Repository logo

Browsing by Person "Peer, Maria"

Filter results by typing the first few letters
Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Peri-surgical changes in functional capabilities associated with reconstructive knee surgery
    (2017) Peer, Maria
    This thesis, using a meta-analytical review of the literature and a controlled longitudinal cohort trial, addresses a knowledge gap regarding peri-surgical changes in self-reported and objective measures of physical function, neuromuscular and sensorimotor performance capabilities of patients undergoing total knee arthroplasty (TKA). Responsiveness and patterns of change in perceived exertion (Borg Category-Ratio Scale [CR-10]), perceived task duration (PTD) and neuromuscular performance during an intermittent isometric fatigue task (IIF) were also investigated. Twenty-six individuals (50 % female, 66.8 ± 1.4 years) underwent evaluation at 3 and ~12 weeks pre-surgery, and again at 6 and 12 weeks post-operatively. Patient-reported outcomes including the Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), 36-Item Short Form Health Survey (SF-36), Performance Profile and International Physical Activity Questionnaire demonstrated significant changes in peri-surgical functional status. Significant time related interactions between operated and control legs were observed for range of movement, knee circumference and neuromuscular performance indices of volitional peak force (PFV), rate of force development, rate of force relaxation, electromechanical delay activation and relaxation (vastus medialis). Items of the KOOS (pain and activities of daily living), OKS and SF-36 (role emotional) and PFV demonstrated significant differences at three weeks pre-surgery compared to baseline. Differences in the rate of change of performance at week 6 and week 12 post-surgery contributed most to the overall interactive- and main effect-related changes in the selected outcome measures. In estimating patient perceptions of exercise stress in an environment mimicking aspects of self-managed rehabilitative conditioning, the Borg Category-Ratio Scale and PTD showed a differential pattern of change during a novel IIF, with the latter perceptual tool showing congruency with patterns of objective fatigue-related loss of performance. This thesis provides the most comprehensive evaluation of peri-surgical physical function using patient-reported and objective (physical and physiological performance) outcomes. Further, this study is the first to contribute insight into how people undergoing TKA perceive exercise exertion and task duration. The research presents possible directions of future research to optimise physical function of TKA recipients.
  • Thumbnail Image
    Item
    Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials
    (Foundation for Rehabilitation Inofrmation, 2017-03-29) Peer, Maria; Rush, Robert; Gallacher, P.; Gleeson, Nigel
    Objective: To summarize the evidence regarding the effectiveness and dose-response characteristics of pre-operative exercise programmes on post-operative physical function following total knee arthroplasty. Data sources: CINAHL, Cochrane Library, PubMed, SPORTDiscus and EMBASE. Study selection: Randomized controlled trials were eligible if they provided full description of physiological stress (i.e. mode, frequency, intensity and duration). Data extraction: Data extraction and evaluation were performed by one reviewer. Methodological quality of the selected studies was assessed using the Physiotherapy Evidence Database scale. Data synthesis: Twelve candidate studies were identified, but only 3 papers satisfied all inclusion criteria: 2 studies evaluated the effect of resistance training and 1 trial investigated proprioceptive training. The latter study elicited significantly enhanced post-operative gains in function for indices of standing balance (overall stability index: Hedges' g = -1; anteroposterior stability index: Hedges' g = -1.15; 6 weeks post-surgery). Results of meta-analysis based on the findings of 2 studies showed that, compared with controls, prehabilitative exercise involving resistance training offered no additional gains in isometric quadriceps muscle strength at 6 and 12 weeks post-operatively. Conclusion: Despite a potential for efficacy of exercise-based conditioning, this review highlights the scarcity of robust dose-response evidence to guide the formulation of total knee arthroplasty prehabilitation effectively.
  • Thumbnail Image
    Item
    The Knee Injury and Osteoarthritis Outcome Score (KOOS): A Review of Its Psychometric Properties in People Undergoing Total Knee Arthroplasty
    (2013-01) Peer, Maria; Lane, Judith
    STUDY DESIGN: Systematic literature review, clinical measurement. OBJECTIVE: To review and summarize the evidence regarding the psychometric properties of the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients undergoing total knee arthroplasty (TKA). METHODS: A comprehensive review of the existing literature was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review guidelines. Studies were included if they reported the psychometric properties of the KOOS or the KOOS-Physical Function Shortform (KOOS-PS). Papers written in both English and German were analyzed. Studies of patients undergoing primary total TKA or TKA revision, or those with severe osteoarthritis and awaiting TKA, were considered. The methodological quality of the included articles was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. RESULTS: Six studies fulfilled the inclusion criteria. Of these, 5 evaluated psychometric properties of the KOOS and 1 evaluated the KOOS-PS. Both the KOOS and KOOS-PS have moderate-to-high construct validity with existing validated self-report measures. However, construct validity of the KOOS function in sport and recreation subscale was weak. Further, these instruments demonstrated a high level of responsiveness, with effect sizes and standard response means of greater than 0.80. Overall, both questionnaires demonstrated clinically acceptable reliability (intraclass correlation coefficient of 0.70 or greater). However, somewhat lower reliability was observed for the KOOS function in sport and recreation subscale (intraclass correlation coefficients of 0.45 and 0.65, respectively) and the other symptoms subscale (internal consistency, = .56). CONCLUSION: The KOOS and KOOS-PS exhibit clinically acceptable psychometric properties. Their strength is in large effect sizes to measure outcomes over time and their weakness is in weak-to-moderate reliability and weak construct validity in some subscales of the KOOS