Abstract
BackgroundTotal knee arthroplasty (TKA) is effective in reducing pain and improving function for end-stage knee osteoarthritis. However, muscle weakness and functional limitations persist despite assistance from post-operative rehabilitation programs that traditionally focus on quadriceps strengthening and range of movement exercises. Hip abductor muscle weakness is evident in knee osteoarthritis and hip muscle strengthening reduces knee pain in this group. Following TKA, people with weak hip abductor strength perform more poorly on measures of physical function. However, very little is known of the effectiveness of including hip abductor strengthening exercises in post-operative rehabilitation. The aim of this trial is to compare the effects of targeted hip abductor strengthening to those of traditional care in a TKA rehabilitation program on muscle strength, patient reported outcomes and functional performance measures.Methods/designThis protocol describes a single-blinded randomized controlled trial, where 104 participants referred for inpatient rehabilitation following TKA will be recruited. Participants will be randomized using computer-generated numbers to one of two groups: usual care or usual care with additional hip strengthening exercises. Participants will attend physiotherapy daily during their inpatient length of stay, and will then attend between six and eight physiotherapy sessions as an outpatient. Primary outcomes are isometric hip abductor strength and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes are stair climb test, 6 min walk test, timed up and go, 40 m fast-paced walk test, 30 second chair stand test, isometric quadriceps strength, Lower Extremity Functional Scale (LEFS) and SF-12. Outcome measures will be recorded at baseline (admission to inpatient rehabilitation), and then 3 weeks, 6 weeks and 6 months post admission to rehabilitation.DiscussionThe findings of this study will determine whether the addition of targeted hip strengthening to usual care rehabilitation improves physical performance and patient reported outcomes following TKA when compared to usual care rehabilitation. This will then determine whether targeted hip strengthening exercises should be included in traditional rehabilitation programs to improve the outcomes following total knee arthroplasty.Trial registrationThe trial protocol was registered with the Australian Clinical Trial Registry (ACTRN12615000863538) on 18 August 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1104-x) contains supplementary material, which is available to authorized users.
Highlights
Total knee arthroplasty (TKA) is effective in reducing pain and improving function for end-stage knee osteoarthritis
The findings of this study will determine whether the addition of targeted hip strengthening to usual care rehabilitation improves physical performance and patient reported outcomes following TKA when compared to usual care rehabilitation
This will determine whether targeted hip strengthening exercises should be included in traditional rehabilitation programs to improve the outcomes following total knee arthroplasty
Summary
This study describes a protocol for a RCT that will investigate whether the addition of hip abductor muscle strengthening to the usual care rehabilitation program following TKA leads to superior performance based and patient reported outcomes. This is the first reported study to assess the effect of hip strengthening exercises in this population. Abbreviations 30s CST, 30-second chair stand test; 6MWT, 6 min walk test; 95 % CI, 95 % confidence interval; ACSM, American College of sports medicine; ADL, activities of daily living; ANOVA, analysis of variance; BMI, body mass index; CONSORT, consolidated standards of reporting trials; HHD, hand held dynamometer; ICC, intra-class coefficient; KOOS, knee injury and osteoarthritis outcome score; LEFS, lower extremity functional scale; m/s, metres per second; MDC90, minimal detectable change at the 90 % confidence level; MVC, maximal voluntary contraction; OA, osteoarthritis; OARSI, osteoarthritis research society international; QOL, quality of life; RCT, randomized controlled trial; ROM, range of movement; SCT, stair climb test; SEM, standard error of measurement; SPIRIT, standard protocol items: recommendation for interventional trials; TKA, total knee arthroplasty; TUG, timed up and go test; WOMAC, Western Ontario and McMaster Universities arthritis index
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