Movement pattern biofeedback training after total knee arthroplasty

项目总结 在美国，每年进行的全膝关节置换术(TKA)超过70万例，其中 到2030年，每年执行的预测为350万。虽然最近的进步导致了TKA的改善 康复，单侧全膝关节置换术后非典型运动模式的持续-特征 外科手术停止使用膝盖--仍然是一个主要问题。重要的是，这些非典型的运动模式 与持续性股四头肌无力和身体功能不佳有关。此外，非典型运动 模式在对侧膝关节上产生代偿性增加的负荷，这可能与进展有关 对侧膝骨性关节炎。当代渐进强化与创新相结合 强调运动学习原则以纠正非典型运动模式的策略具有潜在的 推进康复提高单侧肢体运动模式质量和整体功能恢复 TKA。因此，本次研究的总体目标是进行随机对照试验，以 确定是否将一项新的动作模式训练计划(MOVE)添加到当代 渐进式康复比当代康复更能改善功能运动模式质量 单侧全膝关节置换术后单纯进行性康复(对照组)。移动和控制 干预措施将在门诊物理治疗环境中提供。测试将在手术前和 TKA后：2个月(干预结束)、6个月(主要终点)和2年。主要结果是 术后膝关节伸展高峰时刻由术前改变为术后6个月。尖峰 受试者的膝关节伸展力矩将通过三维仪器化运动分析来计算 走路，从椅子上站起来，走楼梯。第二个目标是确定运动模式 训练改善了基于绩效的自我报告，测量了身体机能，减少了对侧的影响 膝盖骨关节炎进展。我们期望MOVE计划将带来膝关节外科手术的实质性改善。 与控制程序相比的延伸力矩，这些改进将与 改善了身体机能。同样，我们预计峰值膝关节伸展力矩的更大对称性将 与对侧膝关节骨性关节炎进展较少相关。最后，一个探索性的目标将评估膝盖 随着时间的推移，关节合力与对侧膝关节骨性关节炎的进展有关。

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.