Effects of Group-Based Exercise on Range of Motion, Muscle Strength, Functional Ability, and Pain During the Acute Phase After Total Knee Arthroplasty: A Controlled Clinical Trial

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Abstract
Study Design: Prospective observational study including a historical control group. Background: The extent to which group-based exercise (G-EXE) improves knee range of motion (ROM), quadriceps strength, and gait ability is similar to that of individualized exercise (I-EXE) at 6 weeks and 8 months after total knee arthroplasty (TKA). However, the benefits of G-EXE for patients during the acute recovery phase after TKA remain unclear. Objective: To determine the effects of G-EXE during the acute recovery phase after TKA on knee ROM, quadriceps strength, functional ability, and knee pain. Methods: Two hundred thirty-one patients participated in G-EXE in addition to regular ambulation and activities-of-daily-living exercises twice daily during the hospital stay. Outcomes were compared to those of a retrospectively identified, historical control group (I-EXE group [n = 206]) that included patients who performed exercises identical to those performed by the G-EXE group. The outcomes included knee ROM, quadriceps strength, pain intensity, and timed up-and-go test score at 1 month before surgery and at discharge. Analyses were adjusted for age, body mass index, sex, length of hospital stay, and preoperative values. Results: Changes in ROM of knee flexion and extension (P<.001) and quadriceps strength (P<.001) were significantly better in the G-EXE group than those in the I-EXE group at discharge. The pain intensity improved more in the G-EXE group than in the I-EXE group at discharge (P<.001). However, the changes in the timed up-and-go scores were not significantly different. Conclusion: Patients performing G-EXE in addition to regular ambulation and activities-of-daily-living exercises demonstrated greater changes in knee ROM, quadriceps strength, and knee pain than those performing I-EXE in addition to regular ambulation and activities-of-daily-living exercises. The nonrandomized, asynchronous design decreases certainty of these findings. Level of Evidence: Therapy, level 2b. J Orthop Sports Phys Ther 2016;46(9):742–748. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6409

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