Optimizing Physical Activity Outcomes for Veterans After Total Knee Arthroplasty

每年进行的膝关节置换手术总数超过70万例，以减轻疼痛和残疾 与骨关节炎相关；一种慢性退行性疾病，43%的退伍军人使用退伍军人服务。 尽管全膝关节置换术干预改善了疼痛和自我报告的身体功能，但目标是 体力活动仍然很少，与手术前水平几乎没有变化，直到康复后一年。 这些数据表明，目前的常规康复主要针对手术后的急性 损害，没有解决关键-潜在的问题，持续的身体活动行为后 膝关节置换术。低体力活动对健康的负面影响是有据可查的。因此， 这项随机对照试验的主要目的是评估体力活动行为改变的效果。 远程康复作为现代康复的辅助手段，用于增加以下行为的体力活动 全膝关节置换术。这种新颖的低成本干预结合了基于证据的行为改变 方法和远程康复技术。结果将在全膝关节手术前立即进行评估 关节成形术，在康复中点、康复结束(主要终点)和24周后 康复。主要结果将是加速计评估的平均每日步数。次要的 结果包括：平均每天花在站立和步行活动上的时间，自我报告的体力活动(生活 空间评估)、以绩效为基础的身体机能(30秒椅子站立测试、计时起立、 六分钟步行测试)，自我报告身体功能(安大略省西部大学和麦克马斯特大学 骨关节炎指数和退伍军人12项健康调查)、医疗保健利用和二级健康 有问题。这项研究中使用的独特康复范式解决了慢性精神分裂症的问题 全膝关节置换术后体力活动较差。拟议的干预还增加了当前退伍军人管理局的价值 通过提高康复可及性，加快康复技术的发展。这次试验的产品将会进步 康复知识，为临床实施体力活动提供必要依据 行为改变对退伍军人全膝关节置换术后康复的影响。

More than 700,000 total knee arthroplasty surgeries are performed annually to alleviate pain and disability associated with osteoarthritis; a chronic, degenerative condition present in 43% of Veterans using VA services. Although total knee arthroplasty intervention improves pain and self-reported physical function, objective physical activity remains low and nearly unchanged from pre-surgery levels up to one year after rehabilitation. These data suggest that current conventional rehabilitation, primarily directed towards acute post-operative impairment, does not address the key-underlying problem of persistent physical activity behaviors after total knee arthroplasty. The negative health consequences of low physical activity are well documented. Therefore, the primary aim of this randomized controlled trial is to assess the efficacy of physical activity behavior-change telerehabilitation as an adjunct to contemporary rehabilitation for increasing physical activity behavior following total knee arthroplasty. The novel, low-cost intervention incorporates evidence-based behavior-change methods and telerehabilitation technology. Outcomes will be assessed immediately before total knee arthroplasty, at rehabilitation midpoint, end of rehabilitation (primary end point), and 24 weeks after rehabilitation. The primary outcome will be accelerometer-assessed average daily step count. Secondary outcomes include: average daily time spent in standing and walking activity, self-reported physical activity (Life Space Assessment), performance-based physical function (30-Second Chair-Stand Test, Timed Up-and-Go, Six-Minute Walk Test), self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index and Veterans 12-Item Health Survey), healthcare utilization and secondary health problems. The distinct and unique rehabilitation paradigm used in this study addresses the problem of chronic poor physical activity following total knee arthroplasty. The proposed intervention also adds value to current VA telerehabilitation technology by improving rehabilitation accessibility. The products of this trial will advance rehabilitation knowledge and provide necessary evidence for the clinical implementation of physical activity behavior-change telerehabilitation for the large population of Veterans recovering from total knee arthroplasty.