Virtual versus in-person physiotherapy following total knee arthroplasty: a comparative analysis.

PURPOSE: At our centre, we developed and implemented a video-based post-operative physiotherapy program for patients undergoing total knee arthroplasty (TKA). Our aims were to analyse and compare the outcomes of this program to in-person physiotherapy. METHODS: We reviewed the outcomes of 112 patients and captured range-of-motion (ROM) measurements and pain scores (P4 questionnaire). We compared the outcomes to a cohort of 175 patients undergoing in-person therapy. Comparative analysis was performed using a two-tailed Student's t-test. RESULTS: There was no significant difference between the two groups in age, sex, or initial post-operative knee ROM. On discharge from virtual physiotherapy, mean flexion was 122.6° (SD 7.6). There was no significant difference in improvement in knee flexion between the virtual and in-person groups (mean 30.6° vs 34.0°, p = 0.07). There was no significant difference in the proportion of patients achieving ≥ 120° of flexion (85.0% virtual vs 91.3% in-person, p = 0.11) or those achieving an extension deficit of ≤ 5° (96.0% vs 98.3%, p = 0.25). There was no difference in the number of PT visits to discharge (10.5 vs 11.1, p = 0.14) or final pain scores (12.4 vs 11.9, p = 0.61). CONCLUSION: Improvements in knee ROM measures are comparable between virtual and in-person physiotherapy with both groups achieving a good functional range. These findings have implications for the virtual delivery of healthcare, especially among remote populations and patients with mobility limitations.

The Group Experience: Remodelling Outpatient Physiotherapy after Knee Replacement Surgery.

UNLABELLED: Purpose : To estimate responses to short-duration (4-6 weeks) group-based physiotherapy after knee replacement in terms of pain, function, and satisfaction. METHOD: The study used a prospective, observational design. A total of 169 participants (111 women, 58 men) were consecutively recruited to attend a twice-weekly post-operative knee replacement class focused on mobility, strength, balance, and functional retraining. Changes in pain, function, and satisfaction were measured using the P4 pain intensity measure, the Lower Extremity Functional Scale (LEFS), a timed stair test (TST), knee range of motion (ROM), the Patient Specific Functional Scale (PSFS), and the Client Satisfaction Questionnaire (CSQ-8). Using Stata version 12.1, the data were summarized descriptively, and change scores were calculated with 95% CIs. Results : On average, participants were discharged within 11 classes, having achieved their treatment goals. More than 77% exceeded the minimal detectable change at the 90% confidence level (MDC90) on the LEFS, TST, PSFS, and ROM assessments. The mean CSQ-8 score at discharge was 31.8 (SD 1.46); 66.7% recorded a perfect score of 32. Conclusions : Patients attending a short group-based outpatient knee replacement class demonstrated significant improvements in pain and lower extremity function and were highly satisfied with their physiotherapy treatment.

Objectif : Estimer la réaction des patients à un traitement de physiothérapie en groupe de courte durée (de 4 à 6 semaines) à la suite d'une arthroplastie du genou en ce qui concerne la douleur, la fonction et la satisfaction. Méthode : L'étude a utilisé un concept prospectif d'observation. Au total, 169 patients (111 femmes) ayant subi une arthroplastie du genou ont été recrutés de façon consécutive pour assister deux fois par semaine à un cours axé sur la mobilité, la force, l'équilibre et le recyclage fonctionnel. Les changements relatifs à la douleur, à la fonction et à la satisfaction ont été mesurés à l'aide du questionnaire sur l'intensité de la douleur (P4), de l'échelle fonctionnelle des membres inférieurs (EFMI), d'un test de l'escalier chronométré (TEC), d'une mesure de l'amplitude des mouvements (ADM) du genou, de l'échelle fonctionnelle spécifique au client (EFSC) et du questionnaire de satisfaction de la clientèle (CSQ-8). À l'aide de STATA 12.1, les données ont été résumées de façon descriptive et les valeurs numériques des changements ont été calculées avec des intervalles de confiance de 95%. Résultats : En moyenne, les patients ont obtenu leur congé en 11 séances ou moins, leurs objectifs de traitement ayant été atteints. Plus de 77% des participants ont dépassé le seuil de changement détectable à un niveau de confiance de 90% (CDM90) pour les évaluations de l'EFMI, du TEC, de l'EFSC et de l'ADM. La note moyenne au CSQ-8 à l'obtention du congé était de 31,8 (ET 1,46); une note parfaite de 32 a été obtenue dans 66,7% des cas. Conclusions : Les patients ayant participé à un cours de courte durée en service externe après une arthroplastie du genou ont affiché une nette amélioration en ce qui concerne la douleur et la fonction des extrémités inférieures et se sont montrés très satisfaits de leur traitement de physiothérapie.

