Pre-surgery exercise-conditioning (P–SEC) in patients waiting for Total Knee Arthroplasty

Abstract

Using a randomised controlled trial to assess efficacy, a ‘novel’ pre-surgical exerciseconditioning (P–SEC) programme was investigated in this thesis addressing the knowledge gap in the literature regarding pre-surgical conditioning for improving objective measures of physical performance (neuromuscular and sensorimotor) and self-reported outcomes in patients waiting to undergo total knee arthroplasty (TKA) surgery. Crosseducation (CE) effects measured in the untrained limb following the P–SEC intervention were also investigated.A single-centre, assessor-blinded randomised controlled study was conducted over an 11-month period. Forty-six participants waiting to undergo TKA surgery were enrolled and randomised into one of three groups (two intervention groups (P–SECIPSI (n = 15) and P–SECCONTRA (n = 17), in which the knee extensors of the leg awaiting surgery and the non-surgical leg, respectively, were trained) and one control group (n = 14), which received usual care practice of no training). Seventeen participants (out of 46) had been lost-to-follow-up. Participants underwent evaluation at four pre-surgery assessments: 12 weeks (T1), 2 weeks (T2), 1 week (T3) pre-surgery, week of surgery (T4) and at 6 weeks post surgery (T5). Objective measures of neuromuscular (electromechanical delay (EMD), rate of force development (RFD), peak force (PF)) and sensorimotor (force error (FE)) performance outcomes revealed statistically significant group x time x leg interactions with moderate to large gains (12% – 37%; ES = 2.0; p < 0.05) in the respective outcomes. No statistically significant (p > 0.05) group x time interactions were found for the patient reported outcomes as measured by the Oxford Knee Score (OKS), Knee injure and Osteoarthritis Score (KOOS), 36-Item Short Form Health Survey (SF-36v2TM), Pain Self Efficacy Questionnaire (PSEQ), Performance Profile (PP) and International Physical Activity Questionnaire (IPAQ). Small but approaching moderate (4% – 11%; ES = 0.1 – 0.4; p < 0.05) CE-related improvements in the physical performance outcomes (EMD, RFD, PF and FE) were also reported in the untrained limb. This thesis provides evidence that a novel approach to P–SEC which elicited statistically significant improvements in physical performance outcomes (neuromuscular and sensorimotor) in patients waiting for TKA surgery compared to a usual care control group. Furthermore, this study is the first of its kind to evaluate and confirm the presence of CE in this cohort of patients. The novel characteristics of P–SEC highlight the importance for revisiting contemporary pre-surgical conditioning. Limitations to the study included sample’ size attrition, with the potential for bias and inflated rates of Type II error. The thesis presents possible directions into the use of this ‘novel’ intervention in clinical practices and in other joint related conditions. Keywords: arthroplasty, sensorimotor, knee osteoarthritis, pre-surgical, neuromuscular, cross-education