Dissertations / Theses on the topic 'Total knee replacement. Physical therapy'

The purpose of this study was to determine the effectiveness of the Augmented Soft Tissue Mobilization (A.S.T.M.) Rehabilitation Technique on total knee replacement patients. The specific measurements assessed were stride length (SL), stride frequency (SF), walking velocity, support time (ST), total time (TT), static and walking range of motion (ROM) of the hip, knee, and ankle, ground reaction forces (GRF), and torques. Fourteen subjects (Female = 7, Male = 7) completed the study. Subjects were randomly assigned to two experimental groups, the Traditional Therapy treatment or the A.S.T.M. treatment. There were five testing sessions: pre operation, 8 weeks, 12 weeks, 16 weeks, and 24 weeks post operation. On the 12 week test, the subject had completed their assigned of treatment protocol. Static ROM was derived from gonimetric measurements before each testing session. Stride length, stride frequency, velocity, time, and walking ROM were derived from accelerometer data. Statistical analysis using ANOVA revealed a significant change in all static ROM, SL, and ST. The data indicated that both groups of the Total Knee Replacement patients did improve their functional status from their status prior to surgery. In addition, the data indicated that the Augmented Soft Tissue Mobilization program and the Traditional Therapy program are equally acceptable rehabilitation techniques.
School of Physical Education

Este estudo compara dois protocolos de reabilitação fisioterapêutica - um com três meses de duração (protocolo padrão IOT) e outro com dois meses (protocolo avançado) - para evidenciar a real necessidade de um tempo prolongado de reabilitação em 31 pacientes submetidas a artroplastia total do joelho. O estudo é prospectivo e randomizado e a faixa etária avaliada está entre 60 e 76 anos. As pacientes são avaliadas no pré-operatório e após o tratamento com avaliação clínica (escala de dor, Knee Society Score, SF-36 e goniometria) e avaliação de força (avaliação isocinética) para comparação dos protocolos. A análise estatística dos valores da escala de dor, do Knee Society Score, da amplitude de movimento, do pico de torque muscular e da avaliação da qualidade de vida (SF-36) demonstra que todas as pacientes obtêm melhora quando comparamos o pré e pós-operatório, independente do grupo. Conclui-se que o protocolo de reabilitação fisioterapêutica com dois meses de duração para o pós-operatório de artroplastia total do joelho mostra ser eficaz, alcançando os mesmos objetivos e resultados que o protocolo com três meses de duração
The present study compares two physiotherapeutic rehabilitation protocols - one lasting three months (standard IOT protocol), the other lasting two months (advanced protocol) - to assert the actual need of a prolonged rehabilitation period in 31 cases of patients who went through total knee arthroplasty. The study is prospective and randomized; the age group of evaluated patients is between 60 and 76 years-old. In order to compare the two protocols, patients are evaluated before surgery and after treatment, by means of clinical evaluation (pain scale, Knee Society Score, SF-36 and goniometry) and isokinetic strength test. Statistical analyses of results from pain scale, Knee Society Score, movement amplitude, muscular torque peak and quality of life show improvement for all patients between pre- and post-operation, regardless of group. The study concludes the two months physiotherapeutic rehabilitation protocol for total knee arthroplasty is as effective as the three months protocol, as both reached the same goals and results

