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  • Title: The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty.
    Author: Topp R, Swank AM, Quesada PM, Nyland J, Malkani A.
    Journal: PM R; 2009 Aug; 1(8):729-35. PubMed ID: 19695525.
    Abstract:
    OBJECTIVE: The purpose of this study was to examine the effect of a preoperative exercise intervention on knee pain, functional ability, and quadriceps strength among patients with knee osteoarthritis before and after total knee arthroplasty (TKA) surgery. DESIGN: A repeated-measures design was used to compare 2 groups over 4 data collection points. SETTING AND PATIENTS: Community-dwelling subjects with osteoarthritis of the knee who were scheduled for a unilateral TKA were recruited from a single orthopedic surgeon's office and were randomized into control (n = 28) or prehab groups (n = 26). INTERVENTIONS: The control patients maintained usual care before their TKA. The exercisers performed prehabilitation exercises, which included resistance training, flexibility, and step training, 3 times per week before their TKA. OUTCOME MEASURES: Knee pain, functional ability, quadriceps strength, and strength asymmetry were assessed at baseline (T1), at 1 week before the patients' TKA (T2), and again at 1 (T3) and 3 (T4) months after TKA. RESULTS: The exercisers improved their sit-to-stand performance at T2, whereas the control group did not change their performance of functional tasks and had increased pain at T2. At T3 the exercisers demonstrated improved sit-to-stand performance. The control patients at T3 exhibited decreases in pain, their 6-minute walk, surgical leg strength and an increase in their nonsurgical leg strength and leg strength asymmetry. At T4 the exercisers improved in their performance of 3 of the 4 functional tasks, decreased all of their pain measures, and increased their surgical and nonsurgical quadriceps strength. At T4 the control group improved their performance on 2 of the 4 functional tasks, decreased all of their pain measures, increased their nonsurgical leg strength, and exhibited greater leg strength asymmetry. CONCLUSION: These findings appear to indicate the efficacy of prehabilitation among TKA patients and support the theory of prehabilitation.
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