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Article
A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement
Orthopedics and Physical Rehabilitation Publications and Presentations
  • Milagros C. Rosal, University of Massachusetts Medical School
  • David C. Ayers, University of Massachusetts Medical School
  • Wenjun Li, University of Massachusetts Medical School
  • Carol Oatis, Arcadia University
  • Amy Borg, University of Massachusetts Medical School
  • Hua Zheng, University of Massachusetts Medical School
  • Patricia D. Franklin, University of Massachusetts Medical School
UMMS Affiliation
Department of Orthopedics and Physical Rehabilitation; Department of Medicine, Division of Preventive and Behavioral Medicine
Date
10-11-2011
Document Type
Article
Medical Subject Headings
Arthroplasty, Replacement, Knee; *Behavior Therapy; Directive Counseling; Exercise; Female; *Health Behavior; Humans; Knee Joint; Male; Patient Acceptance of Health Care; Patient Dropouts; Perioperative Care; Prospective Studies; Self Efficacy
Abstract

BACKGROUND: Total knee replacement (TKR) is a common and effective surgical procedure to relieve advanced knee arthritis that persists despite comprehensive medical treatment. Although TKR has excellent technical outcomes, significant variation in patient-reported functional improvement post-TKR exists. Evidence suggests that consistent post-TKR exercise and physical activity is associated with functional gain, and that this relationship is influenced by emotional health. The increasing use of TKR in the aging US population makes it critical to find strategies that maximize functional outcomes.

METHODS/DESIGN: This randomized clinical trial (RCT) will test the efficacy of a theory-based telephone-delivered Patient Self-Management Support intervention that seeks to enhance adherence to independent exercise and activity among post- TKR patients. The intervention consists of 12 sessions, which begin prior to surgery and continue for approximately 9 weeks post-TKR. The intervention condition will be compared to a usual care control condition using a randomized design and a probabilistic sample of men and women. Assessments are conducted at baseline, eight weeks, and six- and twelve- months. The project is being conducted at a large healthcare system in Massachusetts. The study was designed to provide greater than 80% power for detecting a difference of 4 points in physical function (SF36/Physical Component Score) between conditions (standard deviation of 10) at six months with secondary outcomes collected at one year, assuming a loss to follow up rate of no more than 15%.

DISCUSSION: As TKR use expands, it is important to develop methods to identify patients at risk for sub-optimal functional outcome and to effectively intervene with the goal of optimizing functional outcomes. If shown efficacious, this peri-TKR intervention has the potential to change the paradigm for successful post-TKR care. We hypothesize that Patient Self-Management Support to enhance adherence to independent activity and exercise will enhance uniform, optimal improvement in post-TKR function and patient autonomy, the ultimate goals of TKR.

Rights and Permissions
Citation: BMC Musculoskelet Disord. 2011 Oct 7;12:226. Link to article on publisher's site
Comments

Copyright 2011 Rosal et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Related Resources
Link to Article in PubMed
PubMed ID
21981909
Citation Information
Milagros C. Rosal, David C. Ayers, Wenjun Li, Carol Oatis, et al.. "A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement" Vol. 12 (2011) ISSN: 1471-2474 (Linking)
Available at: http://works.bepress.com/milagros_rosal/56/