Tyrimo tikslas – įvertinti kineziterapijos pratimų ir keturgalvio šlaunies raumens elektrinės stimuliacijos poveikį moterų, kurioms endoprotezuotas kelio sąnarys, judėjimo funkcijai. Uždaviniai: 1. Nustatyti kineziterapijos pratimų poveikį moterų, kurioms endoprotezuotas kelio sąnarys, judesių amplitudei, raumenų jėgai, skausmo intensyvumui, kelio tinimui ir funkcinei būklei. 2. Nustatyti kineziterapijos pratimų, derinamų su raumenų elektrine stimuliacija, poveikį moterų, kurioms endoprotezuotas kelio sąnarys, judesių amplitudei, raumenų jėgai, skausmo intensyvumui, kelio tinimui ir funkcinei būklei. 3. Palyginti skirtingų kineziterapijos programų efektyvumą. Išvados: 1. Taikant kineziterapijos pratimus statistiškai reikšmingai padidėjo moterų, kurioms endoprotezuotas kelio sąnarys, operuotos kojos kelio judesių amplitudės, raumenų jėga, sumažėjo skausmo intensyvumas, kelio tinimas bei pagerėjo funkcinė būklė. 2. Taikant kineziterapijos pratimus ir keturgalvio šlaunies raumens elektrinę stimuliaciją statistiškai reikšmingai padidėjo moterų, kurioms endoprotezuotas kelio sąnarys, operuotos kojos kelio judesių amplitudės, raumenų jėga, sumažėjo skausmo intensyvumas, kelio tinimas bei pagerėjo funkcinė būklė. 3. Kineziterapijos pratimai, derinami su keturgalvio šlaunies raumens elektrine stimuliacija, labiau padidino blauzdą tiesiančių raumenų jėgą ir pagerino „Stotis ir eiti“ testo rezultatus nei vien kineziterapijos pratimai. Judesių amplitudei, skausmo intensyvumui, kelio... [toliau žr. visą tekstą]
The aim of the study: to evaluate the effect of physical therapy exercises and electrical stimulation of the quadriceps muscle on motor function in women after total knee replacement. Goals of the study: 1. To assess the effect of physical therapy exercises for range of motion, muscles strength, pain intensity, knee swelling and functional performance in women after total knee replacement. 2. To determine the effect of physical therapy exercises combined with neuromuscular electrical stimulation for range of motion, muscle strength, pain intensity, knee swelling and functional performance in women after total knee replacement. 3. To compare the effectiveness of different physical therapy programs. Coclusions: 1. Physical therapy exercises have significantly increased the knee range of motion, muscle strength, decreased pain intensity, the swelling of the knee and improved functional performance for women after total knee replacement surgery. 2. Physical therapy exercises with quadriceps muscle neuromuscular electrical stimulation have significantly increased the knee range of motion, muscle strength, decreased pain intensity, the swelling of the knee and improved functional performance for women after total knee replacement surgery. 3. Physical therapy exercises combined with quadriceps muscle neuromuscular electrical stimulation whilst compared to physical therapy exercises alone increased the strength of quadriceps muscle and results of “Timed up and go” test more. Both... [to full text]

Discharge readiness following total knee replacement (TKR) has often been defined using quantitative factors, such as knee range of motion or walking a specified distance. These measurements fail to include other features that could impact readiness for discharge, such as social support or patient perceptions. Most patients have positive results following TKR surgery, however others experience negative outcomes such as falls, reduced functional performance, and hospital readmission. Readiness for returning home after TKR begins with pre-operative education to prepare patients for surgery and the post-operative phase. Health care providers must have a clear understanding of patients’ perceptions of readiness to return home after surgery. It is also essential to describe the current structure of pre-operative education nationally as a mechanism for better preparing patients to return home following knee replacement. This dissertation includes three studies that explore aspects of discharge readiness following TKR including patients’ perceptions of readiness for discharge as well as the structure of pre-operative education for TKR across the United States. The first study examined patients’ experiences preparing for discharge home from the acute care setting following TKR surgery. Results indicated that patients felt prepared overall for discharge and received appropriate supports for returning home after surgery, but some felt unprepared for certain aspects of recovery such as the amount of pain experienced in the post-operative phase. The second study surveyed health care providers who participated in pre-operative education before TKR to identify the current structure of education programs in the United States. This pilot study revealed that pre-operative education teams were commonly interprofessional with education being typically provided in a group format in a single session lasting between 1 and 1.5 hours. Verbal and written instruction were common delivery methods to provide education. The final dissertation study used mixed-methods to explore the current structure of pre-operative education for TKR in the United States with a large, national sample. Orthopedic nurses completed an online survey to describe their pre-operative education program. The majority of participants provided pre-operative education as part of interprofessional teams in either a group format or a format that included both group and individual education. Verbal instruction was the most common educational delivery method followed by written instruction. Most pre-operative education classes lasted between 1 and 1.5 hours, were delivered in a single session, and included a variety of topics. Ten orthopedic nurses were then interviewed and interview transcripts were analyzed qualitatively for common themes among participants. Participants expressed that pre-operative education was a significant component impacting patient outcomes following surgery. Interprofessional pre-operative education was valued by participants, but pragmatic factors were identified as barriers to the inclusion of other disciplines within these programs. Education programs were constantly evolving based on current evidence-based practice and changes to orthopedic protocols. Descriptions of pre-operative programs nationally combined with providers’ perceptions provides a strong basis for determining best practice to support better post-operative patient outcomes. This dissertation research culminated in recommendations for best practice as well as the creation of a model, the ICF-I-EDUCATE, which combines the International Classification of Health, Functioning and Disability (ICF), interprofessional practice, and the EDUCATE model for providing patient and family education. Research is needed to examine the ICF-I-EDUCATE model in clinical practice for patients with planned TKR.

The purpose of the present study was to compare total knee arthroplasty (TKA) rehabilitation with and without whole-body vibration (WBV) to 1) understand if WBV is a useful treatment during TKA rehabilitation to increase quadriceps strength and function, and 2) to investigate the effect of WBV on quadriceps voluntary muscle activation. Subject and Methods. Individuals post TKA (WBV n=8, control n=8) received physical therapy with and without WBV for four weeks. Quadriceps strength and muscle activation, function, perceived pain, and knee range of motion were measured. Results. No adverse side effects were reported in either group. There was a significant increase in strength and function for both groups (P<0.01). There was no difference pre to posttest between groups for strength, muscle activation, or pain (Hotelling’s T2=0.42, P=.80) or for function (F=0.54, P=0.66). Discussion and Conclusion. In individuals with TKA, WBV showed equal strength and function improvement to physical therapy directed progressive resistive exercise. Influence of WBV on muscle activation remains unclear, as initial muscle activation was near established normal quadriceps levels and remained so post treatment.

