Background: In total knee replacement (TKR), a surgery for people with severe knee damage, the surgeon removes damaged cartilage and bone from the surface of the knee joint and replaces them with a man-made surface of metal and plastic. Although TKR decreases pain in numerous patients, it does not resolve many of the substantial functional limitations and physical inactivity that existed for a long time prior to the surgery, as the knee worsened. Exercise is an intervention that could improve these long-term limitations. To promote these improvements, exercise should be implemented at a later post-TKR stage, when patients can tolerate sufficient exercise to promote substantial changes. There is not enough information to indicate which type of exercise works best for which patients at a later post-TKR stage. This research study will provide such information.
Objectives: This study will compare the effectiveness of three treatment approaches after TKR:
- Individualized rehabilitative exercises given in a clinic setting by physical therapists
- Group exercise in supervised classes given in a community center setting
- Usual medical care
The researchers are interested in answering several questions that are important to patients:
- How do group exercise in the community and individual exercise in a rehabilitation clinic compare with usual medical care?
- How do group exercise in the community and individual exercise in a rehabilitation clinic compare with each other?
- Are there any of the doctor’s findings on examination helpful in determining which exercise is best for individual patients?
- Are these approaches safe?
Methods: This research study will involve 240 adults who had TKR at least two months prior to study participation. The research volunteers will be divided into three groups, each receiving one of the three types of treatments listed under “Objectives.” The type of treatment each person receives will be determined by chance, using a computerized version of flipping a coin. A series of tests and questionnaires will be given to the patients before and after they receive treatment, and comparisons will be made to see how much improvement they made with each type of treatment. Finally, the researchers will compare the differences between the three treatment groups to see if certain types of treatment produced better results than others, and if there were any examination findings that could be used to predict which type of patient would do better with which type of treatment.
Patient Outcomes (Projected): Results of this study will inform the choice of interventions to improve physical function and physical activity for patients during the later stage post TKR and determine which type of treatment is best for which type of patient. It will extend the number of years free of disability after the already significant investment in this increasingly prevalent surgery.