Article

OBJECTIVE: To examine the effect of a 6-week prehabilitation exercise training
program on presurgical quadriceps strength for patients undergoing total knee
arthroplasty (TKA). DESIGN: Two-arm, parallel, randomized, controlled pilot
trial. SETTING: Private exercise space in a research facility. PARTICIPANTS:
Twenty-two patients scheduled for primary TKA. METHODS: Participants completed a
series of baseline questionnaires (Western Ontario and McMaster Universities
Osteoarthritis Index [WOMAC], Short Form 36, and Arthritis Self-efficacy Scale)
and functional testing (isometric quadriceps strength assessment, flat-surface
walk test, and stair ascent-descent test). The participants were randomized to a
lower-body strength training program or to a nonspecific upper-body strength
training program. The participants exercised 3 times per week for 6 weeks before
TKA. Postintervention assessment occurred immediately before TKA, with follow-up
assessments at 6 and 12 weeks after surgery. OUTCOMES: The primary outcome was
isometric quadriceps strength. Secondary outcomes were mobility, pain,
self-reported function, health-related quality of life, and arthritis
self-efficacy. RESULTS: There was no significant treatment condition-by-time
effect on quadriceps strength, but the effect size was large (F(3,18) = 0.89, P =
.47, eta(2) = 0.13). Similar findings were shown for walking speed (F(3,18) =
1.47, P = .26, eta(2) = 0.20). There was a significant treatment-by-time effect
for the Short Form 36 mental component score (F(3,18) = 0.41, P = .02, eta(2) =
0.41), with differences emerging before surgery but not at either postoperative
assessment. For all other secondary outcome measures, the treatment-by-time
effect was nonsignificant and small. CONCLUSION: The intervention elicited
clinically meaningful increases in quadriceps strength, walking speed, and mental
health immediately before TKA. It did not impart lasting benefits to patients in
the 12 weeks after surgery. Analysis of the results suggests that quadriceps
strength may not drive functional improvements after surgery. These findings need
to be replicated in larger trials before clinical recommendations are made about
including strength training prehabilitation in everyday practice.
CI - Copyright (c) 2012 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS