Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement: an assessor-blinded randomized controlled trial

BMC Musculoskeletal Disorders

Heike A Bischoff-Ferrari²  Rob A de Bie⁴  André Meichtry³  Ewa M Roos¹  Erika O Huber⁴ 

[1] University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics, Campusvej 55, Odense M, 5230, Denmark;Department of Geriatrics and Aging Research, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland;School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Technikumstrasse 71, Winterthur, 8401, Switzerland;Department of Epidemiology, Musculoskeletal Research Division CAHPRI, Maastricht University, Maastricht, The Netherlands

关键词: Randomized controlled trial;    Total knee replacement;    Knee osteoarthritis;    Preoperative;    Neuromuscular training;   

Others  :  1177694
DOI  :  10.1186/s12891-015-0556-8

 received in 2014-10-09, accepted in 2015-04-16,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Huber et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Harris WH, Sledge CB: Total hip and total knee replacement (2). N Engl J Med 1990, 323(12):801-7.
• [2]Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, et al.: The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 1994, 84(3):351-8.
• [3]Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, et al.: Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 2000, 133(8):635-46.
• [4]Seed SM, Dunican KC, Lynch AM: Osteoarthritis: a review of treatment options. Geriatrics 2009, 64(10):20-9.
• [5]Kurtz SM, Ong KL, Lau E, Widmer M, Maravic M, Gomez-Barrena E, et al.: International survey of primary and revision total knee replacement. Int Orthop 2011, 35(12):1783-9.
• [6]Meneghini RM, Russo GS, Lieberman JR: Modern perceptions and expectations regarding total knee arthroplasty. J Knee Surg 2014, 27(2):93-7.
• [7]Hamilton DF, Clement ND, Burnett R, Patton JT, Moran M, Howie CR, et al.: Do modern total knee replacements offer better value for money? A health economic analysis. Int Orthop 2013, 37(11):2147-52.
• [8]Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P: What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012, 2(1):e000435.
• [9]Alzahrani K, Gandhi R, Debeer J, Petruccelli D, Mahomed N: Prevalence of clinically significant improvement following total knee replacement. J Rheumatol 2011, 38(4):753-9.
• [10]Judge A, Welton NJ, Sandhu J, Ben-Shlomo Y: Equity in access to total joint replacement of the hip and knee in England: cross sectional study. BMJ 2010, 341:c4092.
• [11]Singh JA, O’Byrne MM, Harmsen WS, Lewallen DG: Predictors of moderate-severe functional limitation 2 and 5 years after revision total knee arthroplasty. J Arthroplasty 2010, 25(7):1091-5.
• [12]Scott CE, Howie CR, MacDonald D, Biant LC: Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg 2010, 92(9):1253-8.
• [13]Hoogeboom TJ, van den Ende CH, van der Sluis G, Elings J, Dronkers JJ, Aiken AB, et al.: The impact of waiting for total joint replacement on pain and functional status: a systematic review. Osteoarthritis Cartilage 2009, 17(11):1420-7.
• [14]Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, et al.: Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res 2008, 466(2):424-31.
• [15]Hoogeboom TJ, Oosting E, Vriezekolk JE, Veenhof C, Siemonsma PC, de Bie RA, et al.: Therapeutic validity and effectiveness of preoperative exercise on functional recovery after joint replacement: a systematic review and meta-analysis. PLoS One 2012, 7(5):e38031.
• [16]Beckwee D, Vaes P, Cnudde M, Swinnen E, Bautmans I: Osteoarthritis of the knee: why does exercise work? A qualitative study of the literature. Ageing Res Rev 2013, 12(1):226-36.
• [17]Bennell KL, Wrigley TV, Hunt MA, Lim BW, Hinman RS: Update on the role of muscle in the genesis and management of knee osteoarthritis. Rheum Dis Clin North Am 2013, 39(1):145-76.
• [18]Ageberg E, Link A, Roos EM: Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal-based NEMEX-TJR training program. BMC Musculoskelet Disord 2010, 11:126. BioMed Central Full Text