Assessing the patient-specific functional scale's ability to detect early recovery following total knee arthroplasty.

BACKGROUND: The Patient-Specific Functional Scale (PSFS) has received considerable attention over the last 2 decades; however, validation studies have not examined its performance in patients after total knee arthroplasty (TKA). OBJECTIVE: The purpose of this study was to investigate the ability of the PSFS to detect change in patients post-TKA by comparing PSFS change scores with Lower Extremity Functional Scale (LEFS) and pooled impairment change scores. METHODS: One hundred thirty-three patients participating in a post-TKA exercise class were assessed at their initial and discharge visits. Initial assessments occurred within 28 days of arthroplasty; follow-up assessments occurred within 80 days of surgery. At both assessments, participants completed the PSFS, LEFS, and the P4 pain measure, and their knee range of motion (ROM) and extensor strength were measured. The ability to detect change was expressed as the standardized response mean (SRM) and as a correlation between the PSFS change scores and 2 reference standards: (1) LEFS change scores and (2) pooled impairment change scores. The pooled impairment measure consisted of pain, ROM, and strength change scores. RESULTS: The SRMs were PSFS 4.60 (95% confidence interval [CI]=4.00, 5.36) for the PSFS and 2.28 (95% CI=2.04, 2.60) for the LEFS. The correlation between the PSFS and pooled impairment change scores was 0.12 (95% CI=-0.04, 0.25), and the correlation between the PSFS and LEFS changes scores was 0.18 (0.02, 0.34). LIMITATIONS: The order of measure administration was not standardized, and fixed activity set does not reflect clinical application in many instances. CONCLUSIONS: The results suggest that the PSFS is adept at detecting improvement in patients post-TKA but that the PSFS, like other patient-specific measures, is likely to be of limited value in distinguishing different levels of change among patients.

An example of end-digit preference in physiotherapy practice.

PURPOSE: Standardizing and improving the validity of range of motion (ROM) measurements is of clinical relevance to physiotherapists. The purpose of this study was to assess whether end-digit preference exists in the measurement of knee ROM in people after knee replacement. METHOD: Following total knee replacement, 100 people underwent active-assisted knee ROM measurements using a goniometer calibrated in 1° increments. RESULTS: The data showed strong end-digit preferences for 0s and 5s (p<0.001). CONCLUSIONS: End-digit preference does exist in the measurement of knee ROM. This has the potential to influence both the validity of ROM measurements and clinical decisions.

Objectif : Normaliser et améliorer la validité des mesures d'amplitude des mouvements (ADM) est particulièrement pertinent sur le plan clinique pour les physiothérapeutes. L'objectif de cette étude est d'évaluer si une préférence quant au dernier chiffre existe dans la mesure de l'ADM du genou chez les personnes qui ont subi un remplacement du genou. Méthodologie : À la suite d'un remplacement total du genou, 100 personnes ont subi des mesures actives assistées de l'ADM du genou à l'aide d'un goniomètre calibré selon des échelons de 1°. Résultats : Les données ont démontré une préférence marquée quant au dernier chiffre pour les 0 et les 5 (p<0,001). Conclusions : Il existe effectivement une préférence quant au dernier chiffre dans la mesure de l'ADM du genou. Cette préférence pourrait avoir une influence sur la validité des mesures d'ADM et sur les décisions cliniques.