Improving physical activity and gait symmetry after total knee arthroplasty

全膝关节置换术(TKA)是美国最常见的外科手术之一， 正在迅速上升。全膝关节置换术可以减轻疼痛，增加活动范围，并改善某些 大多数患者的身体功能方面。然而，越来越多的证据表明，患者有 TKA后其他关键结果持续存在缺陷。首先，大多数患者没有实质性的 增加体力活动，超过TKA前的水平，保持在远低于推荐水平。这有 对关节健康和整体健康都有负面影响。其次，步态不对称是常见的 TKA，使患者在行走过程中经常继续增加非手术腿的负荷，即使在 手术后的腿是无痛的，将对侧肢体置于发展或恶化骨关节炎的风险中。 我们的长期目标是改善TKA术后的结果，特别是整体体力活动和关节 加载对称性，通过实施直接解决这些核心问题的修复过程 域名。这项拟议研究的目的是对一种新的体力活动进行探索性试验 以及对称性(PAS)干预，在常规情况下解决这些持续的TKA后缺陷 全膝关节置换术后物理治疗。这项研究的具体目的是获得关于PAS有效性的初步数据 干预，涉及以下方面的变化：1)客观评估体力活动和2)峰值负荷对称性 在步态中使用一种新的鞋垫装置。这项研究亦会评估机场管理局的可行性和可接受性。 干预。这项试验将包括72名在TKA术后常规物理治疗过程中登记的患者 谁将被随机分为PAS干预组或注意力控制组。PAS干预将 在传统面对面PT的最后访问期间由治疗物理治疗师发起，并将 继续通过四周后的电话和八周后的亲自访问来监测进展， 解决参与的障碍，并就练习修改提供建议。PAS干预将利用 基于证据的策略，包括简短的激励性访谈、设定目标和与适当的人建立联系 协助参与者逐步提高整体体力活动水平的资源。量身定制的天平 练习将被用来解决关节加载不对称问题。结果将在基线上进行评估，8 几周(在考绩完成后)和6个月。这项探索性研究将为 指导一项更大规模的PAS干预的多部位随机对照试验。

Total knee arthroplasty (TKA) is one of the most common surgical procedures performed in the U.S., and rates are rising rapidly. TKA results in decreased pain, increased range of motion, and improvements in some aspects of physical function for most patients. However, accumulating evidence shows that patients have persistent deficits in other critical outcomes following TKA. First, the majority of patients do not substantially increase physical activity beyond levels prior to TKA, remaining well below recommended levels. This has negative implications for both joint health and overall health. Second, gait asymmetries are common following TKA, such that patients often continue to load the non-surgical leg more heavily during walking, even when the post-surgical leg is pain free, placing the contralateral limb at risk for developing or worsening osteoarthritis. Our long-term objective is to improve post-TKA outcomes, particularly overall physical activity and joint loading symmetry, through implementation of a rehabilitation process that directly addresses these core domains. The objective of the proposed study is to conduct an exploratory trial of a novel Physical Activity and Symmetry (PAS) intervention, which addresses these persistent post-TKA deficits in the context of routine post-TKA physical therapy. The study specifically aims to obtain preliminary data on the efficacy of the PAS intervention, with respect to changes in: 1) objectively assessed physical activity and 2) peak load symmetry during gait using a novel insole device. The study will also assess the feasibility and acceptability of the PAS intervention. The trial will involve 72 patients enrolled during the course of routine post-TKA physical therapy who will be randomized either to the PAS intervention or an attention control group. The PAS intervention will be initiated by the treating physical therapist during the final visits of traditional in-person PT and will be continued via a phone call after four weeks and an in-person visit after eight weeks to monitor progress, address barriers to engagement, and advise on exercise modifications. The PAS intervention will utilize evidence-based strategies of brief motivational interviewing, goal-setting and connection with appropriate resources to assist participants with progressively increasing overall physical activity levels. Tailored balance exercises will be used to address joint loading asymmetries. Outcomes will be assessed at baseline, eight weeks (following completion of PAS), and 6 months. This exploratory study will provide essential information to guide a larger, multi-site randomized controlled trial of the PAS intervention.