.1002/art.22223.
    1. Hoogeboom TJ, Oosting E, Vriezekolk JE, Veenhof C, Siemonsma PC, de Bie RA, van den Ende CH, van Meeteren NL. Therapeutic validity and effectiveness of preoperative exercise on functional recovery after joint replacement: a systematic review and meta-analysis. PLoS One. 2012;7(5):e38031. doi: 10.1371/journal.pone.0038031.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295–309. doi: 10.7326/0003-4819-148-4-200802190-00008.
    1. Folstein MF, Folstein SE, McHugh PR. Mini-mental state A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Oldmeadow LB, McBurney H, Robertson VJ. Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty. J Arthroplasty. 2003;18(6):775–779. doi: 10.1016/S0883-5403(03)00151-7.
    1. Ageberg E, Link A, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal-based NEMEX-TJR training program. BMC Musculoskelet Disord. 2010;11:126. doi: 10.1186/1471-2474-11-126.
    1. Swiss Federal Office of Sports SFOoPH, Health Promotion Switzerland, Network HEPA Switzerland. Health Enhancing Physical Activity. A Base Document. .
    1. Klassbo M, Larsson G, Harms-Ringdahl K. Promising outcome of a hip school for patients with hip dysfunction. Arthritis Rheum. 2003;49(3):321–327. doi: 10.1002/art.11110.
    1. Bohannon RW. Alternatives for measuring knee extension strength of the elderly at home. Clin Rehabil. 1998;12(5):434–440. doi: 10.1191/026921598673062266.
    1. Bohannon RW. Sit-to-stand test for measuring performance of lower extremity muscles. Percept Mot Skills. 1995;80(1):163–166. doi: 10.2466/pms.1995.80.1.163.
    1. Lord SR, Murray SM, Chapman K, Munro B, Tiedemann A. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol A Biol Sci Med Sci. 2002;57(8):M539–M543. doi: 10.1093/gerona/57.8.M539.
    1. Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test. Phys Ther. 2005;85(10):1034–1045.
    1. Villadsen A, Roos EM, Overgaard S, Holsgaard-Larsen A. Agreement and reliability of functional performance and muscle power in patients with advanced osteoarthritis of the hip or knee. Am J Phys Med Rehabil / Assoc Acad Physiatrists. 2012;91(5):401–410. doi: 10.1097/PHM.0b013e3182465ed0.
    1. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556–561. doi: 10.1056/NEJM199503023320902.
    1. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS) Arthritis Care Res (Hoboken) 2011;63(Suppl 11):S208–S228.
    1. Roos EM. Effectiveness and practice variation of rehabilitation after joint replacement. Curr Opin Rheumatol. 2003;15(2):160–162. doi: 10.1097/00002281-200303000-00014.
    1. Kessler S, Lang S, Puhl W. Stove J: [The Knee Injury and Osteoarthritis Outcome Score–a multifunctional questionnaire to measure outcome in knee arthroplasty] Z Orthop Ihre Grenzgeb. 2003;141(3):277–282.
    1. Stoll T, Huber E, Seifert B, Michel BA, Stucki G. Maximal isometric muscle strength: normative values and gender-specific relation to age. Clin Rheumatol. 2000;19(2):105–113. doi: 10.1007/s100670050026.
    1. Huber E, Stoll T, Ehrat B, Hofer HO, Seifert B, Stucki G. Zuverlässigkeit und Normperzentilen einer neuen isometrischen Muskelkraftmessmethode. Physiotherapie SPV. 1997;33(9):29–39.
    1. Hortobagyi T, Garry J, Holbert D, Devita P. Aberrations in the control of quadriceps muscle force in patients with knee osteoarthritis. Arthritis Rheum. 2004;51(4):562–569. doi: 10.1002/art.20545.
    1. Roos EM, Bremander AB, Englund M, Lohmander LS. Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis. Ann Rheum Dis. 2008;67(4):505–510.
    1. Lenssen AF, van Dam EM, Crijns YH, Verhey M, Geesink RJ, van den Brandt PA, de Bie RA. Reproducibility of goniometric measurement of the knee in the in-hospital phase following total knee arthroplasty. BMC Musculoskelet Disord. 2007;8:83. doi: 10.1186/1471-2474-8-83.
    1. Faulkner KA, Redfern MS, Rosano C, Landsittel DP, Studenski SA, Cauley JA, Zmuda JM, Simonsick EM, Kritchevsky SB, Newman AB. Reciprocal influence of concurrent walking and cognitive testing on performance in older adults. Gait Posture. 2006;24(2):182–189. doi: 10.1016/j.gaitpost.2005.08.004.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–148.
    1. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J. 2006;27(5):1040–1055. doi: 10.1183/09031936.06.00064105.
    1. Holsgaard-Larsen A, Roos EM. Objectively measured physical activity in patients with end stage knee or hip osteoarthritis. Eur J Phys Rehabil Med. 2012;48(4):577–585.
    1. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, Dawson-Hughes B. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004;80(3):752–758.
    1. Nelson KM, Reiber G, Boyko EJ. Diet and exercise among adults with type 2 diabetes: findings from the third national health and nutrition examination survey (NHANES III) Diabetes Care. 2002;25(10):1722–1728. doi: 10.2337/diacare.25.10.1722.
    1. Ware JE. Measuring patients’ views: the optimum outcome measure. BMJ. 1993;306(6890):1429–1430. doi: 10.1136/bmj.306.6890.1429.
    1. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483. doi: 10.1097/00005650-199206000-00002.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337–343. doi: 10.3109/07853890109002087.
    1. LEP - Leistungen sichtbar machen. [ ]
    1. Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B, Herrero-Beaumont G, Kirschner S, Leeb BF, Lohmander LS. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2010;69(3):483–489. doi: 10.1136/ard.2009.113100.
    1. Gill SD, McBurney H. Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2013;94(1):164–176. doi: 10.1016/j.apmr.2012.08.211.
    1. Westby MD. Exercise can improve the outcomes in hip and knee replacement surgery. Rheumatologist. 2008;2(9):16–18.
    1. Katz JN. Total joint replacement in osteoarthritis. Best Pract Res Clin Rheumatol. 2006;20(1):145–153.

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