| Author: | Lo, Wai Ting |
| Title: | Feasibility and acceptability of a community-based post-operative fall prevention program in improving physical function and balance of patients following total knee arthroplasty |
| Advisors: | Wong, Arnold (RS) Tsang, William (RS) |
| Degree: | Ph.D. |
| Year: | 2023 |
| Subject: | Falls (Accidents) -- Prevention Total knee replacement -- Patients -- Rehabilitation Knee -- Surgery -- Patients -- Rehabilitation Tai Chi Hong Kong Polytechnic University -- Dissertations |
| Department: | Department of Rehabilitation Sciences |
| Pages: | xiv, 250 pages : color illustrations |
| Language: | English |
| Abstract: | Background: Total knee arthroplasty (TKA) is a common surgical intervention to treat patients with end-stage knee osteoarthritis. Various studies have shown independently that the rate of falls in patients after TKA is high and is probably related to lower limb muscle weakness and poor postural control. However, a routine post-TKA rehabilitation is uncommon due to a limited funding and human resource of local hospitals. It is crucial to explore alternative strategies to enhance balance and physical functioning in patients after TKA. Unfortunately, prior to this dissertation, no research has adopted a multi-model intervention program incorporating evidence-based Tai Chi exercise in improving balance and physical functioning in patients after TKA. Objective: To develop and evaluate the effectiveness of the multi-model community-based Tai Chi intervention program in improving balance and physical functioning in patients after TKA as compared to usual postoperative care and asymptomatic controls Methods: Two systematic reviews and two clinical studies (a cross-sectional study and a pilot randomized control trial) were conducted. In the clinical studies, TKA participants with either posterior-stabilized TKA systems or medial-pivot TKA systems were recruited. Both subjective and objective outcome measures were included and assessed from baseline to 52-week post-operation follow-ups. Results: The first systematic review identified twenty-nine non-modifiable and modifiable risk factors for post-THA/TKA falls. Risk factors were classified into either inpatient or post-discharge risk factors from very low to moderate levels of evidence. The findings revealed the importance of developing strategies to lower the falls risk among patients following THA/TKA. The second systematic review revealed that the Brief-Balance Evaluation Systems test (BESTest) was a valid tool in terms of criterion- and construct-related to assess postural control in multiple populations. The review suggested to investigate the reliability of individual items and minimal clinically important difference of the Brief-BESTest so as to widen its applicability in clinical research/practice. Of the clinical studies, the cross-sectional pilot study found that no significant differences in pain, balance and mobility performance were observed between TKA participants with posterior-stabilized systems and Medial-pivot systems one year after surgery. Compared to asymptomatic controls, both TKA groups reported significantly more pain and stiffness, and demonstrated reduced functional mobility, increased stride-time-variability and impaired balance. Of the clinical studies, the pilot RCT study revealed that the concern of falling and 6MWT of TKA participants in the intervention group were akin to the asymptomatic controls after the 12 supervised exercise at 24-week post-operation follow-up. Approximately half of the TKA participants in the intervention group demonstrated clinically relevant improvement of outcomes 6MWT, TUG and operated knee flexion at 24- or 52-week after TKA. However, the adherence to the intervention and dosage of exercise during home-based sessions from 24-week to 36-week follow-up were not satisfactory. Conclusion: The multi-model community-based rehabilitation was feasible and well-accepted for patients after TKA. The trivial differences in subjective and objective outcome measures between the intervention group and usual care group imply that some adaptations such as modifying recruitment strategy and improving home-based exercise compliance before progressing forwards to a stronger future main trial. This work provided a foundation to the process and implementation of the multi-model community-based intervention so as to optimize clinical outcomes in future studies. |
| Rights: | All rights reserved |
| Access: | open access |
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