即使没有证据,康复从业者继续引入新的干预措施,以提高近期全膝关节置换术(TKA)人群的活动度.
比较3种新开发的物理治疗方案与标准护理后TKA康复方案的TKA后功能活动结局。
这项随机临床试验包括在巴尔的摩一个卫生系统内的15个门诊诊所实施的4个研究组,马里兰,和华盛顿,哥伦比亚特区,地区从2013年10月到2017年4月。参与者包括接受选择性单侧TKA的患者,年龄在40岁以上,并在TKA后24天内开始门诊物理治疗。总共对505名患者进行了筛查,并招募了386名参与者。患者提供知情同意书,并被随机分配到4组中的1组。由于干预的性质,失明患者和治疗治疗师是不可行的。从2017年10月至2019年5月,根据修改后的意向治疗原则进行了分析。
对照组使用标准横卧自行车,每次15到20分钟。干预使用3种方式中的1种,每次15至20分钟:(1)体重可调的跑步机,(2)图案化电神经肌肉刺激装置,或(3)跑步机和神经肌肉电刺激的组合。
结果包括急性护理后基本流动性评分的活动测量,患者报告的结果指标,还有6分钟步行测试.结果在基线测量,每月,从门诊治疗出院后.
来自363名患者的数据(平均[SD]年龄,63.4[7.9]岁;222[61.2%]女性)被纳入最终分析,包括随机分配到对照组的92名参与者,91名参与者随机分配到跑步机组,90名参与者随机分配到神经肌肉刺激设备组,90名参与者随机分配到联合干预组。出院时急性护理后评分的活动测量在各组之间相似,范围从61.1到61.3(P=.99),自基线以来至少提高9.0分(P=.80)。通过6分钟步行测试测得的距离在各组之间没有统计学差异(范围,382.9-404.5米;P=.60)。
这项随机临床试验发现,4组的结果没有统计学或临床上的显著差异。因为武器之间的结果相似,临床医生应该考虑定制TKA康复的相对成本.
ClinicalTrials.gov标识符:NCT02426190。
Even without evidence, rehabilitation practitioners continue to introduce new interventions to enhance the mobility outcomes for the increasing population with a recent total knee arthroplasty (TKA).
To compare post-TKA functional mobility outcomes among 3 newly developed physical therapy protocols with a standard-of-care post-TKA rehabilitation protocol.
This randomized clinical
trial included 4
study arms implemented in 15 outpatient clinics within a single health system in the Baltimore, Maryland, and Washington, District of Columbia, region from October 2013 to April 2017. Participants included patients who underwent elective unilateral TKA, were aged 40 years and older, and began outpatient physical therapy within 24 days after TKA. A total of 505 patients were screened and 386 participants were enrolled. Patients provided informed consent and were randomly assigned to 1 of 4 groups. Blinding patients and treating therapists was not feasible owing to the nature of the intervention. Analysis was conducted under the modified intent-to-treat principle from October 2017 to May 2019.
The control group used a standard recumbent bike for 15 to 20 minutes each session. Interventions used 1 of 3 modalities for 15 to 20 minutes each session: (1) a body weight-adjustable treadmill, (2) a patterned electrical neuromuscular stimulation device, or (3) a combination of the treadmill and electrical neuromuscular stimulation.
Outcomes included the Activity Measure for Post-acute Care basic mobility score, a patient-reported outcome measure, and the 6-minute walk test. Outcomes were measured at baseline, monthly, and on discharge from outpatient therapy.
Data from 363 patients (mean [SD] age, 63.4 [7.9] years; 222 [61.2%] women) were included in the final analysis, including 92 participants randomized to the control group, 91 participants randomized to the treadmill group, 90 participants randomized to the neuromuscular stimulation device group, and 90 participants randomized to the combination intervention group. Activity Measure for Post-acute Care scores at discharge were similar across groups, ranging from 61.1 to 61.3 (P = .99) with at least 9.0 points improvement (P = .80) since baseline. The distances as measured by the 6-minute walking test were not statistically different across groups (range, 382.9-404.5 m; P = .60).
This randomized clinical
trial found no statistically or clinically significant differences in outcomes across the 4 arms. Because outcomes were similar among arms, clinicians should instead consider relative cost in tailoring TKA rehabilitation.
ClinicalTrials.gov Identifier: NCT02426190.