Modern advances in technology have allowed for an increase in the precision with which we are able to measure, record, and affect behavior. These developments suggest that the domains in which behavior analysis might contribute are considerably broader than previously appreciated, for instance the area of behavioral medicine. One way the field of behavior analysis can begin to address problems in behavioral medicine is with biosensor technology, like surface electromyography (sEMG). For sEMG technology to be useful in behavioral medicine, specifically recovery from total knee arthroplasty, a reference value (the maximum voluntary individual contraction-MVIC) must be established. The MVIC value allows for the comparison of data across days and may allow the programming of contingencies. However, current MVIC methods fall short. Study 1 compares MVIC values produced by a participant given the typical instruction only method with two alternative methods: instruction + feedback, and instruction + feedback in a game context. Across 10 participants both feedback conditions lead to higher MVIC values then the instruction only condition. Study 2 applies the MVIC techniques developed during Study 1 to an exercise procedure. Using an MVIC value as the criteria for feedback Study 2 compares the same three conditions, however this time assessing for the conditions under which exercise performance is optimal. Across all 9 participants the instruction + feedback in a game context lead to the participant ‘working harder' and 8 out of 9 participants exceeded the MVIC value more often during this condition then in the other two conditions.

Background: Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis. Growth in the number of procedures performed annually in the United States is expected to increase steadily. Post-operative rehabilitation settings vary and include both institutional and community based physical therapy (PT) services. Despite access to PT, deficits in gait often persist for months and even years after surgery. Slow gait speed, asymmetrical walking patterns, and prolonged time in double-limb support following the TKA often lead to the need for an assistive device for walking and prolong the rehabilitation phase. Purpose: The purpose of this study is to analyze early gait during inpatient rehabilitation to quantify both the improvements made and deficits that remain in important gait variables. This study identifies predictor variables that contribute to the variance in discharge ambulation device use and IRF length of stay. Subjects: A convenience sample of 230 patients discharged to an IRF following a TKA (160 following a single TKA and 70 following a bilateral procedure) was used for this analysis. Method: Paired t-tests were used to compare temporal and spatial gait variables from the initial gait assessment compared to the discharge gait assessment in patients following single TKA to determine remaining deficits. Right vs left comparisons were made for patients following a bilateral procedure. A binary logistic regression was used to identify predictors associated with the need for a two-handed ambulation device at discharge. A multiple linear regression developed a model to assess predictors of the inpatient rehabilitation length of stay. Finally, a self-assessment to evaluate patient confidence with walking (mGES scale) was correlated to actual gait speed performed on the gait analysis in a sample of patients from our study population. Findings: Deficits in step length, step time and percent of single limb support remained in the involved limb compared to uninvolved limb at discharge from inpatient rehabilitation following single TKA; no limb differences between the right and left side were noted in patients after bilateral TKA. The discharge gait speed of 54.6 cm/sec for single TKA patients and discharge speed of 61.5 cm/sec for bilateral TKA patients is within the classification of limited community ambulators and making them appropriate for a home discharge. But despite improvement from admission to discharge, the gait speed for both groups in our study remain below the gait speed identified by prior studies 3-months following TKA surgery where speed reached 135 cm/sec. The need for a two-handed ambulation device, such as bilateral canes or a walker, was associated with slow walking speed and prior use of a device before surgery. A longer rehabilitation length of stay was associated with slower initial gait speed, lower motor FIM scores and reduced knee extension at admission. The mGES patient self-report conducted at the time of the discharge gait assessment showed a moderate correlation to the discharge gait speed; however, the pairing of the admission mGES with the admission gait speed was not significantly correlated.

