Clinical effects of early, active range of motion via stationary cycling with reduced pedal arm length in knee surgery patients

Kelln, Brent Michael, Curry School of Education, University of Virginia
Hertel, Jay, Department of Kinesiology, University
Miller, Mark, Orthopaedic Surgery Sports Medicine Division, University of Virginia
Saliba, Susan, Department of Kinesiology, University of Virginia
Ingersoll, Christopher, Department of Sports Medicine, University of Virginia

Whether or not supervised rehabilitation is necessary to facilitate good patient outcomes following knee surgery is controversial in the available literature. Early, protected range of motion (ROM) activities have progressively gained favor over prolonged immobilization. Questions regarding the best ways to incorporate preand post-operative interventions to generate optimal patient outcomes remain. My dissertation consisted of two research components, a randomized controlled trial (RCT) and a systematic literature review, which aimed to add clinical understanding in this area. The purpose of the RCT was to determine whether a specific early, active ROM intervention using a bicycle ergometer equipped with an adjustable pedal arm system offered any measurable benefit to post-operative partial meniscectomy subjects. Thirtyone subjects (11 males and 20 females) scheduled for partial meniscectomy surgery, were randomly assigned to either the control group (5 males and 10 females) or the experimental group (6 males and 10 females). All received the same instruction in home management needs during their orthopaedic workup. All subjects were seen preoperatively by a member of the research team in order to obtain baseline girth, range of motion (ROM), gait and quadriceps control outcome measures. All subjects returned on post-operative day 1, weeks 1 and 2, and months 1 and 3 for follow-up outcome measures. Starting post-operative day 1, only the experimental group subjects were instructed to ride a stationary bicycle ergometer equipped with an adjustable pedal arm system to allow for comfortable full pedal revolutions, while under the direct supervision of a physical therapist. All experimental group subjects completed 2 sets of 10 minutes on the bike with a 5 minute rest between sessions 3 times a week for the first two weeks following surgery. Both control and experimental group subjects received the same progressive home management instruction at each follow-up visit. The experimental intervention resulted in significant improvements in subjective gait measures at intermediate follow-up in patients recovering from partial meniscectomy. There were not statistically significant improvements in measures of limb girth, knee ROM, self-reported function, or quadriceps control; however, effect size analysis for the self-reported function measures revealed some promising trends in favor the experimental intervention. The purpose of the systematic review was to identify existing surgical knee pathology prehabilitation (pre-operative rehabilitation) programs and evaluate their effectiveness on available clinical outcome measures. Our systematic review for prehabilitation programs accompanying surgical knee pathology only generated 5 RCTs, all of which dealt with total knee arthroplasty (TKA) patients. No prehabilitation RCTs were found for any other surgical knee pathology. Of the five articles presented in the review, only one cited a statistically significant long-term outcome measure in support of prehabilitation intervention. Further analysis of that particular outcome measure (hospital length of stay) via effect size (ES = -.28) would suggest that even though it showed statistical significance, it offered very little clinical meaningfulness. Due to the limited amount of studies found and their questionable quality of evidence, per the SORT guidelines our review scored at a level 2 with a grade recommendation of B. In conclusion, these results indicate a promising role for early, active ROM on intermediate outcomes in subjects recovering from partial meniscectomy which warrants further study and a clear need for research assessing the effectiveness of prehabilitation in patients undergoing knee surgeries other than TKA.

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PHD (Doctor of Philosophy)
immobility, range of motion, rehabilitation, knee surgery

Digitization of this thesis was made possible by a generous grant from the Jefferson Trust, 2015.

Thesis originally deposited on 2016-02-18 in version 1.28 of Libra. This thesis was migrated to Libra2 on 2017-03-23 16:33:41.

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