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

摘要

Whether or not supervised rehabilitation is necessary to facilitate good patient outcomes following knee surgery is controversial in the available literature. Early range of motion (ROM) activities have progressively gained favor over prolonged immobilization. Questions regarding the best ways to incorporate pre- and post-operative interventions to generate optimal patient outcomes remain. This dissertation consists of two research components: a randomized controlled trial (RCT) and a systematic literature review.;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. Thirty-one subjects scheduled for partial meniscectomy surgery, were randomly assigned to either the control group or the experimental group. All subjects were seen pre-operatively by a researcher 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 evaluation. 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. The experimental group 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.;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 revealed 5 RCT, total knee arthroplasty (TKA) prehabilitation studies. No prehabilitation RCTs were found for any other surgical knee pathology. Due to the limited amount of studies 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 both a promising role for early, active ROM on intermediate outcomes in subjects recovering from partial meniscectomy which warrant further study and a clear need for research assessing the effectiveness of prehabilitation in patients undergoing knee surgeries.