L’objectif de ce travail de thèse était d’évaluer les bénéfices thérapeutiques d’un entraînement par imagerie motrice chez les patients ayant subi une prothèse totale de genou unilatérale. Combiner l’imagerie motrice avec la physiothérapie classique a permis de diminuer la douleur et d’augmenter la force du quadriceps durant la phase aiguë, au 1er mois postopératoire. Durant la phase chronique, au 6ème mois postopératoire, l’imagerie motrice permettrait de corriger l’asymétrie de la marche, d’une part en augmentant la force du quadriceps ipsilatéral et, par conséquent, en accentuant la charge sur le genou opéré, et d’autre part en augmentant la flexion maximale du genou durant la phase oscillante. L’imagerie motrice pourrait également aider les personnes âgées après la prothèse totale du genou à monter les escaliers plus rapidement, en toute sécurité. Cela peut atténuer le risque de chute dans les escaliers et, par conséquent, diminuer la fréquence des blessures graves. En conclusion, intégrer l’imagerie motrice dans les programmes de rééducation après prothèse totale du genou primaire unilatérale est pertinent et prometteur
The primary aim of the present work was to determine the therapeutic benefits of a specific motor imagery training. Combining motor imagery with classical physical therapy was found to be effective in reducing pain and increasing quadriceps strength after total knee arthroplasty during the acute phase at the first month postoperatively. During the chronic phase, at the 6th month postoperatively, motor imagery might contribute to correct the asymmetry of gait by increasing the strength of the ipsilateral quadriceps and, consequently accentuating the weight loading on the operated knee, as well as by improving knee proprioception through an increase in the maximum knee flexion during the swing phase. MI might also help elderly people after total knee arthroplasty to climb stairs more quickly, easily, and safely. This could attenuate the risk of falls on stairs, and consequently decrease the frequency of major injuries. In summary, the integration of motor imagery in clinical rehabilitation programs after primary unilateral total knee arthroplasty is relevant and promising

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The loss of hip mobility, spontaneous or surgical, is an important and frequent functional impairment. In the evolvement of operative techniques of the muscoskeletal system, the cemented total hip replacement is pointed out since it improves the patients quality of life. Physiotherapy is an important resource in the patients care after Total Hip Replacement (THR) to aid their functional return. Objective: to analyze the physiotherapy intervention in the improvement of pain, gait, mobility and quality of life in the postoperative period of patients who have undergone THR, moreover, comparing the physiotherapic ambulatory rehabilitation with orientations and self-care guide.Casuistics and Method: This is a randomized clinical trial and double blinded study, in which patients with osteoarthritis submitted to THR in the period of May to October 2005 were evaluated. They were objectively evaluated either for pain, gait or mobility, according to D´Aubigné and Postel´s criteria in the preoperative, with 1 month and 3 months of postoperative, respectively. Life quality was evaluated by means of the questionnaire SF-36. The patients were randomly divide into two groups: the study group and the control group. The patients of the study group were submitted to a protocol of physiotherapic treatment during twelve weeks, with two-week sessions. The control group did not receive the guide of instructions related to postoperative cares. Mood´s median test was used to evaluate the results for the non-parametric values to compare the results between the groups. Wilcoxon´s test was used to compare the evolution of the groups. A level of significance of p=0.05, with a confidence interval (CI) of 95% was used. Results: Twenty patients, 10 from the study group and 10, the control group, finished the study. In the first evaluation, there was a significance just regarding the general state of health. This showed a smaller median in the study group (p=0.025), In the second, at the 30th PO period, there was statistical significance in relation to the study group regarding both the gait (p=0.007) and the mobility (p=0.001). In the third, there was a statistical significance after three months of postoperative, and at the end of the physiotherapeutic intervention in the study group: in the functional capacity (p<0.0005), in the physical aspects (p=0,002), in the pain (p=0,019), in the vitality (p=0,025), in the emotional aspects (p<0.0005), in the gait (p=0.001) and in the mobility (p=0.010). Regarding the evolution, after three months of postoperative period, a greater median was observed in the study group according to the physical capacity (p=0.006), physical aspects (p=0,002), general state of health (p<0,0005), vitality (p=0,025) and emotional aspects (p=0,001). Conclusion: Early physiotherapy procedures can improve the rehabilitation process of patient´s submitted to THR.
A perda de mobilidade do quadril, espontânea ou cirúrgica, é um comprometimento funcional importante e freqüente. Na evolução das técnicas operatórias do aparelho locomotor, destacam-se as relacionadas com a substituição da articulação do quadril por uma prótese total de quadril cimentada que melhora a qualidade de vida dos pacientes. A fisioterapia é um importante recurso nos cuidados de pacientes após a Artroplastia Total de Quadril (ATQ) para auxiliar o retorno funcional. Objetivos: analisar a intervenção da fisioterapia na melhora da dor, marcha, mobilidade e qualidade de vida no pós-operatório de pacientes que realizaram ATQ cimentada, além de comparar a reabilitação fisioterapêutica ambulatorial com um guia de orientações e auto-cuidados. Casuística e Método: Trata-se de um ensaio clínico aleatorizado, mono-cego, no qual foram avaliados os pacientes portadores de osteoartrose submetidos a ATQ no período de maio a outubro de 2005. Os pacientes foram avaliados objetivamente quanto à dor, marcha e mobilidade, de acordo com os critérios estabelecidos por DAubigné e Postel no pré-operatório, com 1 mês e 3 meses de pós-operatório, respectivamente.A qualidade de vida foi avaliada por meio do questionário SF-36. Os pacientes foram divididos, de forma aleatória em dois grupos - o grupo de estudo e o grupo controle. Os pacientes do grupo de estudo foram submetidos a um protocolo de tratamento fisioterapêutico durante doze semanas, com duas sessões semanais. O grupo controle não recebeu intervenção fisioterapêutica padronizada precocemente, tendo recebido apenas o guia de instruções quanto aos cuidados pós-operatórios. Os resultados foram avaliados pelo teste de Mediana de Mood para valores não paramétricos a fim de comparar os resultados entre os grupos. Nota de Resumo A evolução dos grupos foi comparada utilizando-se o teste estatístico de Wilcoxon. Adotou-se um nível de significância de p= 0,05, com intervalo de confiança (IC) de 95%. Resultados: 20 pacientes terminaram o estudo, 10 pertenciam ao grupo de estudo e 10 ao grupo controle. Na avaliação inicial, houve significância apenas com relação ao estado geral de saúde, que demonstrou uma menor mediana no grupo de estudo (p=0.025).Na segunda avaliação, realizada no 30 PO, houve significância a favor do grupo de estudo com relação à marcha (p=0,007) e com relação à mobilidade (p=0,001). Na terceira avaliação, realizada após três meses de pós-operatório e ao término da intervenção fisioterápica no grupo de estudo, houve significância na capacidade funcional (p<0,0005), nos aspectos físicos (p=0,002), na dor (p=0,019), na vitalidade (p=0,025), nos aspectos emocionais (p<0,0005), na marcha (p=0,001) e na mobilidade (p=0,010). Quanto à evolução, após três meses de pós operatório, percebeu-se uma maior mediana no grupo de estudo quanto à capacidade física (p=0,006), aspectos físicos (p=0,002), estado geral de saúde (p<0,0005), vitalidade (p=0,025) e aspectos emocionais (p=0,001). Conclusão: A fisioterapia precoce auxilia no processo de recuperação dos pacientes submetidos a ATQ.

