Significance of prehabilitation in obese TKR patients
Corresponding Author(s) : DivyaJethwani
honapnirmitee@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 10 No. 1 (2022): 2022 Volume - 10 Issue - 1
Abstract
Background
Obesity is related with an increased risk of osteoarthritis, and the occurrence of obese patients needing a total knee replacement (TKR) has increased in the latest years. A high body mass index (BMI) may impact post-TKR rehabilitation outcomes. Currently, rehabilitation programmes after TKR concentrate on increasing the range of movement and strengthening exercises, while prehabilitation for improving balance, mobility is relatively neglected. Prehabilitation may be effective in bringing the fitness level of elderly patients to a higher level before they go for surgery.Thus the aim of our study is to find out significance of prehabilitation in obese TKR patients.
Method
Activity Specific balance confidence scale was taken and ROM was assessed. The aims and objectives of research were explained and willing participants were included in the study after their written consent.
Results
ABC scale: In group A (who have taken prehabilitation), 64% participants had high level of physical functioning, 36% showed moderate level of physical functioning and 0% had low level of physical functioning. In group B (who haven’t taken prehabilitation), 76% participants had moderate level of physical functioning, 20% showed low level of physical functioning and 4% had high level of physical functioning. When assessed for knee rom,in group A, 4 people had 111-1200of Knee ROM, 14 people had121-1300 and 7 people had 131-1400 of Knee ROM. In group B, 2 people had 90-1000 of Knee ROM, 14 people had 101-1100, 8 people had 111-1200 and 1 had 121-1300of Knee ROM.
Conclusion
The study concluded that there is significance of prehabilitation in obese TKR patients.
Obesity is related with an increased risk of osteoarthritis, and the occurrence of obese patients needing a total knee replacement (TKR) has increased in the latest years. A high body mass index (BMI) may impact post-TKR rehabilitation outcomes. Currently, rehabilitation programmes after TKR concentrate on increasing the range of movement and strengthening exercises, while prehabilitation for improving balance, mobility is relatively neglected. Prehabilitation may be effective in bringing the fitness level of elderly patients to a higher level before they go for surgery.Thus the aim of our study is to find out significance of prehabilitation in obese TKR patients.
Method
Activity Specific balance confidence scale was taken and ROM was assessed. The aims and objectives of research were explained and willing participants were included in the study after their written consent.
Results
ABC scale: In group A (who have taken prehabilitation), 64% participants had high level of physical functioning, 36% showed moderate level of physical functioning and 0% had low level of physical functioning. In group B (who haven’t taken prehabilitation), 76% participants had moderate level of physical functioning, 20% showed low level of physical functioning and 4% had high level of physical functioning. When assessed for knee rom,in group A, 4 people had 111-1200of Knee ROM, 14 people had121-1300 and 7 people had 131-1400 of Knee ROM. In group B, 2 people had 90-1000 of Knee ROM, 14 people had 101-1100, 8 people had 111-1200 and 1 had 121-1300of Knee ROM.
Conclusion
The study concluded that there is significance of prehabilitation in obese TKR patients.
Keywords
Significance
Prehabilitation
Total Knee Replacement
Obese
Physiotherapy
1.
NirmiteeHonap, DivyaJethwani, VaibhaviMahendrakar. Significance of prehabilitation in obese TKR patients. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2022 Feb. 18 [cited 2025 Jul. 12];10(1):64-70. Available from: https://ijamscr.com/ijamscr/article/view/1142
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References
-
1. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH, American Heart Association, Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006 Feb 14;113(6):898-918. doi: 10.1161/CIRCULATIONAHA.106.171016, PMID 16380542.
2. Liao CD, Huang YC, Lin LF, Huang SW, Liou TH. Body mass index and functional mobility outcome following early rehabilitation after a total knee replacement: a retrospective study in Taiwan. Arthritis Care Res. 2015 May;67(6):799-808. doi: 10.1002/acr.22474, PMID 25201765.
3. Yasuda K. Knee pain in the aged--pathomechanism, diagnosis, and treatment of osteoarthritis of the knee. [Hokkaido igakuzasshi]. Hokkaido J Med Sci. 1997 Jul 1;72(4):369-76. PMID 9266248.
4. Akodu AK, Giwa SO, Akinbo SR, Ahmed UA. Physiotherapy in the management of knee arthroplasty: a review. Nig Q J Hosp Med. 2011;21(2):99-105. PMID 21913506.
