BACKGROUND

Recovery of physical activity (PA) after telerehabilitation following knee and hip arthroplasty (TKA-THA) has rarely been studied. An improved understanding of PA recovery is needed, as it could be influenced by many factors such as age, gender or pre-operative physical function.

OBJECTIVES

To assess PA recovery weekly for 3 months after TKA-THA and to determine perioperative factors that could help predict PA recovery at 3 months.

METHODS

From one week before until 3 months after surgery, 132 patients wore a fitness tracker continuously. Each patient received personalized and daily exercises and feedback through a tablet. Before and after surgery, patient-reported outcome measures of symptoms, pain, activities of daily living and quality of life were recorded. A one-way repeated-measure ANOVA was used to assess the time effect on step count for each post-operative week. To predict the absolute step count at 3 months post-surgery, a backward multiple linear regression was used.

RESULTS

Patients reached their pre-operative PA level at week 7, with no significant additional improvement by 3 months post-surgery. Pre-operative step count, the number of days using crutches and pre-operative symptoms explained 35% of the variability of step count at 3 months.

CONCLUSION

This patient population receiving telerehabilitation reached their pre-operative PA level at 7-week post-surgery with no further improvement over the subsequent 5 weeks. The PA level at 3 months could be predicted by pre-operative step count, duration of crutches use, and pre-operative symptoms.

Copyright © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.

AIMS AND OBJECTIVES

To examine the effects of lower extremity muscle strength training on knee function recovery and quality of life in patients who underwent total knee replacement.

BACKGROUND

Patients with knee osteoarthritis after surgery experience decreased knee function that impacts their quality of life. However, patients typically lack a long-term, home-based and continuous leg exercise training method and rarely have studies explored the effects of exercise training on knee function recovery and quality of life.

DESIGN

A experimental and longitudinal study design.

METHODS

The simple randomised sampling (based on patients' admission priority order) was used to collect participant data. Outcome measurements included the Knee Injury and Osteoarthritis Outcome Score. Participants were randomised to receive and starting lower extremity muscle strength training before surgery (training group, n = 100) or to receive usual care (nontraining group, n = 100). Data were collected and followed up with the patients before surgery (T1) and at 2 weeks (T2), 1 month (T3), 2 months (T4) and 3 months (T5) after discharge.

RESULTS

The Knee Injury and Osteoarthritis Outcome Score subscale scores showed that both groups of patients experienced knee function and quality of life decreases 2 weeks after total knee replacement, but all subscale scores gradually increased from the first month to the third month after total knee replacement. Both groups and times were significantly different, but the training group's knee function and quality of life recovered earlier and better than the nontraining group does.

CONCLUSIONS

This study confirmed that lower extremity muscle strength training helps to improve quality of life and knee function in patients who undergo total knee replacement. Healthcare staff should include this training in presurgical nursing care and in patients' discharge plans as a continuous, daily rehabilitation activity at home.

RELEVANCE TO CLINICAL PRACTICE

When patients are diagnosed with knee osteoarthritis and undergo surgery, a presurgical exercise education and discussion of knee function rehabilitation should be part of standard care.

© 2018 John Wiley & Sons Ltd.

