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Effect of Comprehensive Behavioral and Exercise Intervention on Physical Function and Activity Participation After Total Knee Replacement: A Pilot Randomized Study
Author(s) -
Piva Sara R.,
Almeida Gustavo J.,
Gil Alexandra B.,
DiGioia Anthony M.,
Helsel Diane L.,
Sowa Gwendolyn A.
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23227
Subject(s) - medicine , physical therapy , analysis of variance , randomized controlled trial , physical activity , physical fitness , test (biology) , intervention (counseling) , physical medicine and rehabilitation , surgery , paleontology , biology , psychiatry
Objective To test the feasibility of a comprehensive behavioral intervention (CBI) program that combines intense exercises with an education program, to be implemented at a later stage (3 months) following total knee replacement (TKR), and to get a first impression of the effects of the CBI as compared to a standard of care exercise (SCE) program on the outcomes of physical function and physical activity. Methods A total of 44 subjects participated in a 3‐month program of either CBI or SCE, followed by 3 months of a home exercise program. Outcomes of physical function and physical activity were measured at baseline and at 6‐month followup. Analysis of variance was used to compare statistical differences between groups, whereas responder analyses were used for clinically important differences. Results The CBI was found to be safe and well tolerated. As compared to the SCE group, the CBI group had less pain ( P = 0.035) and better physical function based on the Short Form 36 health survey ( P = 0.017) and the single‐leg stance test ( P = 0.037). The other outcome measures did not demonstrate statistically significant differences between the 2 groups. Results from the responder analysis demonstrated that the CBI group had a 36% higher rate of responders in physical function as compared to the SCE group. Also, the CBI group had 23% more responders in the combined domains of physical function and physical activity. Conclusion The CBI program is feasible and improves physical function and physical activity in patients several months after TKR. Larger pragmatic randomized trials are needed to confirm the results of this study.