Thesis (M.S.)--University of Wisconsin--Madison, 1989.
Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 89-92).

BACKGROUND: There has been an enormous rise in total joint arthroplasties (TJA) in the United States over the past several years. Researchers have documented the increase in healthcare costs associated with unplanned hospital readmissions among patients post-TJA, specifically total hip and total knee arthroplasties. Additionally, researchers have reported the burden that these costs place on the healthcare system, private payers and on patients and their caregivers. Social routines, quality of life and occupational functioning are often interrupted because of a patient’s unplanned hospital readmission after receiving a total hip or total knee arthroplasty. Investigators have identified the major causes of costly unexpected hospital readmissions among patients with a TJA; they include surgical site infections, blood clots, joint dislocations and periprosthetic fractures. The Occupational Therapy Practice Framework: Domain and Process describes the practice of occupational therapy as promoting health, well-being, and engagement in meaningful occupation. Nonetheless, there is limited literature in the occupational therapy field directed towards reducing hospital readmissions among patients with a total hip or knee arthroplasty, thus suggesting an area that is well-positioned for intervention development and testing. PURPOSE: This Occupational Therapy Doctoral Project entitled Teaching Intervention to Reduce Readmissions-Post Surgery (TIRR-PS) is a proposed program for an acute care hospital setting which: (a) described the problem of hospital readmissions among patients with a total hip or total knee arthroplasty, (b) investigated evidence and best practices for imparting knowledge and/or teaching skills to hospital administrators, healthcare professionals, occupational therapy staff, patients, and caregivers, (c) proposed an intervention based on empirically supported strategies and theoretical frameworks, (d) recommended activities to include as part of the program evaluation, the funding plan and the dissemination plan to promote this multi-level, multi-component pilot program. TIRR-PS will aim to reduce unplanned 30-day hospital readmissions and their associated healthcare costs. Unplanned readmissions are in part caused by inadequate education of hospital administrators, occupational therapy staff, patients, and caregivers. The TIRR-PS program will raise awareness about how to address common medical complication risks and promote the support of hospital administration for the education and skill building activities directed towards healthcare professionals with an emphasis on occupational therapy. CONCLUSION: TIRR-PS was designed for an acute care setting to reduce hospital readmission rates, to reduce healthcare costs, to improve patient quality of life, and to reduce the societal burden of unplanned hospital care. TIRR-PS is an innovative program designed to be comprehensive and to impart knowledge and skills to all relevant professionals in an acute care setting with a particular emphasis on the contribution of the OT profession. TIRR-PS, once evaluated, will provide a standardized, systematic approach to reducing unexpected hospitalizations post-TJA and shows promise for contributing to routine orthopaedic rehabilitative practice in acute care hospitals. This in turn will not only reduce healthcare costs, but will improve the post-surgery quality of life for patients with a recent total hip or total knee arthroplasty.

