Improving Physical Activity and Gait Symmetry After Total Knee Arthroplasty
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 60
- Locations
- 2
- Primary Endpoint
- Change From Baseline to Month 3 in Objectively Assessed Physical Activity (Accelerometer)
Study Overview
Brief Summary
The purpose of this pilot study is to examine the effectiveness of the Physical Activity and Symmetry (PAS) program, compared to an attention (ATT)control group, for patients with post-total knee arthroplasty (TKA). The investigators hypothesize that the PAS treatment will result in meaningful improvements in physical activity (PA) and joint loading symmetry compared to the ATT group.
Detailed Description
Background and Significance: Total knee arthroplasty (TKA) has been shown to decrease pain and to improve range of motion and some aspects of physical function. However, accumulating evidence shows that patients have persistent deficits in other critical outcomes following TKA. First, the majority of patients do not substantially increase physical activity beyond levels prior to TKA, remaining well below Department of Health and Human Services recommendations and levels of healthy individuals. This has serious negative implications for both joint health and overall health. Second, studies show that gait asymmetries are common following TKA, such that patients continue to load the non-surgical leg more heavily during walking, even when the post-surgical leg is pain free. This places the contralateral limb at risk for developing or worsening osteoarthritis. Other research shows there is large variability in post-TKA rehabilitation, along with sub-optimal exercise content. Collectively, these findings emphasize the critical need to improve the post-TKA rehabilitation process. However, there are currently no evidence-based approaches to improve overall physical activity and deficits in joint loading symmetry that have been identified following TKA.
Study Aims: This research project will provide important preliminary information on the novel post-TKA PAS program through achieving the following specific aims: 1) Obtain preliminary data on the efficacy of the PAS program with respect to the change in objectively assessed physical activity, measured via accelerometers; 2) Obtain preliminary data on the efficacy of the PAS program with respect to change in peak load symmetry during walking, measured by a novel 3-sensor insole device; 3) Assess the feasibility and acceptability of the PAS program following TKA.
Study Description: Investigators will conduct an exploratory randomized controlled study, with n=60 patients >=18 years receiving post-TKA physical therapy (PT) at a UNC Healthcare System clinic. Patients will be equally allocated to the PAS intervention or an attention (ATT) control group.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patients receiving post-total knee arthroplasty (TKA) physical therapy (PT) at a University of North Carolina (UNC) Healthcare System clinic
Exclusion Criteria
- •significant cognitive impairment
- •neurological disorders affecting gait
- •systemic rheumatic disease
- •hospitalization for a cardiovascular condition the past six months
- •psychosis
- •substance abuse disorder
- •lower extremity surgery in the past year
- •any other health conditions determined to be contraindications to a home exercise program
Outcomes
Primary Outcomes
Change From Baseline to Month 3 in Objectively Assessed Physical Activity (Accelerometer)
Time Frame: Baseline, Month 3
Minutes of moderate to vigorous intensity PA (MVPA) per week measured via accelerometer. A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.
Change From Baseline to Month 3 in Peak Joint Load Symmetry During Walking
Time Frame: Baseline, Month 3
Participants will complete a 10 meter walking test while load beneath each foot is recorded using an instrumented insole. Loading symmetry (peak ground reaction force) will be assessed using the limb symmetry index (LSI (\|Surgical/Non-Surgical\|\*100), values lower than 100% indicate less loading of the surgical limb. A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.
Change From Baseline to Month 6 in Objectively Assessed Physical Activity (Accelerometer)
Time Frame: Baseline, Month 6
Minutes of moderate to vigorous intensity PA (MVPA) per week measured via accelerometer. A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.
Change From Baseline to Month 6 in Peak Joint Load Symmetry During Walking
Time Frame: Baseline, Month 6
Participants will complete a 10 meter walking test while load beneath each foot is recorded using an instrumented insole. Loading symmetry (peak ground reaction force) will be assessed using the limb symmetry index (LSI (\|Surgical/Non-Surgical\|\*100), values lower than 100% indicate less loading of the surgical limb. A log transformation was applied due to superior diagnostics relative to untransformed values in statistical modeling; transformed values are presented here.
Secondary Outcomes
- Change From Baseline to Month 6 in Brief Balance Evaluation Systems Test(Baseline, Month 6)
- Change From Baseline to Month 6 in Minutes of Any Physical Activity (PA)(Baseline, Month 6)
- Change From Baseline to Month 3 in Berg Balance Scale(Baseline, Month 3)
- Change From Baseline to Month 6 in Tampa Scale for Kinesiophobia(Baseline, Month 6)
- Change From Baseline to Month 3 in Self-Reported Physical Activity.(Baseline, Month 3)
- Change From Baseline to Month 3 in Minutes of Any Physical Activity (PA)(Baseline, Month 3)
- Change From Baseline to Month 3 in Sedentary Minutes(Baseline, Month 3)
- Change From Baseline to Month 6 in Sedentary Minutes(Baseline, Month 6)
- Change From Baseline to Month 6 in Knee Injury and Osteoarthritis Outcome Score (KOOS)(Baseline, Month 6)
- Change From Baseline Month 6 in Self-Reported Physical Activity.(Baseline to Month 6)
- Change From Baseline to Month 3 in Steps Per Day(Baseline, Month 3)
- Change From Baseline to Month 6 in Steps Per Day(Baseline, Month 6)
- Change From Baseline to Month 6 in Berg Balance Scale(Baseline, Month 6)
- Change From Baseline to Month 3 in Brief Balance Evaluation Systems Test(Baseline, Month 3)
- Change From Baseline to Month 3 in Knee Injury and Osteoarthritis Outcome Score (KOOS)(Baseline, Month 3)
- Change From Baseline to Month 3 in Tampa Scale for Kinesiophobia(Baseline, Month 3)