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Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement: an assessor-blinded randomized controlled trial.

Huber EO, Roos EM, Meichtry A, de Bie RA, Bischoff-Ferrari HA - BMC Musculoskelet Disord (2015)

Bottom Line: Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation.A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone.These benefits were not sustained after TKR.

View Article: PubMed Central - PubMed

Affiliation: Centre of Aging and Mobility, University Hospital Zurich and Waid City Hospital Zurich, Rämistrasse 100, Zurich, Switzerland. omega-e.huber@zhaw.ch.

ABSTRACT

Background: Improving functional status preoperatively through exercise may improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is insufficient. The aim of the study was to compare the difference in change between groups in lower extremity function from baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone.

Methods: 45 patients (55-83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3 sessions of KS or 3 sessions of KS alone. Function was assessed with the Chair Stand Test (CST, primary endpoint) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales focusing on daily living function (ADL) and pain (secondary endpoints). Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation.

Results: After intervention before surgery we observed a small improvement for primary and secondary endpoints in both groups, which did not differ significantly between groups: comparing the exercise to the control group the treatment effect for the CST was -1.5 seconds (95% CI: -5.3, 2.2), for KOOS ADL and KOOS pain the treatment effect was 1.3 points (-10.1, 12.8) and -2.3 (-12.4, 7.9) respectively. At 3 months after surgery we observed a small improvement in the primary endpoint in the control group and a significant improvement in the secondary endpoints in both exercise and control groups, which did not differ significantly between groups: comparing the exercise group to the control group the treatment effect in the CST was 2.0 seconds (-1.8, 5.8), for KOOS ADL and KOOS pain the treatment effect was -4.9 points (-16.3, 6.5) and -3.3 points (-13.5, 6.8) respectively.

Conclusions: A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone. These benefits were not sustained after TKR. Our trial doesn't give a conclusive answer to whether additional preoperative exercise on postoperative functional outcomes is beneficial.

No MeSH data available.


Related in: MedlinePlus

Secondary endpoint results. Observed means +/− 1 Standard Error of the KOOS ADL and KOOS pain scores for the two groups, at baseline, prior to surgery, 6 weeks, 3 months and 12 months after surgery. Baseline is treated as outcome, making no assumptions about group differences in the mean response at baseline, adjusted for age, gender and BMI.
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Fig3: Secondary endpoint results. Observed means +/− 1 Standard Error of the KOOS ADL and KOOS pain scores for the two groups, at baseline, prior to surgery, 6 weeks, 3 months and 12 months after surgery. Baseline is treated as outcome, making no assumptions about group differences in the mean response at baseline, adjusted for age, gender and BMI.

Mentions: All results are presented in Table 2, Figures 2 and 3.Figure 2


Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement: an assessor-blinded randomized controlled trial.

Huber EO, Roos EM, Meichtry A, de Bie RA, Bischoff-Ferrari HA - BMC Musculoskelet Disord (2015)

Secondary endpoint results. Observed means +/− 1 Standard Error of the KOOS ADL and KOOS pain scores for the two groups, at baseline, prior to surgery, 6 weeks, 3 months and 12 months after surgery. Baseline is treated as outcome, making no assumptions about group differences in the mean response at baseline, adjusted for age, gender and BMI.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4414282&req=5

Fig3: Secondary endpoint results. Observed means +/− 1 Standard Error of the KOOS ADL and KOOS pain scores for the two groups, at baseline, prior to surgery, 6 weeks, 3 months and 12 months after surgery. Baseline is treated as outcome, making no assumptions about group differences in the mean response at baseline, adjusted for age, gender and BMI.
Mentions: All results are presented in Table 2, Figures 2 and 3.Figure 2

Bottom Line: Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation.A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone.These benefits were not sustained after TKR.

View Article: PubMed Central - PubMed

Affiliation: Centre of Aging and Mobility, University Hospital Zurich and Waid City Hospital Zurich, Rämistrasse 100, Zurich, Switzerland. omega-e.huber@zhaw.ch.

ABSTRACT

Background: Improving functional status preoperatively through exercise may improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is insufficient. The aim of the study was to compare the difference in change between groups in lower extremity function from baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone.

Methods: 45 patients (55-83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3 sessions of KS or 3 sessions of KS alone. Function was assessed with the Chair Stand Test (CST, primary endpoint) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales focusing on daily living function (ADL) and pain (secondary endpoints). Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation.

Results: After intervention before surgery we observed a small improvement for primary and secondary endpoints in both groups, which did not differ significantly between groups: comparing the exercise to the control group the treatment effect for the CST was -1.5 seconds (95% CI: -5.3, 2.2), for KOOS ADL and KOOS pain the treatment effect was 1.3 points (-10.1, 12.8) and -2.3 (-12.4, 7.9) respectively. At 3 months after surgery we observed a small improvement in the primary endpoint in the control group and a significant improvement in the secondary endpoints in both exercise and control groups, which did not differ significantly between groups: comparing the exercise group to the control group the treatment effect in the CST was 2.0 seconds (-1.8, 5.8), for KOOS ADL and KOOS pain the treatment effect was -4.9 points (-16.3, 6.5) and -3.3 points (-13.5, 6.8) respectively.

Conclusions: A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone. These benefits were not sustained after TKR. Our trial doesn't give a conclusive answer to whether additional preoperative exercise on postoperative functional outcomes is beneficial.

No MeSH data available.


Related in: MedlinePlus