Hing, Wayne A

Sattler, Larrisa Nicole

Vertullo, Christopher

English

BackgroundDespite Total Knee Replacement (TKR) patients routinely receiving physical therapy in the immediate and early post-operative phase, there is a paucity of research into the optimal exercise protocols in both the acute inpatient setting and early post-operative period after discharge. The early postoperative inpatient days after TKR have become increasingly important for post-operative rehabilitation as average length of stay (LOS) rates decline worldwide. Pedaling has often recommended by clinicians after TKR for rehabilitation, but to our knowledge, there has been no investigation into its utility in the acute postoperative setting.MethodsStudy Design: Randomized Control Trial. 60 TKR patients were randomized to either a 3 exercise pedaling or 10 exercise non-pedaling physical therapy postoperative protocol both commencing with 24 hours of surgery and continuing after discharge till 14 days post-op. Outcomes were assessed at 2 days, 2 weeks and 4 months, and included physical tests of function, patient reported outcomes, and other perioperative outcomes. The primary outcome of performance-based physical function was the TKR validated 6-minute walk test (6MWT) which measures the distance walked along a 30-meter corridor in 6 minutes. All patients received low dose spinal analgesia and peri-articular local anathestic infiltration to allow mobilization on the day of surgery.ResultsThe primary outcome, the Six Minute Walk Test (6MWT), was significantly greater in the three exercise pedaling group than the ten exercise non-pedaling group at 2 days postoperatively (mean difference 66 meters, p = .001). Other functional tests, the 10-meter walk speed (10MWT) and the Timed Up and Go (TUG) test, were both significantly superior in the three exercise pedaling group at 2 days (10MWT p = .016; TUG p = .020) as was the patient reported Oxford Knee Score (p = .034). The VAS component of the EQ5D was significantly better for the pedaling group at all assessment time-points (U= 305.0, p = .031 (Day 2); U= 318.5, p = .050 (Day 14); U= 271.0, p = .044 (4 months)). Length of stay was significantly shorter for the pedaling group compared with the non-pedaling group by a half day (Av. 1.5 days vs 2 days, p = 0.024). The ten exercise protocol was not superior for any outcome measure at any time point.ConclusionsA post-operative pedaling-based three exercise protocol after TKR was superior to a standard ten exercise non-pedaling protocol in both functional and patient reported outcomes.Level of evidence: Therapeutic Level 