Multilimb amputation poses a significant challenge to an individual's mobility, independence, and overall quality of life. Comprehensive rehabilitation is essential for these patients to restore functional abilities and facilitate their reintegration into society. This case study details the rehabilitation of a 23-year-old male who sustained bilateral transradial and right transtibial amputations due to an electric burn injury. Upon presentation, the patient exhibited severe functional limitations, with complete dependence on caregivers for mobility, self-care, and activities of daily living (ADLs). A structured inpatient rehabilitation program was initiated, focusing on stump care, contracture prevention, range of motion, strengthening exercises, and functional training. He was educated on prosthetic options and fitted with customized prostheses, including a right cosmofunctional prosthesis with a hook terminal device, a left cosmofunctional prosthesis with a hand terminal device, a right patellar tendon-bearing above-knee prosthesis with supracondylar suspension, and an ankle-foot orthosis for his left foot's equinus deformity. Rehabilitation emphasized upper limb prosthetic adaptation, progressive gait training, and stair-climbing exercises to enhance mobility and self-sufficiency. At the time of discharge, the patient demonstrated significant improvement in functional independence. His Nottingham Extended Activities of Daily Living (NEADL) score increased from 0 to 27, out of a maximum score of 66, indicating partial autonomy. A follow-up assessment conducted three months later revealed continued progress, with his NEADL score reaching 47 out of 66, reflecting enhanced mobility and self-reliance. The NEADL scale, with scores ranging from 0 (complete dependence) to 66 (full independence), offers a comprehensive measure of functional ability across domains such as mobility, kitchen activities, domestic tasks, and leisure. The patient's improvement from 0 to 47 illustrates a substantial functional gain and increasing independence in daily life. This report highlights the importance of a structured rehabilitation program in promoting functional recovery and social reintegration in multilimb amputees. Early intervention, patient motivation, prosthetic rehabilitation, and a multidisciplinary approach play crucial roles in optimizing outcomes. The findings emphasize that with appropriate rehabilitation strategies, multilimb amputees can achieve a high level of independence, mobility, and meaningful engagement in their daily lives.

Copyright © 2025, Dhole et al.

Active physiotherapy (APT) embraces a patient-centered approach, prioritizing self-management within the biopsychosocial model and involving active patient movements. Beyond structured exercise, APT incorporates pain neuroscience education, Mulligan Mobilization (MWM), and active myofascial release techniques to integrate sensory-motor information for functional recovery and pain relief. This study aims to rigorously compare the effectiveness of APT versus conventional physical therapy (CPT) on pain and functional outcomes in patients with chronic knee pain. Eighty-seven patients with symptomatic and radiographically confirmed knee pain were included in this 12-month follow-up of a randomized controlled trial, conducted at a national institute and a rehabilitation clinic. Patients were randomized to either APT (n = 44) or CPT (n = 43). The APT protocol integrated pain neuroscience education, MWM, active myofascial release techniques, and structured exercises focusing on flexibility, stability, neuromuscular control, and coordination. The CPT protocol included health education, laser therapy, ultrasound therapy, and exercise. Both interventions were performed for 60 min twice a week for 3 months. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score-4 domain version (KOOS4). Secondary outcomes included pain intensity (VAS), KOOS-pain, activities of daily living (ADL), function in sport and recreation (Sports/Rec), knee-related quality of life, global rating of change (GROC), quality of life (SF-36), Tampa Scale for Kinesiophobia (TSK), and functional performances measured at different intervals. Intention-to-treat analyses were performed. Of the 87 patients, 70 (80.5%) completed the 12-month follow-up. KOOS4 improved more in the APT group (16.13; 95% CI, 10.39-21.88) than in the CPT group (11.23; 95% CI, 5.42-17.04). APT showed additional improvement in KOOS4 compared to CPT (2.94; 95% CI: 0.04 to 5.85, p = 0.047). The VAS difference was -3.41 mm (95% CI: -6.40 to -0.43, p = 0.025), favoring APT. APT also showed more improvements in KOOS-pain, KOOS-ADL, KOOS-Sports/Rec, and TSK (p < 0.05). No differences between groups were observed in GROC and SF-36. APT significantly improved most functional performance variables compared to CPT (p < 0.05). Active Physiotherapy outshines conventional physical therapy by delivering more substantial reductions in pain intensity and marked enhancements in function among patients with knee pain. This distinctive efficacy underscores the invaluable role of APT in the management of chronic knee pain. By actively involving patients in their recovery journey, APT not only fosters superior results but also emphasizes the critical need to integrate these advanced therapeutic strategies into everyday clinical practices.

Copyright © 2024 Cui, Zhao, Guo, Wang, Han, Zhang, Zhou and Yan.