A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy, to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg 2018
Knee osteoarthritis (OA) is the most prevalent form of OA and it is present in over 33% of adults aged 50 years and above. Patients with end-stage knee OA have poor health outcomes including severe knee pain, functional limitations and poor quality of life (QoL) with decreased physical activity (PA) and increased sedentary behaviour (SB). In spite of the cost-effectiveness of total knee arthroplasty (TKA) in improving patients’ health outcomes (as measured using patient-reported outcome measures (PROMs)), the objectively measured PA shows little or no change after surgery and SB has received very little attention following TKA. However, published studies have only been conducted in populations from high-income countries and no studies have assessed PA and SB in knee OA patients from low-middle income countries including South Africa. Furthermore, the detailed patterns by which patients with knee OA accumulate PA and SB before and after TKA have not been described. Studies have mainly focused on measuring overall PA or moderate to vigorous PA (MVPA) and/or patients’ adherence to the PA guidelines with very little attention to low intensity activities of the movement continuum (SB and light activity- LPA). Furthermore, different activity monitors have been used with very few of them capable of measuring low intensity activities. Assessing activity behaviours incidental in activities of daily living (ADL) (such as sitting, standing and walking) before and after TKA may be clinically useful as activities of older adults undergoing TKA mainly constitute these low intensity activities. With no previously published systematic review on changes in SB following TKA, the objective of the first study of this thesis was to integrate available evidence on changes in SB in patients with knee OA after a primary TKA. A systematic literature search from January 2002 to 31 October 2017 was performed across seven electronic databases, for longitudinal and cross-sectional studies published in English on objectively (through accelerometry) and/or subjectively measured changes in SB following TKA. Ten studies reporting on SB with a total of 1,028 participants were included in the review. Three studies reported changes in SB with two showing a reduction in SB and one, with high risk of bias, showing an increase in SB after TKA. Seven studies showed no change in SB following TKA. The second study of this thesis was a longitudinal design comprising of two parts (Study 2A and B). Participants wore two activity monitors (ActiGraph GT3X+ and ActivPAL) to measure PA and SB for seven consecutive days (24 hours/day) at baseline (preoperative), six weeks and six months after TKA. Therefore, the second objective (Study 2A) of this thesis was to objectively measure changes in volume and pattern of PA and SB (using ActiGraph GT3X+ accelerometer) in patients with knee OA from baseline to six months after TKA and to assess changes in PROMs following TKA. Eighty-nine patients (13 males, 76 females between 55 and 80 years of age) scheduled for primary TKA took part in the study. Physical activity and SB were measured with an ActiGraph GT3X+ accelerometer for seven consecutive days (24 hours/day) and range of motion (ROM) was measured prior to TKA, and six weeks and six months after TKA. The University of California Los Angeles (UCLA) Activity index and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to assess self-reported activity and physical function respectively. Of the initial 89 patients recruited, 57 completed the six months followup and 45 had valid activity data at the 6 months follow-up. The proportion of time (% of waking day) patients spent in light physical activity (LPA) increased from baseline [29.0 (26.6-31.4)%] to 6 months [34.8 (31.3-38.3)%; p=0.008]. However, time spent in moderate to vigorous PA (MVPA) did not change from baseline [median (interquartile range): 2.0 (7.8) min/day] to six months after TKA [3.4 (11.6) min/day, p>0.05]. Approximately 9%, 5% and 18% of the patients met the PA guidelines at baseline, and six weeks and six months after TKA respectively. The proportion of time (% of waking day) patients spent in SB decreased after TKA [baseline: mean (95% CI): 70.1 (67.5-72.7)%; six months: 64.0 (60.6-67.9)%; p=0.009]. The interruptions to SB increased between baseline and six months after TKA [mean (95% CI): 85.0 (80.0-90.0) to 93.0 (88.0-98.0) breaks/day, p=0.014]. There was a significant improvement in WOMAC score [median (interquartile range): 71.0 (27.0) vs. 4.0 (11.3), p<0.001], UCLA score [median (interquartile range): 2.0 (1.0) vs. 5.0 (1.0), p<0.001] as well as ROM [mean range: (0.0 - 90.0)° vs (0.0 - 110)°, p<0.05] between baseline and six months after TKA. Study 2A showed that LPA increased and SB decreased as measured using ActiGraph GT3X+. In addition, self-reported functional capacity (FC) or functional ability (as measured with PROMs) improved after TKA. The third objective (Study 2B) of this thesis was to objectively assess changes in the times spent sitting, standing and walking following TKA and to examine their associations with the changes in PROMs after TKA. The same patients in Study 2A also wore a second activity monitor, the ActivPAL (which accurately measures low intensity activities and posture) for the same periods of time as described in Study 2A above. Patients spent significantly more of their waking wear time walking at six months after TKA (mean% (95% CI): 10.8% (9.4-12.1)), than preoperatively (mean% (95% CI): 8.3% (7.7-10.0)), p=0.039), however, the percentage of daily time spent standing did not change at six months after TKA (mean% (95% CI): 34.2% (29.8-38.6)) compared to percentage time preoperatively (mean% (95% CI): 32.4% (28.6-35.5)), p=0.530). Patients decreased their average daily time spent sitting from preoperative to six months after TKA by 33.7 mins/day (95% CI: -18.9 – 106.3, p=0.099). Patients took significantly more steps per day at six months after TKA [mean (95% CI: 3670 (2886-4020)] steps/day compared to preoperatively 2570 (2366-3189) steps/day, p<0.001. Participants also increased their cadence (steps/min) six months after surgery [mean (95% CI): 33 (31-34) vs. 38 (33-39), p=0.004]. There were no associations between objectively measured changes in the time spent sitting, standing and walking and changes in PROMs (p>0.05). The studies presented in this thesis have novel aspects that extend the body of knowledge on activity behaviours of patients with knee OA undergoing TKA. The studies in this thesis report the first systematic review on changes in SB of knee OA patients following TKA. This thesis is the first to objectively measure the detailed patterns of PA and SB in patients with knee OA undergoing TKA from a low-middle income country (South Africa). Furthermore, this thesis is also the first to use two accelerometers to generate detailed activity behaviour in patients with knee OA undergoing TKA. Lastly, this thesis is the first to assess the association between changes in times spent sitting, standing and walking in relation to changes in health outcomes in knee OA patients after TKA. In conclusion, the systematic review showed that SB has been superficially described and there is insufficient evidence to suggest that time spent in SB decreases following TKA. Majority of the studies reported no change in SB after TKA. The longitudinal study showed that, following TKA, there was a decrease in the overall time spent in SB and an increase in the number of breaks in SB that appeared to be replaced by LPA. Participants’ volume and average daily cadence increased following TKA. In addition, participants decreased their time spent sitting by over half an hour at six months after TKA. However, there were no associations between changes in the times spent sitting, standing and walking and changes in measures of participants’ health outcomes (PROMs) following TKA. Both objective and subjective measures should be used to accurately assess improvements in patients’ health outcomes following TKA. This comprehensive analysis of detailed daily activity behaviours can be used to employ feasible interventions for increasing the duration of LPA (standing and walking) and decreasing sedentary time (sitting/lying) to improve quality of life and overall health following TKA.
XL2019