• [19]Johansson K, Nuutila L, Virtanen H, Katajisto J, Salantera S: Preoperative education for orthopaedic patients: systematic review. J Adv Nurs 2005, 50(2):212-23.
• [20]Nunez M, Nunez E, Segur JM, Macule F, Quinto L, Hernandez MV, et al.: The effect of an educational program to improve health-related quality of life in patients with osteoarthritis on waiting list for total knee replacement: a randomized study. Osteoarthritis Cartilage 2006, 14(3):279-85.
• [21]Ageberg E, Nilsdotter A, Kosek E, Roos EM: Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study. BMC Musculoskelet Disord 2013, 14(1):232. BioMed Central Full Text
• [22]Huber EO, de Bie RA, Roos EM, Bischoff-Ferrari HA: Effect of pre-operative neuromuscular training on functional outcome after total knee replacement: a randomized-controlled trial. BMC Musculoskelet Disord 2013, 14:157. BioMed Central Full Text
• [23]Bohannon RW: Alternatives for measuring knee extension strength of the elderly at home. Clin Rehabil 1998, 12(5):434-40.
• [24]Bohannon RW: Sit-to-stand test for measuring performance of lower extremity muscles. Percept Mot Skills 1995, 80(1):163-6.
• [25]Lord SR, Murray SM, Chapman K, Munro B, Tiedemann A: Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol A Biol Sci Med Sci 2002, 57(8):M539-43.
• [26]Villadsen A, Roos EM, Overgaard S, Holsgaard-Larsen A: Agreement and reliability of functional performance and muscle power in patients with advanced osteoarthritis of the hip or knee. Am J Phys Med Rehabil 2012, 91(5):401-10.
• [27]Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB: Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995, 332(9):556-61.
• [28]Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM: Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011, 63(Suppl 11):S208-28.
• [29]Roos EM: Effectiveness and practice variation of rehabilitation after joint replacement. Curr Opin Rheumatol 2003, 15(2):160-2.
• [30]Kessler S, Lang S, Puhl W, Stove J: The Knee Injury and Osteoarthritis Outcome Score–a multifunctional questionnaire to measure outcome in knee arthroplasty. Z Orthop Ihre Grenzgeb 2003, 141(3):277-82.
• [31]Stoll T, Huber E, Seifert B, Michel BA, Stucki G: Maximal isometric muscle strength: normative values and gender-specific relation to age. Clin Rheumatol 2000, 19(2):105-13.
• [32]Huber E, Stoll T, Ehrat B, Hofer HO, Seifert N, Stucki G: Zuverlässigkeit und Normperzentilen einer neuen isometrischen Muskelkraftmessmethode. Physiotherapie SPV 1997, 33(9):29-39.
• [33]Hortobagyi T, Garry J, Holbert D, Devita P: Aberrations in the control of quadriceps muscle force in patients with knee osteoarthritis. Arthritis Rheum 2004, 51(4):562-9.
• [34]Roos EM, Bremander AB, Englund M, Lohmander LS: Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis. Ann Rheum Dis 2008, 67(4):505-10.
• [35]Lenssen AF, van Dam EM, Crijns YH, Verhey M, Geesink RJ, van den Brandt PA, et al.: Reproducibility of goniometric measurement of the knee in the in-hospital phase following total knee arthroplasty. BMC Musculoskelet Disord 2007, 8:83. BioMed Central Full Text
• [36]Faulkner KA, Redfern MS, Rosano C, Landsittel DP, Studenski SA, Cauley JA, et al.: Reciprocal influence of concurrent walking and cognitive testing on performance in older adults. Gait Posture 2006, 24(2):182-9.
• [37]Podsiadlo D, Richardson S: The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39(2):142-8.
• [38]Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R: Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J 2006, 27(5):1040-55.
• [39]Holsgaard-Larsen A, Roos EM: Objectively measured physical activity in patients with end stage knee or hip osteoarthritis. Eur J Phys Rehabil Med 2012, 48(4):577-85.
• [40]Nelson KM, Reiber G, Boyko EJ: Diet and exercise among adults with type 2 diabetes: findings from the third national health and nutrition examination survey (NHANES III). Diabetes Care 2002, 25(10):1722-8.
