Knee-extension strength or leg-press power after fast-track total knee arthroplasty: Which is better related to performance-based and selfreported

Transkript

1 Knee-extension strength or leg-press power after fast-track total knee arthroplasty: Which is better related to performance-based and selfreported function? Peter K Aalund 1, Kristian Larsen 2,3, Torben B Hansen 2,3, Thomas Bandholm 4,5,6 1 Department of Occupational Therapy and Physiotherapy, Holstebro Regional Hospital, Holstebro; 2 The Lundbeck Center for Fast-Track Hip and Knee Surgery, Aarhus; 3 The Musculoskeletal Research Unit, Department of Orthopedics, Holstebro Regional Hospital, Holstebro; 4 Clinical Research Centre; 5 Department of Orthopedic Surgery; 6 Department of Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark Holstebro Århus Hvidovre

2 Baggrund Knæekstensor styrketab efter total knæalloplastik (TKA) op til 83 % 1 Styrketab = funktionstab 2 Fleste studier har brugt knæekstensions styrke som måleparameter I nyere mindre studie 3 (N = 9) viser benpres styrke bedre sammenhæng med selvrapporteret og præstationsbaseret funktion end knæekstensionsstyrke Kunne et større studie bekræfte denne sammenhæng? 1. Holm et al., (2010). Arch Phys Med Rehabil 91: ; 2. Mizner et al., (2005). J Bone Joint Surg [Am] 87-A: Rossi et al., (2007). J Geriatr Phys Ther 30: 23-27

3 Anvendelse Finde styrkeevalueringsparameter med bedst klinisk relevans. Indikator for hvilken træningsform man bør vælge frem for en anden i travl klinisk praksis, hvor en øvelse skal prioriteres frem for en anden?

4 Design Operation Tværsnitsstudie Patienter testet én gang 4 uger postoperativt (i forbindelse med fys.kontrol på hospitalet) 0 4 Uger

5 Design og målinger Knæekstensions Styrke 10-meter gangtest Oxford Knee Score Operation 0 4 Uger Benpres Rejse-sætte-sig-test

6 Table 1. Patient characteristics. Patients Variable All patients (N = 39) Age, yrs 65.5 (10.3) Women, number 18 Men, number 21 Body weight, kg 83.8 (14.8) Knee pain during the knee-extension strength test, VAS-mm 8 (11) Knee pain during the leg-extension power test, VAS-mm 6 (10) Values are presented as means (1 SD). Four weeks post TKA

7 Muskelstyrke test 5-10 gentagelser / 1 minuts pause Benpres i leg rig Knæekstension med håndholdt dynanometer

8 Selvrapporteret funktion (Western Ontario McMaster University Osteoarthritis index) 24 spørgsmål på 3 dimensioner (smerte, stivhed og funktion) vurderet på de sidste 48 timer. Score: 0-96 / 0-68 Oxford Knee Score (OKS) 12 spørgsmål omkring smerte og funktion hvor pt. skal se tilbage på de sidste 4 uger. Score: 0-48 (12-60)

9 Præstationsbaseret funktion Rejse-sætte-sig-test Antal gentagelser på 30 sekunder 10-meter gangtest Tidsforbrug på en 10 meter gangdistance (bedste af 3 forsøg og omregnet til m/s)

10 Results Table 1. Associations between muscle impairment measures, and performance-based and self-reported measures of function in patients four weeks after TKA (N = 39). 30-s chair stand 10-m fast speed Oxford Knee test walking total physical Score (9.6±5.2 reps) (1.4±.4 m/s) (47.8±10.8 points) (32.9±8.6 points) (31.9±5.5 points) Knee extension strength* (.76±.36 Nm/kg) r =.40 P =.013 r =.51 P =.001 r = -.34 P =.036 r = -.32 P =.047 r =.39 P =.015 Leg press power* (.90±.46 W/kg) r =.74 r =.82 r = -.42 P =.008 r = -.43 P =.006 r =.48 P =.002

11 Results Table 1. Associations between muscle impairment measures, and performance-based and self-reported measures of function in patients four weeks after TKA (N = 39). 30-s chair stand 10-m fast speed Oxford Knee test walking total physical Score (9.6±5.2 reps) (1.4±.4 m/s) (47.8±10.8 points) (32.9±8.6 points) (31.9±5.5 points) Knee extension strength* (.76±.36 Nm/kg) r =.40 P =.013 r =.51 P =.001 r = -.34 P =.036 r = -.32 P =.047 r =.39 P =.015 Leg press power* (.90±.46 W/kg) r =.74 r =.82 r = -.42 P =.008 r = -.43 P =.006 r =.48 P =.002