5. Schwartz I, Kandel L, Sajina A, Litinezki D, Herman A, Mattan Y. Balance is an important predictive factor for quality of life and function after primary total knee replacement. J Bone Joint Surg Br. 2012 Jun;94(6):782-6. doi: 10.1302/0301-620X.94B6.27874, PMID 22628592.
6. Oatis CA, Li W, DiRusso JM, Hoover MJ, Johnston KK, Butz MK, Phillips AL, Nanovic KM, Cummings EC, Rosal MC, Ayers DC, Franklin PD. Variations in delivery and exercise content of physical therapy rehabilitation following total knee replacement surgery: a cross-sectional observation study. Int J Phys Med Rehabil. 2014;Suppl(5). doi: 10.4172/2329-9096.S5-002, PMID 26594649.
7. Kow AW. Prehabilitation and its role in geriatric surgery. Ann Acad Med Singapore. 2019 Nov 1;48(11):386-92. PMID 31960020.
8. Patel BK, Hall JB. Perioperative physiotherapy. Curr Opin Anaesthesiol. 2013 Apr;26(2):152-6. doi: 10.1097/ACO.0b013e32835e8b34, PMID 23385319.
9. Anderson AM, Comer C, Smith TO, Drew BT, Pandit H, Antcliff D, Redmond AC, McHugh GA. Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study. BMC Musculoskelet Disord. 2021 Dec;22(1):352. doi: 10.1186/s12891-021-04160-5, PMID 33853564.
10. Hancock GE, Hepworth T, Wembridge K. Accuracy and reliability of knee goniometry methods. J Exp Orthop. 2018 Dec;5(1):46. doi: 10.1186/s40634-018-0161-5, PMID 30341552.
11. Stratford PW, Kennedy DM, Robarts SF. Modelling knee range of motion post arthroplasty: clinical applications. Physiother Can. 2010 Oct;62(4):378-87. doi: 10.3138/physio.62.4.378, PMID 21886379.
12. Levinger P, Menz HB, Morrow AD, Wee E, Feller JA, Bartlett JR, Bergman N. Lower limb proprioception deficits persist following knee replacement surgery despite improvements in knee extension strength. Knee Surg Sports Traumatol Arthrosc. 2012 Jun;20(6):1097-103. doi: 10.1007/s00167-011-1710-y, PMID 22005965.
13. Kim HS, Yun DH, Yoo SD, Kim DH, Jeong YS, Yun JS, Hwang DG, Jung PK, Choi SH. Balance control and knee osteoarthritis severity. Ann Rehabil Med. 2011 Oct;35(5):701-9. doi: 10.5535/arm.2011.35.5.701, PMID 22506194.
14. Botner EM, Miller WC, Eng JJ. Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disabil Rehabil. 2005 Feb 18;27(4):156-63. doi: 10.1080/09638280400008982, PMID 15824045.
15. Webster KE, Feller JA, Wittwer JE. Balance confidence and function after knee-replacement surgery. J Aging Phys Act. 2006 Apr 1;14(2):181-91. doi: 10.1123/japa.14.2.181, PMID 19462548.
16. Myers AM, Fletcher PC, Myers AH, Sherk W. Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1998 Jul 1;53(4):M287-94. doi: 10.1093/gerona/53a.4.m287, PMID 18314568.
17. Lenguerrand E, Artz N, Marques E, Sanderson E, Lewis K, Murray J, Parwez T, Bertram W, Beswick AD, Burston A, Gooberman?Hill R, Blom AW, Wylde V. Effect of group?based outpatient physical therapy on function after total knee replacement: results from a multicenter randomized controlled trial. Arthritis Care Res. 2020 Jun;72(6):768-77. doi: 10.1002/acr.23909, PMID 31033232.
References
1. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH, American Heart Association, Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006 Feb 14;113(6):898-918. doi: 10.1161/CIRCULATIONAHA.106.171016, PMID 16380542.
2. Liao CD, Huang YC, Lin LF, Huang SW, Liou TH. Body mass index and functional mobility outcome following early rehabilitation after a total knee replacement: a retrospective study in Taiwan. Arthritis Care Res. 2015 May;67(6):799-808. doi: 10.1002/acr.22474, PMID 25201765.