• [41]Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, et al.: 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc 2011, 43(8):1575-81.
• [42]Ware JE: Measuring patients’ views: the optimum outcome measure. BMJ 1993, 306(6890):1429-30.
• [43]Ware JE Jr, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992, 30(6):473-83.
• [44]Rabin R, de Charro F: EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001, 33(5):337-43.
• [45]R Core Team. R: A language and environment for statistical computing. [http://www.R-project.org/.]
• [46]lme4: Linear mixed-effects models using Eigen and S4. R package version 1.1-6. [http://CRAN.R-project.org/package=lme4].
• [47]Villadsen A, Overgaard S, Holsgaard-Larsen A, Christensen R, Roos EM: Immediate efficacy of neuromuscular exercise in patients with severe osteoarthritis of the hip or knee: a secondary analysis from a randomized controlled trial. J Rheumatol 2014, 41(7):1385-94.
• [48]Wallis JA, Taylor NF: Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee osteoarthritis awaiting joint replacement surgery–a systematic review and meta-analysis. Osteoarthritis Cartilage 2011, 19(12):1381-95.
• [49]Villadsen A, Overgaard S, Holsgaard-Larsen A, Christensen R, Roos EM: Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty: a randomised controlled trial. Ann Rheum Dis 2014, 73(6):1130-7.
• [50]Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, et al.: Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum 2006, 55(5):700-8.
• [51]McKay C, Prapavessis H, Doherty T: The effect of a prehabilitation exercise program on quadriceps strength for patients undergoing total knee arthroplasty: a randomized controlled pilot study. PM R 2012, 4(9):647-56.
• [52]Gstoettner M, Raschner C, Dirnberger E, Leimser H, Krismer M: Preoperative proprioceptive training in patients with total knee arthroplasty. Knee 2011, 18(4):265-70.
• [53]Topp R, Swank AM, Quesada PM, Nyland J, Malkani A: The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R 2009, 1(8):729-35.
• [54]Parent E, Moffet H: Comparative responsiveness of locomotor tests and questionnaires used to follow early recovery after total knee arthroplasty. Arch Phys Med Rehabil 2002, 83(1):70-80.
• [55]Maly MR, Costigan PA, Olney SJ: Determinants of self-report outcome measures in people with knee osteoarthritis. Arch Phys Med Rehabil 2006, 87(1):96-104.
• [56]Stratford PW, Kennedy DM: Performance measures were necessary to obtain a complete picture of osteoarthritic patients. J Clin Epidemiol 2006, 59(2):160-7.
• [57]Farquhar SJ, Reisman DS, Snyder-Mackler L: Persistence of altered movement patterns during a sit-to-stand task 1 year following unilateral total knee arthroplasty. Phys Ther 2008, 88(5):567-79.
• [58]Mizner RL, Snyder-Mackler L: Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res 2005, 23(5):1083-90.
• [59]Holm B, Bandholm T, Lunn TH, Husted H, Aalund PK, Hansen TB, et al.: Role of preoperative pain, muscle function, and activity level in discharge readiness after fast-track hip and knee arthroplasty. Acta Orthop 2014, 85(5):488-92.
• [60]King MT: A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res 2011, 11(2):171-84.
• [61]Paradowski PT, Witonski D, Keska R, Roos EM: Cross-cultural translation and measurement properties of the Polish version of the Knee injury and Osteoarthritis Outcome Score (KOOS) following anterior cruciate ligament reconstruction. Health Qual Life Outcomes 2013, 11:107. BioMed Central Full Text
• [62]Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al.: CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 2010, 63(8):e1-37.
• [63]Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al.: The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001, 134(8):663-94.
• [64]McNevin NH, Wulf G, Carlson C: Effects of attentional focus, self-control, and dyad training on motor learning: implications for physical rehabilitation. Phys Ther 2000, 80(4):373-85.