Dose-Associated Changes in Gait Parameters in Response to Exercise Programs after Total Knee Arthroplasty: Secondary Analysis of Two Randomized StudiesSara R Piva1*, Shawn Farrokhi1, Gustavo Almeida1, Kelley Fitzgerald G1, Timothy J Levison2 and Anthony M DiGioia2
- *Corresponding Author:
- Sara R Piva
Department of Physical Therapy
School of Health and Rehabilitation Sciences
University of Pittsburgh, USA
E-mail: [email protected]
Received date: August 29, 2015; Accepted date: November 23, 2015; Published date: November 28, 2015
Citation: Piva SR, Farrokhi S, Almeida G, Fitzgerald KG, Levison TG, et al. (2015) Dose-Associated Changes in Gait Parameters in Response to Exercise Programs after Total Knee Arthroplasty: Secondary Analysis of Two Randomized Studies. Int J Phys Med Rehabil 3:311. doi: 10.4172/2329-9096.1000311
Copyright: © 2015 Piva SR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Rehabilitation plays an important role to improve the outcomes of total knee arthroplasty (TKA). Evidence about the appropriate dose of exercise to recover gait dysfunction after TKA is limited. We posed the research question: In patients during the post-acute stage after TKA, is increased dose of exercise associated with larger improvements in gait parameters such as step length and single support time?
Methods: This was a secondary analysis from two randomized studies on exercise after TKA to investigate dosedependence of gait parameters in response to exercise. Participants were 50 years or older who underwent unilateral TKA at least two months prior. They participated in 2 months of supervised exercises followed by 4 months of a home exercise program. The primary outcome was change in gait parameters from baseline to 6 months. Participants were divided in three groups according to the dose of exercise: group 1 (light-to-moderate intensity exercise), group 2 (high intensity + functional exercise), and group 3 (high intensity + functional + balance exercise). Jonckheere-Terpstra test was used to test if the magnitude of changes in gait parameters increased from group 1 to group 3 in an ordered fashion.
Results: Increased dose of exercise was associated with progressive increases in step length in the operatedlimb (p=0.008) and decreases in step length in the non-operated limb (p=0.011). Increased dose of exercise was associated with ordinal decreases in loading response time (p=0.049) and increases in single-leg support time (p=0.021) on the operated- limb, but not on the non-operated-limb. Increased dose of exercise was associated with decreases in unloading time on the non-operated-limb (p=0.011) but not on the operated-limb (p=0.400).
Conclusions: Significant dose-response of exercise on gait parameters support the promotion of more intensive exercise programs that combine functional and balance training programs after TKA.