Progressive Rehabilitation for Total Knee Arthroplasty

描述(由申请人提供)：在美国，每年有超过500,000例膝关节成形术(TKA)被用于减轻与膝骨性关节炎(OA)相关的疼痛和残疾，预计到2030年，这一数字将增长到每年348万例。虽然TKA可以可靠地减轻疼痛并改善自我报告的功能，但术后数年股四头肌力量和功能活动能力仍然受损。功能活动能力的长期疲弱和缺陷可能源于术后早期的力量丧失，特别是股四头肌的力量丧失。此外，早期股四头肌无力的主要原因是术后早期肌肉难以激活。需要改进的康复策略来针对这些早期损害并预防功能活动障碍。虽然一些研究表明，全膝关节置换术后的康复没有长期好处，但新出现的研究表明，更积极的康复计划，使用密集的渐进式阻力运动和功能强化，可能会在不损害安全性的情况下显著改善患者的功能。渐进式阻力训练有许多可能的优势，包括逆转肌肉激活缺陷、刺激肌肉肥大和改善功能表现。TKA术后早期进行渐进性运动干预提供了更大的好处，因为预防术后早期肌肉功能下降可能比努力扭转术后几个月的损失更有效。然而，目前还没有前瞻性、随机化的临床试验来检验TKA术后立即启动的渐进式康复计划的益处。本研究的总体目的是通过前瞻性、双盲、随机试验，与传统康复计划(TRAD)相比，评价TKA术后渐进式阻力康复计划(PROG)的有效性。PROG干预将包括及早开始密集康复，使用渐进式阻力练习，并更快地进展到功能强化练习。Trad干预代表了之前发布的TKA康复计划的综合。将在6个时间点(术前；术后1、2、3、6和12个月)(目标1和2)测量功能和肌力，主要结果(爬楼梯时间)在3个月测量。我们还将确定与TRAD相比，PROG是否能改善肌肉质量和中枢激活，并探索股四头肌力量改善的机制(目标3)。我们预计PROG将导致功能移动性和强度的实质性改善，这些改善将特别与更好的中枢激活有关。这项研究有很高的潜力改变当前的临床实践范例，并产生直接影响，因为PROG计划可以很容易地在大多数临床环境中实施。1

DESCRIPTION (provided by applicant): Over 500,000 total knee arthroplasties (TKAs) are performed each year in the United States to alleviate pain and disability associated with knee osteoarthritis (OA), and this number is expected to grow to 3.48 million per year by the year 2030. While TKA reliably reduces pain and improves self-reported function, quadriceps strength and functional mobility remain impaired years after surgery. Long-term weakness and deficits in functional mobility likely stem from early post-operative strength loss, especially in the quadriceps muscles. Furthermore, the majority of this early quadriceps weakness occurs because of difficulty activating the muscles early after surgery. Improved rehabilitation strategies are needed to target these early impairments and prevent deficits in functional mobility. While some studies suggest that rehabilitation after TKA has no long-term benefit, emerging investigations suggest that a more aggressive rehabilitation program, using intensive progressive resistance exercise and functional strengthening, may substantially improve patient function without compromising safety. Progressive resistance exercise offers many possible advantages, including the potential to reverse muscle activation deficits, stimulate muscle hypertrophy, and improve functional performance. Early intervention with progressive exercise after TKA offers even greater benefits because preventing the decline of muscle function early after surgery is likely to be more effective than working to reverse losses months after surgery. However, there have been no prospective, randomized clinical trials examining the benefits of a progressive rehabilitation program initiated immediately after TKA. The overall aim of this investigation is to evaluate the effectiveness of a progressive resistance rehabilitation program (PROG) after TKA compared to a traditional rehabilitation program (TRAD) through a prospective, double-blinded, randomized trial. The PROG intervention will involve the early initiation of intensive rehabilitation using progressive resistance exercise and faster progression to functional strengthening exercises. The TRAD intervention represents the synthesis of previously published TKA rehabilitation programs. Functional performance and muscle strength will be measured at six time points (pre-op; 1, 2, 3, 6, and 12 months after TKA) (Aims 1&2) with the primary outcome (stair climbing time) measured at 3 months. We will also determine whether PROG enhances improvements in muscle mass and central activation compared to TRAD, and explore the mechanisms by which quadriceps strength improves (Aim 3). We expect PROG will result in substantial improvements in functional mobility and strength and these improvements will specifically relate to better central activation. This study has high potential to shift current clinical practice paradigms with an immediate impact because the PROG program can be easily implemented in most clinical settings. 1