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Title: Effect of preoperative neuromuscualr training (NEMEX-TJR) on functional outcome after total knee replacement : an assessor-blinded randomized controlled trial
Authors : Huber, Erika O.
Roos, Ewa M.
Meichtry, André
de Bie, Rob A.
Bischoff-Ferrari, Heike A.
Published in : BMC Muculoskeletal Disorders
Volume(Issue) : 16
Issue : 101
Publisher / Ed. Institution : BioMed Central
Issue Date: 2015
License (according to publishing contract) : CC BY 4.0: Namensnennung 4.0 International
Type of review: Open peer review
Language : English
Subjects : Preoperative; Total knee replacement; Neuromuscular training; Knee osteoarthritis; Randomized controlled trial
Subject (DDC) : 615.82: Physical therapy
616.7: Diseases of musculoskeletal system and orthopaedics
Abstract: BACKGROUND: Improving functional status preoperatively through exercise may improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is insufficient. The aim of the study was to compare the difference in change between groups in lower extremity function from baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone. METHODS: 45 patients (55-83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3 sessions of KS or 3 sessions of KS alone. Function was assessed with the Chair Stand Test (CST, primary endpoint) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales focusing on daily living function (ADL) and pain (secondary endpoints). Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation. RESULTS: After intervention before surgery we observed a small improvement for primary and secondary endpoints in both groups, which did not differ significantly between groups: comparing the exercise to the control group the treatment effect for the CST was -1.5 seconds (95% CI: -5.3, 2.2), for KOOS ADL and KOOS pain the treatment effect was 1.3 points (-10.1, 12.8) and -2.3 (-12.4, 7.9) respectively. At 3 months after surgery we observed a small improvement in the primary endpoint in the control group and a significant improvement in the secondary endpoints in both exercise and control groups, which did not differ significantly between groups: comparing the exercise group to the control group the treatment effect in the CST was 2.0 seconds (-1.8, 5.8), for KOOS ADL and KOOS pain the treatment effect was -4.9 points (-16.3, 6.5) and -3.3 points (-13.5, 6.8) respectively. CONCLUSIONS: A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone. These benefits were not sustained after TKR. Our trial doesn't give a conclusive answer to whether additional preoperative exercise on postoperative functional outcomes is beneficial.
Departement: Gesundheit
Organisational Unit: Institute of Physiotherapy (IPT)
Publication type: Article in scientific Journal
DOI : 10.1186/s12891-015-0556-8
ISSN: 1471-2474
Appears in Collections:Publikationen Gesundheit

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