Improving physical activity and gait symmetry after total knee arthroplasty

全膝关节置换术后改善体力活动和步态对称性

• 批准号: 9904486
• 负责人: Kelli D. Allen
• 金额: $ 26.97万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9904486
• 关键词: Accelerometer; Address; Articular Range of Motion; Clinical Research; Contralateral; Control Groups; Data; Degenerative polyarthritis; Devices; Enrollment; Equilibrium; Exercise; Feedback; Gait; Goals; Health; Health Care Costs; Home environment; Individual; Intervention; Intervention Trial; Joints; Journals; Leg; Limb structure; Measures; Modification; Monitor; Operative Surgical Procedures; Outcome; Outcome Assessment; Pain; Pain-Free; Participant; Patients; Pattern; Perception; Persons; Physical Function; Physical Performance; Physical activity; Physical therapy; Postoperative Period; Process; Randomized; Randomized Controlled Trials; Recommendation; Rehabilitation therapy; Research; Research Project Grants; Resources; Risk; Site; Task Performances; Telephone; United States; United States Dept. of Health and Human Services; Visit; Walking; Weight; attentional control; base; bone; evidence base; falls; gait rehabilitation; gait symmetry; health care service utilization; improved; indexing; interest; joint loading; knee replacement arthroplasty; moderate-to-vigorous physical activity; motivational enhancement therapy; novel; physical inactivity; physical therapist; primary outcome; programs; recruit; secondary outcome; sedentary; sensor

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.

全膝关节置换术 (TKA) 是美国最常见的外科手术之一，其发生率 正在迅速上升。 TKA 可减轻疼痛、增加活动范围并改善某些功能 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 TKA 后其他关键结果持续存在缺陷。首先，大多数患者并没有实质上 增加身体活动量，使其超出 TKA 之前的水平，但仍远低于建议水平。这有 对关节健康和整体健康产生负面影响。其次，步态不对称常见于： TKA，使得患者在行走过程中经常继续对非手术腿施加更大的负荷，即使在 术后腿部没有疼痛，使对侧肢体面临发生或恶化骨关节炎的风险。 我们的长期目标是改善 TKA 术后结果，特别是整体身体活动和关节 通过实施直接解决这些核心问题的康复过程来加载对称性 域。拟议研究的目的是对新型体育活动进行探索性试验 对称性 (PAS) 干预，可在常规情况下解决这些持续存在的 TKA 后缺陷 TKA 后物理治疗。该研究的具体目的是获得有关 PAS 功效的初步数据 干预，涉及以下方面的变化：1) 客观评估的体力活动和 2) 峰值负荷对称性 在步态过程中使用新型鞋垫装置。该研究还将评估 PAS 的可行性和可接受性 干涉。该试验将纳入 72 名正在接受 TKA 后常规物理治疗的患者 他们将被随机分配到 PAS 干预组或注意力对照组。伊党的干预将 由主治物理治疗师在传统面对面 PT 的最后一次就诊期间启动，并将 四周后继续通过电话，八周后亲自拜访以监测进展情况， 解决参与障碍，并就练习修改提供建议。伊党干预将利用 基于证据的策略，包括简短的动机访谈、目标设定以及与适当的人的联系 帮助参与者逐步提高整体身体活动水平的资源。量身定制的平衡 练习将用于解决关节负载不对称问题。结果将在基线、八 周（完成 PAS 后）和 6 个月。这项探索性研究将为 指导一项更大规模、多中心的 PAS 干预随机对照试验。