Author: Wan, Ka Yan Kania
Title: Functional outcomes of a fast-track rehabilitation program for patients with total knee replacement
Advisors: Li, Cecilia (RS)
Degree: DHSc
Year: 2021
Subject: Total knee replacement -- Patients -- Rehabilitation
Knee -- Surgery -- Patients -- Rehabilitation
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xii, 182 pages : color illustrations
Language: English
Abstract: Conventional post-total knee replacement (post-TKR) rehabilitation often focuses on physical rehabilitation while often neglecting behavioral interventions for activity participation and functional restoration, especially during the immediate inpatient phase. The current research investigated a fast-track post-TKR rehabilitation program as a designated inpatient management scheme for TKR patients that are transferred to a rehabilitation hospital following surgery. This program was enhanced by incorporating behavioral interventions, including pain self-efficacy and activity pacing, into functional training components. This study aimed to investigate the effectiveness of this fast-track program on pain management, functional performance, and activity participation. The primary outcome measures included the Pain Self-efficacy Questionnaire (PSEQ) for measuring pain self-efficacy, the Modified Barthel Index (MBI) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for functional status, and the Medical Outcomes Study 36-Item Short Form Survey (SF-36) and step counts for quality of life (QOL) and activity participation respectively. Data was collected at discharge and at 1-month post-discharge.
27 subjects were recruited for the study through convenience sampling. The results showed that functional performance improved significantly at discharge and at 1-month post-discharge, as reflected by changes in MBI scores (F(2, 50)=110.80, p<0.01, η2 partial=0.82) and KOOS activities of daily living (ADL) subscale scores (F(2, 50)=118.17, p<0.01, η2 partial =0.83). PSEQ also improved significantly at discharge (mean difference from baseline=9.54, p<0.01), but not at 1-month post-discharge (mean difference from discharge=3.81, p=0.11). At 1-month post-discharge, significant improvements were observed in terms of SF-36 physical component summary scores (PCS) (t=5.23, p<0.01), but not for mental component summary scores (MCS) (t=1.63, p= 0.17). Among the 25 patients who participated in the step count measurement by wearing a commercially available accelerometer, the average daily steps over the 7-day data collection period was 28774.88 (SD=17339.67). Two patients (8%) reported step counts of under 1000 daily steps, while eight patients (32%) reported counts of over 5000 daily steps. The remaining 15 patients (60%) reported steps counts within the range of 1000 to 4999 daily steps.
Regression analysis revealed that at 1-month post-discharge, KOOS-ADL subscale scores were predicted by active knee flexion range and PSEQ (F(3, 22) = 12.64, p<0.01, R2=0.63), while SF-36 PCS scores were predicted by PSEQ (F(3, 22)=3.91, p=0.02, R2=0.35). The positive results that patients attained upon program completion suggested that the fast-track post-TKR program was effective in improving pain self-efficacy and functional performance among the study group of elderly patients with TKR. At 1-month post-discharge, physical QOL as represented by SF-36 PCS scores was shown to have improved alongside MBI and KOOS scores. Patients continued to show improvements in functional performance and activity participation beyond 1-month post-discharge without any other behavioral interventions. The inclusion of behavioral-focused functional training enhanced the comprehensiveness of the post-TKR program and optimized the benefits that patients gained from TKR and physical training. Future studies may focus more on the changes to coping behaviors and activity participation produced in the program.
Rights: All rights reserved
Access: restricted access

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