title: The immediate and long-term effects of a walking-skill program compared to usual physiotherapy care in patients who have undergone total knee arthroplasty (TKA): a randomized controlled trial.
abstract: OBJECTIVE
  To examine the immediate and long-term effects of a walking-skill program compared with usual physiotherapy on physical function, pain and perceived self-efficacy in patients after total knee arthroplasty (TKA).
  
  
  METHODS
  A single blind randomized controlled trial design was applied. Fifty-seven patients with primary TKA, mean age of 69 years (SD ± 9), were randomly assigned to a walking-skill program emphasizing weight-bearing exercises or usual physiotherapy. Outcomes were assessed before the interventions started at 6 weeks postoperatively (T1), directly after the interventions at 12-14 weeks (T2) and 9 months after the interventions (T3). Walking was the primary outcome, assessed by the 6 min walk test (6MWT). The secondary outcomes were timed stair climbing, timed stands, Figure-of-eight test, Index of muscle function, active knee range of motion, Knee Injury and Osteoarthritis Outcome Score and self-efficacy score.
  
  
  RESULTS
  From T1 to T2, a better 6MWT score was found in favor of the walking-skill program of 39 m (2-76), p = 0.04. The difference between the groups in 6MWT persisted at T3, 44 m (8-80), p = 0.02. No differences in other outcome measures were found.
  
  
  CONCLUSIONS
  The walking-skill program had better effect on walking than usual physiotherapy. Weight bearing was tolerated. Implications for Rehabilitation Weight-bearing exercises are tolerated by the patients in the early stage after TKA. Physiotherapy that focuses on learning different ways of walking through practice may be a plausible way to train patients after TKA.
authors.affiliation: Department of Health Sciences, Institute of Health and Society, University of Oslo , Oslo , Norway and.
authors.forename: Vigdis
authors.initials: V
authors.lastname: Bruun-Olsen
authors.forename: Kristi Elisabeth
authors.initials: KE
authors.lastname: Heiberg
authors.forename: Astrid Klopstad
authors.initials: AK
authors.lastname: Wahl
authors.forename: Anne Marit
authors.initials: AM
authors.lastname: Mengshoel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000534:rehabilitation*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011182:Postoperative Care / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*; D016474:Weight-Bearing