Optimizing Physical Activity Outcomes for Veterans After Total Knee Arthroplasty

每年进行超过700，000例全膝关节置换手术，以减轻疼痛和残疾 与骨关节炎相关;使用VA服务的退伍军人中有43%存在慢性退行性疾病。 尽管全膝关节置换术干预改善了疼痛和自我报告的身体功能，但客观上， 身体活动仍然很低，从手术前水平到康复后一年几乎没有变化。 这些数据表明，目前的传统康复，主要是针对急性术后 损伤，并没有解决关键的根本问题，持续的身体活动行为后，总 膝关节置换术低体力活动对健康的负面影响是有据可查的。因此，我们认为， 这项随机对照试验的主要目的是评估身体活动行为改变的疗效 远程康复作为现代康复的辅助手段，用于增加以下身体活动行为 全膝关节置换术。这种新颖的低成本干预措施结合了基于证据的行为改变 方法和远程康复技术。将在全膝关节置换术前立即评估结局 关节成形术，康复中点、康复结束（主要终点）和术后24周 康复活动.主要结局将是加速度计评估的平均每日步数。二次 结果包括：平均每天花费在站立和步行活动的时间，自我报告的身体活动（生活 空间评估），基于表现的身体功能（30秒椅子站立测试，定时起身， 六分钟步行试验），自我报告的身体功能（西安大略和麦克马斯特大学 骨关节炎指数和退伍军人12项健康调查），医疗保健利用和二级健康 问题在这项研究中使用的独特和独特的康复范式解决了慢性 全膝关节置换术后身体活动不良。拟议的干预措施也增加了当前VA的价值 远程康复技术，提高康复的可及性。这项试验的产品将推进 康复知识，为临床实施体力活动提供必要的依据 行为改变远程康复的大量退伍军人从全膝关节置换术恢复。

More than 700,000 total knee arthroplasty surgeries are performed annually to alleviate pain and disability associated with osteoarthritis; a chronic, degenerative condition present in 43% of Veterans using VA services. Although total knee arthroplasty intervention improves pain and self-reported physical function, objective physical activity remains low and nearly unchanged from pre-surgery levels up to one year after rehabilitation. These data suggest that current conventional rehabilitation, primarily directed towards acute post-operative impairment, does not address the key-underlying problem of persistent physical activity behaviors after total knee arthroplasty. The negative health consequences of low physical activity are well documented. Therefore, the primary aim of this randomized controlled trial is to assess the efficacy of physical activity behavior-change telerehabilitation as an adjunct to contemporary rehabilitation for increasing physical activity behavior following total knee arthroplasty. The novel, low-cost intervention incorporates evidence-based behavior-change methods and telerehabilitation technology. Outcomes will be assessed immediately before total knee arthroplasty, at rehabilitation midpoint, end of rehabilitation (primary end point), and 24 weeks after rehabilitation. The primary outcome will be accelerometer-assessed average daily step count. Secondary outcomes include: average daily time spent in standing and walking activity, self-reported physical activity (Life Space Assessment), performance-based physical function (30-Second Chair-Stand Test, Timed Up-and-Go, Six-Minute Walk Test), self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index and Veterans 12-Item Health Survey), healthcare utilization and secondary health problems. The distinct and unique rehabilitation paradigm used in this study addresses the problem of chronic poor physical activity following total knee arthroplasty. The proposed intervention also adds value to current VA telerehabilitation technology by improving rehabilitation accessibility. The products of this trial will advance rehabilitation knowledge and provide necessary evidence for the clinical implementation of physical activity behavior-change telerehabilitation for the large population of Veterans recovering from total knee arthroplasty.