The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty.
OBJECTIVE
To determine the effectiveness of a preoperative exercise/education program on functional recovery, health related quality of life (HRQOL), health service utilization, and costs following primary total knee arthroplasty (TKA).


METHODS
One hundred thirty-one subjects were randomized to either the control (n = 66) or treatment (n = 65) group 6 weeks before TKA surgery. Patients in the treatment group underwent a 4-week exercise/education program before surgery. All subjects were assessed 6 weeks preoperatively (before the exercise/education intervention), immediately preoperatively (after the exercise/education intervention), and 3, 6 and 12 months after surgery utilizing the Western Ontario McMaster Osteoarthritis Index, the SF-36, and knee range of motion (ROM) and strength measures. Data on length of stay, numbers of community rehabilitation or homecare visits following discharge from the surgical hospital, and the costs associated with these services were also collected.


RESULTS
Subjects were similar in demographic characteristics and all measurements at the baseline assessment. No differences were seen in knee measurements (ROM and strength), pain, function, or HRQOL between the 2 groups following the intervention program or at any postoperative measurement point. Patients in the treatment group used fewer postoperative rehabilitation services and stayed for a shorter time in hospital than the control group, but these differences did not attain statistical significance.


CONCLUSIONS
The exercise/education intervention did not alter functional recovery or HRQOL following TKA. Health service utilization was less in the treatment group, but our study was underpowered to attain statistical significance for these measures.
Beaupre
Lauren A
LA
Division of Orthopaedics, University of Alberta Hospital, Capital Health Regional Health Authority, Edmonton, Alberta, Canada. lbeaupre@ualberta.ca
Lier
Doug
D
Davies
Donna M
DM
Johnston
D Bill C
DB
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D015444:Exercise; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000191:economics / Q000534:rehabilitation* / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic; D010359:Patient Readmission; D011300:Preoperative Care; D015397:Program Evaluation; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function