碩士
國立臺灣大學
物理治療學研究所
87
The patients with serious hip problems are mostly treated by total hip replacement. It is then important to design a set of exercise for these patients, to help them enhance their muscle strength, promote functional recovery and prevent postoperative complications. In the current insurance system in Taiwan, total hip replacement patient can not get completely physical therapy. Thus, the purpose of this study is to find out if it is feasible to apply home exercise program on them and to help them enhance their muscle strength and operative outcome. Also, we would like to evaluate the compliance of total hip replacement patients in executing the home exercise program, and to investigate the effect of such compliance to the exercise program. The results of this study show that the experimental group and control group have significant differences on Harris hip score and the peak torque of affected hip abductor, flexor, extensor. However, there is no significant difference on operated hip adductor, all hip muscles of non-operated side, and pace speed. The improvement of Harris hip score and peak torque of hip flexor is related to the extent of exercise distortion. The increases of peak torque of hip abductor and flexor are related to the exercise hobby. The practice ratio depends on loyalty, post-exercise fatigue and the extent of exercise distortion. Therefore, for those patients who had done the total hip replacement operation for more than half year, if give them three month home exercise, and at least six telephone follow ups. This study found out that those patients who execute their home exercise seriously-- those who had more accurate movements or those who do exercise regularly will have better performance. Exercise distortion and compliance of home program are highly related. It is recommended that the patient who execute the home exercise incorrectly will also tend to have lower exercise compliance, the instructor should emphasize on connection or through outpatients department of physical therapy, not just by home exercise only.