3. Yasuda K. Knee pain in the aged--pathomechanism, diagnosis, and treatment of osteoarthritis of the knee. [Hokkaido igakuzasshi]. Hokkaido J Med Sci. 1997 Jul 1;72(4):369-76. PMID 9266248.
4. Akodu AK, Giwa SO, Akinbo SR, Ahmed UA. Physiotherapy in the management of knee arthroplasty: a review. Nig Q J Hosp Med. 2011;21(2):99-105. PMID 21913506.
5. Schwartz I, Kandel L, Sajina A, Litinezki D, Herman A, Mattan Y. Balance is an important predictive factor for quality of life and function after primary total knee replacement. J Bone Joint Surg Br. 2012 Jun;94(6):782-6. doi: 10.1302/0301-620X.94B6.27874, PMID 22628592.
6. Oatis CA, Li W, DiRusso JM, Hoover MJ, Johnston KK, Butz MK, Phillips AL, Nanovic KM, Cummings EC, Rosal MC, Ayers DC, Franklin PD. Variations in delivery and exercise content of physical therapy rehabilitation following total knee replacement surgery: a cross-sectional observation study. Int J Phys Med Rehabil. 2014;Suppl(5). doi: 10.4172/2329-9096.S5-002, PMID 26594649.
7. Kow AW. Prehabilitation and its role in geriatric surgery. Ann Acad Med Singapore. 2019 Nov 1;48(11):386-92. PMID 31960020.
8. Patel BK, Hall JB. Perioperative physiotherapy. Curr Opin Anaesthesiol. 2013 Apr;26(2):152-6. doi: 10.1097/ACO.0b013e32835e8b34, PMID 23385319.
9. Anderson AM, Comer C, Smith TO, Drew BT, Pandit H, Antcliff D, Redmond AC, McHugh GA. Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study. BMC Musculoskelet Disord. 2021 Dec;22(1):352. doi: 10.1186/s12891-021-04160-5, PMID 33853564.
10. Hancock GE, Hepworth T, Wembridge K. Accuracy and reliability of knee goniometry methods. J Exp Orthop. 2018 Dec;5(1):46. doi: 10.1186/s40634-018-0161-5, PMID 30341552.
11. Stratford PW, Kennedy DM, Robarts SF. Modelling knee range of motion post arthroplasty: clinical applications. Physiother Can. 2010 Oct;62(4):378-87. doi: 10.3138/physio.62.4.378, PMID 21886379.
12. Levinger P, Menz HB, Morrow AD, Wee E, Feller JA, Bartlett JR, Bergman N. Lower limb proprioception deficits persist following knee replacement surgery despite improvements in knee extension strength. Knee Surg Sports Traumatol Arthrosc. 2012 Jun;20(6):1097-103. doi: 10.1007/s00167-011-1710-y, PMID 22005965.
13. Kim HS, Yun DH, Yoo SD, Kim DH, Jeong YS, Yun JS, Hwang DG, Jung PK, Choi SH. Balance control and knee osteoarthritis severity. Ann Rehabil Med. 2011 Oct;35(5):701-9. doi: 10.5535/arm.2011.35.5.701, PMID 22506194.
14. Botner EM, Miller WC, Eng JJ. Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disabil Rehabil. 2005 Feb 18;27(4):156-63. doi: 10.1080/09638280400008982, PMID 15824045.
15. Webster KE, Feller JA, Wittwer JE. Balance confidence and function after knee-replacement surgery. J Aging Phys Act. 2006 Apr 1;14(2):181-91. doi: 10.1123/japa.14.2.181, PMID 19462548.
16. Myers AM, Fletcher PC, Myers AH, Sherk W. Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1998 Jul 1;53(4):M287-94. doi: 10.1093/gerona/53a.4.m287, PMID 18314568.
17. Lenguerrand E, Artz N, Marques E, Sanderson E, Lewis K, Murray J, Parwez T, Bertram W, Beswick AD, Burston A, Gooberman?Hill R, Blom AW, Wylde V. Effect of group?based outpatient physical therapy on function after total knee replacement: results from a multicenter randomized controlled trial. Arthritis Care Res. 2020 Jun;72(6):768-77. doi: 10.1002/acr.23909, PMID 31033232.
2. Liao CD, Huang YC, Lin LF, Huang SW, Liou TH. Body mass index and functional mobility outcome following early rehabilitation after a total knee replacement: a retrospective study in Taiwan. Arthritis Care Res. 2015 May;67(6):799-808. doi: 10.1002/acr.22474, PMID 25201765.
