Movement pattern biofeedback training after total knee arthroplasty

项目摘要 美国每年进行超过70万例全膝关节置换术（TKA）， 预计到2030年，每年执行350万次。虽然最近的进展改善了TKA 康复，单侧TKA后非典型运动模式的持续性-特征为 外科膝关节废用仍然是一个主要问题。重要的是，这些非典型的运动模式是 与持续的股四头肌无力和身体功能差有关。此外，非典型运动 模式在对侧膝关节上产生补偿性增加的负荷，这可能与进展有关 对侧膝关节骨关节炎将当代的渐进强化与创新的 强调运动学习原则以纠正非典型运动模式的策略有可能 推进康复，以改善运动模式质量和整体功能恢复， 全膝关节置换术。因此，本研究的总体目标是进行一项随机对照试验， 确定是否增加一个新的运动模式训练计划（MOVE），以当代 渐进式康复改善功能运动模式质量比当代 单侧TKA后单独进行性康复（对照）。移动和控制 将在门诊物理治疗环境中提供干预措施。将在术前进行测试， TKA后：2个月（干预结束）、6个月（主要终点）和2年。主要结局 将是从基线到TKA后6个月的峰值手术膝关节伸展力矩的变化。峰值 在参与者期间，将使用三维仪器运动分析计算膝关节伸展力矩 走路，从椅子上站起来，还有爬楼梯。第二个目标是确定运动模式 训练改善了基于表现和自我报告的身体功能， 膝关节OA进展。我们预计MOVE项目将导致膝关节手术的实质性改善， 与控制计划相比，这些改进将与 改善身体机能。同样，我们预计，在峰值膝关节伸展力矩更大的对称性将 与对侧膝关节OA进展较少相关。最后，一个探索性的目标将评估如何膝关节 关节力与对侧膝关节OA随时间的进展相关。

PROJECT SUMMARY More than 700,000 total knee arthroplasty (TKA) surgeries are performed annually in the United States, with projections of 3.5 million performed annually by 2030. While recent advances have led to improved TKA rehabilitation, the persistence of atypical movement patterns after unilateral TKA—characterized by surgical knee disuse—remains a major problem. Importantly, these atypical movement patterns are associated with persistent quadriceps weakness and poor physical function. In addition, atypical movement patterns create compensatory increased loading on the contralateral knee, which may be linked to progression of contralateral knee osteoarthritis. Coupling contemporary progressive strengthening with innovative strategies emphasizing motor learning principles to remediate atypical movement patterns has the potential of advancing rehabilitation to improve movement pattern quality and overall functional recovery after unilateral TKA. Therefore, the overall aim of this investigation is to perform a randomized controlled trial to determine if the addition of a novel movement pattern training program (MOVE) to contemporary progressive rehabilitation improves functional movement pattern quality more than contemporary progressive rehabilitation alone (CONTROL) after unilateral TKA. Both the MOVE and CONTROL interventions will be delivered in an outpatient physical therapy setting. Testing will occur pre-operatively and after TKA at: 2 months (end of intervention), 6 months (primary endpoint), and 2 years. The primary outcome will be change in peak surgical knee extension moment from baseline to 6 months following TKA. Peak knee extension moment will be calculated with 3-dimensional instrumented motion analysis during participants walking, rising from a chair, and stair stepping. The secondary goal is to determine if movement pattern training improves performance-based and self-report measures physical function, and lessens contralateral knee OA progression. We expect the MOVE program will result in substantial improvements in surgical knee extension moments compared to the CONTROL program, and that these improvements will be associated with improved physical function. Similarly, we expect that greater symmetry in peak knee extension moments will be correlated with less progression of contralateral knee OA. Finally, an exploratory aim will evaluate how knee joint forces relate to contralateral knee OA progression over time.