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，和费率 正在迅速上升。TKA可减少疼痛，增加活动范围，并改善某些 对大多数患者的身体功能。然而，越来越多的证据表明， TKA后其他关键结局的持续缺陷。首先，大多数患者并没有 增加身体活动，超过TKA前的水平，保持远低于推荐水平。这 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以下 全膝关节置换术，使得患者在行走过程中经常继续更重地加载非手术腿，即使当 手术后的腿部没有疼痛，使对侧肢体有发生或恶化骨关节炎的风险。 我们的长期目标是改善TKA术后结局，特别是整体体力活动和关节功能。 负载对称，通过实施直接解决这些核心问题的康复过程， 域.这项研究的目的是对一种新的体力活动进行探索性试验 和对称性（PAS）干预，在常规治疗的背景下解决这些持续性TKA后缺陷 TKA术后物理治疗。这项研究的目的是获得关于PAS疗效的初步数据 干预，关于以下方面的变化：1）客观评估的体力活动和2）峰值负荷对称性 在步态期间使用新颖的鞋内底装置。研究亦会评估考绩制度的可行性和可接受性 干预该试验将纳入72名在常规TKA后物理治疗过程中入组的患者 他们将被随机分配到PAS干预组或注意力控制组。考绩制度的干预将 由治疗物理治疗师在传统亲自PT的最后访视期间发起， 四周后通过电话继续，八周后通过亲自访问继续监测进展， 解决参与的障碍，并就演习修改提出建议。考绩制度的干预将利用 以证据为基础的策略，包括简短的动机性访谈、目标设定和与适当的 帮助参与者逐步提高整体身体活动水平的资源。定制天平 练习将用于解决关节载荷不对称问题。结果将在基线评估，8 周（完成考绩后）和6个月。这项探索性研究将提供重要信息， 指导PAS干预的大型、多中心随机对照试验。

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.