3. Yasuda K. Knee pain in the aged--pathomechanism, diagnosis, and treatment of osteoarthritis of the knee. [Hokkaido igakuzasshi]. Hokkaido J Med Sci. 1997 Jul 1;72(4):369-76. PMID 9266248.
4. Akodu AK, Giwa SO, Akinbo SR, Ahmed UA. Physiotherapy in the management of knee arthroplasty: a review. Nig Q J Hosp Med. 2011;21(2):99-105. PMID 21913506.
5. Schwartz I, Kandel L, Sajina A, Litinezki D, Herman A, Mattan Y. Balance is an important predictive factor for quality of life and function after primary total knee replacement. J Bone Joint Surg Br. 2012 Jun;94(6):782-6. doi: 10.1302/0301-620X.94B6.27874, PMID 22628592.
6. Oatis CA, Li W, DiRusso JM, Hoover MJ, Johnston KK, Butz MK, Phillips AL, Nanovic KM, Cummings EC, Rosal MC, Ayers DC, Franklin PD. Variations in delivery and exercise content of physical therapy rehabilitation following total knee replacement surgery: a cross-sectional observation study. Int J Phys Med Rehabil. 2014;Suppl(5). doi: 10.4172/2329-9096.S5-002, PMID 26594649.
7. Kow AW. Prehabilitation and its role in geriatric surgery. Ann Acad Med Singapore. 2019 Nov 1;48(11):386-92. PMID 31960020.
8. Patel BK, Hall JB. Perioperative physiotherapy. Curr Opin Anaesthesiol. 2013 Apr;26(2):152-6. doi: 10.1097/ACO.0b013e32835e8b34, PMID 23385319.
9. Anderson AM, Comer C, Smith TO, Drew BT, Pandit H, Antcliff D, Redmond AC, McHugh GA. Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study. BMC Musculoskelet Disord. 2021 Dec;22(1):352. doi: 10.1186/s12891-021-04160-5, PMID 33853564.
10. Hancock GE, Hepworth T, Wembridge K. Accuracy and reliability of knee goniometry methods. J Exp Orthop. 2018 Dec;5(1):46. doi: 10.1186/s40634-018-0161-5, PMID 30341552.
11. Stratford PW, Kennedy DM, Robarts SF. Modelling knee range of motion post arthroplasty: clinical applications. Physiother Can. 2010 Oct;62(4):378-87. doi: 10.3138/physio.62.4.378, PMID 21886379.
12. Levinger P, Menz HB, Morrow AD, Wee E, Feller JA, Bartlett JR, Bergman N. Lower limb proprioception deficits persist following knee replacement surgery despite improvements in knee extension strength. Knee Surg Sports Traumatol Arthrosc. 2012 Jun;20(6):1097-103. doi: 10.1007/s00167-011-1710-y, PMID 22005965.
13. Kim HS, Yun DH, Yoo SD, Kim DH, Jeong YS, Yun JS, Hwang DG, Jung PK, Choi SH. Balance control and knee osteoarthritis severity. Ann Rehabil Med. 2011 Oct;35(5):701-9. doi: 10.5535/arm.2011.35.5.701, PMID 22506194.
14. Botner EM, Miller WC, Eng JJ. Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disabil Rehabil. 2005 Feb 18;27(4):156-63. doi: 10.1080/09638280400008982, PMID 15824045.
15. Webster KE, Feller JA, Wittwer JE. Balance confidence and function after knee-replacement surgery. J Aging Phys Act. 2006 Apr 1;14(2):181-91. doi: 10.1123/japa.14.2.181, PMID 19462548.
16. Myers AM, Fletcher PC, Myers AH, Sherk W. Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1998 Jul 1;53(4):M287-94. doi: 10.1093/gerona/53a.4.m287, PMID 18314568.
17. Lenguerrand E, Artz N, Marques E, Sanderson E, Lewis K, Murray J, Parwez T, Bertram W, Beswick AD, Burston A, Gooberman?Hill R, Blom AW, Wylde V. Effect of group?based outpatient physical therapy on function after total knee replacement: results from a multicenter randomized controlled trial. Arthritis Care Res. 2020 Jun;72(6):768-77. doi: 10.1002/acr.23909, PMID 31033232.