Walters, Yelena; (2018) Task-orientated rehabilitation can improve knee function and satisfaction in patients 12 months after knee replacement surgery for osteoarthritis. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

End-stage osteoarthritis (OA) requires joint replacement surgery. Although total knee arthroplasty (TKA) usually relieves pain, some patients are disappointed with their mobility, which may result from an abnormal gait. Post-operative physiotherapy following TKA is essential, although little consensus exists regarding longer-term rehabilitation. Typical rehabilitation has an internal focus on specific muscles and joints, but task-orientated rehabilitation (TOR) may be more effective. This study tested the hypothesis that TOR can improve gait and patient reported functional outcome following TKA. Seventy six patients were studied 12 months after TKA during follow up at the Royal National Orthopaedic Hospital, Stanmore. Patient reported functional outcome was assessed using the Oxford Knee Score (OKS) and gait characteristics were measured using inertial measurement units (IMUs). A subset of 21 patients, exhibiting abnormal gait, entered a 4-week TOR programme, based on daily walking and stair climbing. Patients were re-assessed with OKS and IMUs, and gait quantity compared pre- and post-intervention using pedometers. A subset of 4 patients’ baseline gaits was compared to 5 controls, and to their own gait following the TOR, while subjected to differing treadmill conditions. Multiple regression analysis showed that stride duration significantly predicted OKS (p<0.0001, n=76). Higher OKS was observed in patients who have shorter stride duration, which was in turn a result of greater RoM of the leg joints and segments in the sagittal plane. TKA patients’ response to the varying treadmill conditions was similar, but inferior in the gait parameters’ values as compared to the healthy participants. Following TOR, 21 patients exhibited a significantly higher OKS (p=0.001, n=21). Stride duration, thigh, knee and calf sagittal range of motion and knee flexion in stance significantly increased in both limbs following TOR. In conclusion, the results indicate that there is scope to improve rehabilitation of patients after TKA. TOR improves gait quality and therefore has the potential to improve satisfaction in TKA patients.

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