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Bond UniversityResearch RepositoryA Pedaling-Based Three Exercise Protocol Was Superior to a Non-Pedaling Ten ExerciseProtocol for Post-Operative Rehabilitation After Total Knee Replacement in a RandomizedControlled TrialVertullo, Christopher; Sattler, Larrisa Nicole; Hing, Wayne APublished: 12/05/2019Document Version:Publisher's PDF, also known as Version of recordLink to publication in Bond University research repository.Recommended citation(APA):Vertullo, C., Sattler, L. N., & Hing, W. A. (2019). A Pedaling-Based Three Exercise Protocol Was Superior to aNon-Pedaling Ten Exercise Protocol for Post-Operative Rehabilitation After Total Knee Replacement in aRandomized Controlled Trial. Poster session presented at 12th Biennial International Society of Arthroscopy,Knee Surgery and Orthopaedic Sports Medicine Congress 2019, Cancun, Mexico.General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.For more information, or if you believe that this document breaches copyright, please contact the Bond University research repositorycoordinator.Download date: 12 Apr 2020A Pedaling-Based Protocol was Superior to a Ten Exercise Non-Pedaling Protocol for Post-Operative Rehabilitation after Total Knee Replacement in a Randomized Controlled TrialChristopher Vertullo, MBBS, PhD, FRACS(Orth) Larissa Sattler, MPhtySt, BSPE Wayne Hing, PhDDisclosure:•Larissa Sattler: No conflicts to disclose•Wayne Hing: No conflicts to disclose•Christopher Vertullo: •Held shares in: Nil•Received royalties from: Nil •Done consulting work for: Nil•Given paid presentations for: Zimmer, Smith & NephewBackground•There is a lack in research into the optimal exercise protocols in both the acute inpatient setting and early period after discharge following Total Knee Replacement•Pedaling is recommended by clinicians for TKR for rehabilitation, however, there has been no investigation into its utility in the acute postoperative setting. •Therefore, we performed a RCT trial evaluating the efficacy of pedaling in the acute postoperative periodMethods•Sixty TKR patients were randomized to receive postoperative physical therapy involving either a: 3-exercise pedaling (pedaling-based) OR10-exercise, non-pedaling (multi-exercise) protocol•Outcomes were assessed at 2 days, 2 weeks, and 4 months •Including tests of physical function, patient-reported outcomes, and other perioperative measures.Outcomes SuperiorP=<0.05Randomised to a PT groupRecruitment 60 TKR PatientsPedalingN=306 Minute Walk distanceTimed Up & Go SpeedOxford Knee ScoreShorter Length of StayNon-PedalingN=30No superior outcomesMethods10 Exercise, Non-Pedaling (Multi-exercise) Protocol3 Exercise Pedaling (Pedaling-based) ProtocolBaseline Preoperative CharacteristicsMulti-Exercise Protocol Pedaling-Based ProtocolOutcome No. Measured Value* No. Measured Value* Mean Difference (95% CI) P Value6-min walk test† (m)2 days 30 187.0 ± 67.0 30 252.9 ± 73.5 65.8 (29.4 to 102.2) 0.001‡2 wk 30 348.6 ± 81.8 30 390.2 ± 94.2 41.6 (4.0 to 87.2) 0.0734 mo 28 488.3 ± 89.7 28 514.0 ± 78.5 25.7 (19.5 to 70.9) 0.25910-m walk test (m/sec)2 days 30 0.60 (0.20 to 1.10)§ 30 0.70 (0.50 to 1.50)§ 0.016‡2 wk 30 1.05 (0.70 to 1.70)§ 30 1.15 (0.70 to 2.30)§ 0.1994 mo 28 1.50 ± 0.25 28 1.54 ± 0.24 0.04 (0.01 to 0.12) 0.592Timed Up & Go test (sec)2 days 30 23.9 (12.6 to 54.3)§ 30 19.3 (9.4 to 40.2)§ 0.020‡2 wk 30 10.7 (6.4 to 24.4)§ 30 10.0 (5.7 to 18.5)§ 0.6624 mo 28 7.1 ± 1.3 28 6.9 ± 1.3 0.2 (−0.05 to 0.9) 0.578Knee flexion (°)2 days 30 90 (50 to 110)§ 30 90 (80 to 115)§2 wk 30 93 (70 to 150)§ 30 95 (80 to 125)§4 mo 28 110.4 ± 9.1 28 113.0 ± 10.4 2.7 (2.6 to 7.9) 0.310Oxford Knee Score2 days 30 20.2 ± 7.4 30 24.7 ± 8.5 4.5 (0.34 to 8.6) 0.034‡2 wk 30 23.1 ± 7.9 30 28.8 ± 7.6 5.6 (1.6 to 