12 Results Table 1. Associations between muscle impairment measures, and performance-based and self-reported measures of function in patients four weeks after TKA (N = 39). 30-s chair stand 10-m fast speed Oxford Knee test walking total physical Score (9.6±5.2 reps) (1.4±.4 m/s) (47.8±10.8 points) (32.9±8.6 points) (31.9±5.5 points) Knee extension strength* (.76±.36 Nm/kg) r =.40 P =.013 r =.51 P =.001 r = -.34 P =.036 r = -.32 P =.047 r =.39 P =.015 Leg press power* (.90±.46 W/kg) r =.74 r =.82 r = -.42 P =.008 r = -.43 P =.006 r =.48 P =.002

13 Results Table 1. Associations between muscle impairment measures, and performance-based and self-reported measures of function in patients four weeks after TKA (N = 39). 30-s chair stand 10-m fast speed Oxford Knee test walking total physical Score (9.6±5.2 reps) (1.4±.4 m/s) (47.8±10.8 points) (32.9±8.6 points) (31.9±5.5 points) Knee extension strength* (.76±.36 Nm/kg) r =.40 P =.013 r =.51 P =.001 r = -.34 P =.036 r = -.32 P =.047 r =.39 P =.015 Leg press power* (.90±.46 W/kg) r =.74 r =.82 r = -.42 P =.008 r = -.43 P =.006 r =.48 P =.002

14 Results Table 1. Associations between muscle impairment measures, and performance-based and self-reported measures of function in patients four weeks after TKA (N = 39). 30-s chair stand 10-m fast speed Oxford Knee test walking total physical Score (9.6±5.2 reps) (1.4±.4 m/s) (47.8±10.8 points) (32.9±8.6 points) (31.9±5.5 points) Knee extension strength* (.76±.36 Nm/kg) r =.40 P =.013 r =.51 P =.001 r = -.34 P =.036 r = -.32 P =.047 r =.39 P =.015 Leg press power* (.90±.46 W/kg) r =.74 r =.82 r = -.42 P =.008 r = -.43 P =.006 r =.48 P =.002

15 Results Table 1. Associations between muscle impairment measures, and performance-based and self-reported measures of function in patients four weeks after TKA (N = 39). 30-s chair stand 10-m fast speed Oxford Knee test walking total physical Score (9.6±5.2 reps) (1.4±.4 m/s) (47.8±10.8 points) (32.9±8.6 points) (31.9±5.5 points) Knee extension strength* (.76±.36 Nm/kg) r =.40 P =.013 r =.51 P =.001 r = -.34 P =.036 r = -.32 P =.047 r =.39 P =.015 Leg press power* (.90±.46 W/kg) r =.74 r =.82 r = -.42 P =.008 r = -.43 P =.006 r =.48 P =.002

16 Results Table 1. Associations between muscle impairment measures, and performance-based and self-reported measures of function in patients four weeks after TKA (N = 39). 30-s chair stand 10-m fast speed Oxford Knee test walking total physical Score (9.6±5.2 reps) (1.4±.4 m/s) (47.8±10.8 points) (32.9±8.6 points) (31.9±5.5 points) Knee extension strength* (.76±.36 Nm/kg) r =.40 P =.013 r =.51 P =.001 r = -.34 P =.036 r = -.32 P =.047 r =.39 P =.015 Leg press power* (.90±.46 W/kg) r =.74 r =.82 r = -.42 P =.008 r = -.43 P =.006 r =.48 P =.002

17 Results Table 1. Associations between muscle impairment measures, and performance-based and self-reported measures of function in patients four weeks after TKA (N = 39). 30-s chair stand 10-m fast speed Oxford Knee test walking total physical Score (9.6±5.2 reps) (1.4±.4 m/s) (47.8±10.8 points) (32.9±8.6 points) (31.9±5.5 points) Knee extension strength* (.76±.36 Nm/kg) r =.40 P =.013 r =.51 P =.001 r = -.34 P =.036 r = -.32 P =.047 r =.39 P =.015 Leg press power* (.90±.46 W/kg) r =.74 r =.82 r = -.42 P =.008 r = -.43 P =.006 r =.48 P =.002

18 Konklusion Hovedfund / overordnet: Benpres korrelerer bedre (bedre sammenhæng) med selvrapporteret funktion og præstationsbaseret funktion end knæekstensionsstyrke Benpres i leg rig Knæekstension med håndholdt dynanometer

19 Studiedesign Begrænsninger

20 Tak for opmærksomheden Spørgsmål?