The effects of aquatic prehabilitation in knee OA patients on knee arthroplasty outcomes

 描述(申请人提供)：随着人口老龄化，全膝关节置换术越来越频繁。虽然手术总体上是成功的，但许多患者仍有持续性的疼痛和残疾。传统的风险评估工具侧重于单一器官系统。我们的团队发现，通过活动能力评估工具短表(MAT-SF)评估的活动能力是一种简单而准确的方法来预测术后结果，包括住院时间、术后并发症和老年患者的疗养院安置。康复是增强人的机能能力以承受即将到来的压力源的过程。尽管多项研究已经测试了关节置换手术前的康复，但结果好坏参半。我们假设活动受限的患者最有可能从康复治疗中受益。我们计划使用个性化的水上运动作为一种康复工具；水的阻力增强肌肉，增加能量消耗，而不会对承重关节造成压力。本探索性R03研究的目的是：1)评估6-8周水上运动康复的可行性。 40名计划进行全膝关节置换术治疗骨性关节炎的老年人；2)检查效果 观察6-8周水上运动对(A)活动能力、疼痛、僵硬、身体功能、认知功能和抑郁的影响；(B)用双能X线骨密度仪(DXA)测量身体成分；(C)炎症标志物，包括C反应蛋白、IL-6和肿瘤坏死因子-a；以及3)评估康复对术后结果的影响。我们将在术前评估诊所对患者进行筛查，并招募通过MAT-SF测量活动能力下降的患者。患者将被随机分为康复训练组或常规护理组。将使用西安大略大学和麦克马斯特大学骨关节炎指数(WOMAC)、老年抑郁量表简表(GDS-SF)、短身体表现成套测验(SPPB)、Berg平衡量表和蒙特利尔认知评估(MoCA)对所有患者的疼痛、僵硬和身体功能、抑郁、平衡和认知功能进行广泛评估。血清炎症标志物，包括C反应蛋白、IL-6和肿瘤坏死因子-α，以及身体成分，将在基线时使用双能X射线吸收法(DXA)进行评估。康复组将在恒温游泳池中进行6-8周的个性化水上运动(60分钟/次，每周3次)。所有参与者将在手术前和手术后4周使用WOMAC、GDS-SF、SPPB、Berg Balance Scale、MoCA和MAT-SF进行重新评估。血清炎性标志物和身体成分将在同一时间点重新评估。令人感兴趣的主要结果是术后并发症、住院时间、ICU住院时间和住院时间。如果成功，我们将拥有几个关键健康结果的可靠试点数据，以支持外部更大规模研究的提议。这项研究和所描述的职业发展活动将有助于申请人成为老年围手术期医学的独立研究人员。

 DESCRIPTION (provided by applicant): With our aging population, total knee arthroplasty is performed with increasing frequency. Although the surgery is generally successful, many patients have persistent pain and disability. Traditional risk assessment tools have focused on single organ systems. Our team has found that mobility, assessed by the Mobility Assessment Tool short form (MAT-sf), is a simple and accurate method to predict postoperative outcomes, including length of stay, postoperative complications, and nursing home placement for older patients. Prehabilitation is the process of enhancing a person's functional capacity to withstand an incoming stressor. Although multiple studies have tested prehabilitation before joint replacement surgery, results have been mixed. We hypothesize that patients with limited mobility are most likely to benefit from prehabilitation. We plan to use individualized aquatic exercise as a prehabilitation tool; the resistance of water strengthens muscle and increases energy expenditure without stressing weight-bearing joints. The aims of this exploratory R03 study are: 1) To evaluate the feasibility of prehabilitation using 6-8 weeks of aquatic exercise in 40 older adults scheduled for total knee arthroplasty for osteoarthritis; 2) To examine the effects of 6-8 weeks of aquatic exercise on (a) mobility, pain, stiffness, physical function, cognitive function and depression; (b) body composition measured by dual-energy X-ray absorptiometry (DXA); and (c) inflammatory markers, including CRP, IL-6 and TNF-a; and 3) To estimate the effect of prehabilitation on postoperative outcomes. We will screen patients in the Preoperative Assessment Clinic and enroll patients who have decreased mobility, measured by MAT-sf. Patients will be randomized into either a prehabilitation group or a usual care group. All will be extensively assessed regarding pain, stiffness, and physical function, depression, balance and cognitive function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Geriatric Depression Scale Short Form (GDS-SF), the Short Physical Performance Battery (SPPB), Berg Balance Scale, and Montreal Cognitive Assessment (MoCA). Serum inflammatory markers including CRP, IL-6 and TNF-alpha and body composition, using dual energy X-ray absorptiometry (DXA), will be assessed at the baseline. The prehabilitation group will participate in 6-8 weeks of individualized aquatic exercise in a heated pool (60 min/session, 3 times per week). All participants will be reassessed immediately before surgery and 4 weeks after the surgery using WOMAC, GDS-SF, SPPB, Berg Balance Scale, MoCA and MAT-sf. Serum inflammatory markers and body composition will be reassessed at the same time points. The primary outcomes of interest are postoperative complications, length of stay, ICU length of stay, and institutionalization. If successful, we will have sound pilot data for several critical health outcomes with which to support an external proposal for a larger-scale study. This study and the career development activities described will help the applicant to become an independent researcher in geriatric perioperative medicine.