碩士
義守大學
醫務管理學系
103
Purpose: Early physical therapy can improve functional mobility and prevent contradictions after total knee arthroplasty(TKA). The purpose of this study is to examine the relationship between with demography, surgical factors, timing of physical therapy and length of stay(LOS) and amount of therapy and analysis quality after total knee arthroplasty. Material and method: This retrospective study use chart review design, collecting data from patients post total knee arthroplasty at a Metropolitan hospital in Southern Taiwan between August 1, 2014 and July 31, 2015. Univariate analysis use Chi-square, t test, analysis of correlation, and ANOVA. Multivariate analysis use liner regression and logistic regression to analyze factors predict length of stay, amount of therapy and quality. Result: Patients who received thysical therapy mean age were 69.64±8.18 years, mean length of stay were 6.72±1.03 days, mean timing of physical therapy after surgery were 48.12±37.17 hours, mean amount of therapy were 3.52±1.20. Patients who was younger than 64 years old, had cormobidity, reversion TKA, bilateral TKA, amount of therapy over 4 times had higher length of stay. Patients who have been bilateral and reversion TKA, cormobidity, type of anesthesia, amount of therapy and timing of therapy had significant different in quality. Positive predictors of longer LOS were cormobidity, reversion TKA, amount of therapy, and timing of rehabilitation; negative predictors was unilateral TKA. Predicrors of patients who could walk with a walker at discharge were second staged TKA, general anesthesia, amount of therapy, and older than 76 years old. Predicrors of patients who could perform range of motion of knee flexion over 90 degrees at discharge were second stage and reversion TKA, cormobidity, amount and timing of therapy. Predicrors of pain improved at discharge were amount of therapy and cormobidity. Conclusion: Patients’ demography factors, surgical factors and timing of therapy indeed affected medical utilization and quality of patients who received TKA. In this study, more times of therapy combined with higher LOS because the frequency for physical therapy was once a day, but led to better functional outcome. Post acute care is important for decreasing LOS and improving quality of inpatient care.

碩士
國立雲林科技大學
健康產業管理研究所碩士班
101
Total knee replacement(TKR) is a commonly adopted procedure for arthritis related disease.Although the TKR efficacy in pain relief and restoration of physical functioning has been extensively studied,it remains unclear how health-related quality of life is affected by TKR. the major purpose of this study was to examine and compare the differences in physical functioning and health-related quality of life for TKR patients before and after operation. During the period from April 2012 to October 2012,to a regional teaching hospital in south-central with an orthopedic surgeons perform total knee replacement (TKR) patients samples side by side to get rid of due to traffic accidents and resulting unable to communicate with patients, a prospective study method for data collection, is expected to undergo surgery and 28 to collect the same period 29 cases did not receive surgery to complete their preoperative and postoperative evaluation 1-6 months.In addition to collecting basic information on the case,reuse Knee Society score (Knee Society ScoreKSS),the Oxford knee score (Oxford Knee score﹐OKS) and the short version of the Chinese health assessment scales (SF-36) score before surgery and after surgery 4,8,12,16,20 and 24 weeks were measured.Visual analog scale (Visual Analog Scale﹐VAS) “pain score”,etc to assess their pain,walking situation,activity,joint deformation,joint activity and physical function (PF),role due to physical limitations caused by health problems (RP),bodily pain (BP),vitality status (VT),general health perception (GH),social function (SF),mental health problems due to limitations caused by the role (RE),mental health (MH),etc.The study is expected to have known,the implementation of total knee replacement surgery does improve pain and physical function,and thus their health-related quality of life more improved results.

碩士
輔仁大學
公共衛生學系碩士班
107
According to the forecast based on the population data of Republic of China (ROC) announced by the National Development Council in August 2018, ROC has already transformed from the ageing society in 1993 to an aged society in 2018, and it is estimated that it will officially enter into the hyper-aged society in 2026. According to international standards, when the 65 years old take up 7% within the whole population, it is called an aging society, when it reaches 14%, it is called an aged society, and when it comes to 20% it is called a hyper-aged society. The estimated data shows that until 2065, there will be 4 out of 10 that are elderly over 65 years old, and among the 4 that are over 65 years old, there will be 1 super elderly that is over 85 years old. Because the population ageing problem is very serious, the number of people in need of long-term care is also gradually increasing. However, the family care function is gradually decreasing due to the changes of employment patterns, which magnifies the issue of disabled population care. The Executive Yuan has passed through the " 10-year Long-Term Care Plan 2.0" (Long-Term Care 2.0) on September 29, 2016, and has put into practice on January 1, 2017, expecting that through the Long-Term Care 2.0(LTC 2.0) strategy, it can satisfy the care requirements of the disables, and allow aging in place, as well as enjoy dignity and have the high quality service of long-term care service. In the International Federation of Aging Summit held in Copenhagen in 2016, Mishra & Barratt who are experts and scholars called on to countries all over the world, that the elderly care policy should focus on the environment which is able to provide support and enablement, allowing elders to feel free to do what they consider valuable in this environment, thus achieving a good reablement condition. And when the service design is able to design a product according to the user’s vision, which he considers valuable, it coincides with the concept of reablement. Therefore, this study introduces service designs, including concepts of exploration, creation, reflection, and reablement, which are applied to the reablement service of patients after total hip replacement. The part that patients after total hip replacement care about the most is independent ambulation. By putting the patient's economy basis under consideration, referring to domestic and foreign scales can classify a set of implement standards for reablement teams to carry out. We hope that through this simple standard, patients and reablement teams can have standards to follow, which allows the patients to achieve the expectation of reablement, and also reach the goal of common good.