9.7) 0.007‡4 mo 28 37.6 ± 4.8 28 39.3 ± 6.1 1.7 (1.3 to 4.6) 0.259EQ-5D score2 days 30 12.1 ± 3.1 30 11.1 ± 3.5 1.0 (−0.7 to 2.7) 0.2442 wk 30 10.4 ± 2.6 30 9.0 ± 2.2 1.3 (0.1 to 2.6) 0.037‡4 mo 28 7.0 (5.0 to 11.0)§ 28 6.0 (5.0 to 11.0)§ 0.263EQ-5D VAS2 days 30 60 (10 to 95)§ 30 80 (25 to 100)§ 0.031‡2 wk 30 75 (50 to 97)§ 30 88 (40 to 100)§ 0.050‡4 mo 28 88 (50 to 100)§ 28 90 (75 to 100)§ 0.044‡*The values are given as the mean and standard deviation, except where otherwise noted. †Primary outcome measure. ‡Significant difference (p < 0.05). §The values are given as the median, with the range in parentheses.Results of Functional Outcome Measures (Physical and Patient-Reported) at All Time Points•For the primary outcome, the Six Minute Walk Test (6MWT), the Pedaling group walked further at 2 days postoperatively (mean difference, 66 m; p = 0.001). •Secondary outcomes, the Timed Ten Meter Walk (10MWT) and the Timed Up and Go (TUG) tests were faster in the pedaling-based group at 2 days (p = 0.016 for 10MWT, and p = 0.020 for TUG), but did not differ significantly at 2 weeks or 4 months. •The Oxford Knee Score was significantly better for the pedaling group at 2 days (mean difference, 4.5; p = 0.034) and at 2 weeks (mean difference, 5.6; p = 0.007) •The EQ-5D score was also significantly better at 2 weeks (mean difference, 1.3; p = 0.037), and the VAS component of the EQ-5D was significantly better for the pedaling group at all time points (p = 0.031 at 2 days, p = 0.050 at 2 weeks, and p = 0.044 at 4 months). Results: Functional Outcome MeasuresMulti-Exercise Protocol Pedaling-Based ProtocolOutcome No. Median (Range) No. Median (Range) P ValueLOS (days) 30 3.0 (2.0 to 6.0) 30 2.5 (2.0 to 5.0) 0.024*Readiness for discharge† (days) 30 2.0 (1.0 to 4.0) 30 2.0 (1.0 to 4.0) 0.002*As-needed analgesia (mg oxycodone)2 days 30 10.0 (0.0 to 40.0) 30 5.0 (0 to 60.0) 0.350Pain threshold‡2 days 30 2.0 (1.0 to 4.0) 30 2.0 (1.0 to 5.0) 0.557Satisfaction with protocol§2 days 30 1.0 (1.0 to 2.0) 30 1.0 (1.0 to 3.0) 0.1152 wk 30 1.0 (1.0 to 2.0) 30 1.0 (1.0 to 3.0) 0.687Compliance with home-exercise program2 wk 30 100 (55 to 100) 30 100 (50 to 100) 0.314*Significant difference (p < 0.05). †Difference indicated by mean ranks: pedaling protocol (24.1) was better than standard protocol (36.9); U = 257.00. ‡Likert scale: high pain threshold 1 (strongly agree) to 5 (strongly disagree). §Likert scale: satisfaction with protocol 1 (very satisfied) to 5 (very dissatisfied).Results of Perioperative Measures and Pain and Satisfaction Scales at Indicated Time Points•Length of Stay (LOS) was shorter for the pedaling-based group, by a half-day (median of 2.5 compared with 3.0 days; p = 0.024). •Analgesic consumption, home-exercise-program compliance, self-reported pain threshold, and satisfaction with the exercise protocol were similar between the 2 groups.Results: Perioperative Measures, Pain and Satisfaction Conclusion•A pedaling-based physical therapy protocol after TKR was superior to a standard multi-exercise protocol in the acute postoperative period. •The multi-exercise protocol was not superior for any outcome measure at any time point.References• Kurtz SM, Ong KL, Lau E, Widmer M, Maravic M, Gómez-Barrena E, et al. 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A Pedaling-Based Three Exercise Protocol Was Superior to a Non-Pedaling Ten Exercise Protocol for Post-Operative Rehabilitation After Total Knee Replacement in a Randomized Controlled Trial

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A Pedaling-Based Three Exercise Protocol Was Superior to a Non-Pedaling Ten Exercise Protocol for Post-Operative Rehabilitation After Total Knee Replacement in a Randomized Controlled Trial

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