Effect of Pre-surgery Neuromuscular Physiotherapy (PT)
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional
Phase: Phase 3

Summary: 
      Background:

      Osteoarthritis (OA) is a common degenerative condition of large weight-bearing joints, such
      as the hip and knee, as well as small hand joints. Current interventions in patients with OA
      are limited to symptomatic pain relief and later with total joint replacement (TJR). While
      TJR improves function and pain, it does not fully restore function in most individuals. A key
      factor of functional outcome is probably conditioning before and after TJR surgery. However,
      this has not been studied conclusively in patients undergoing TKR surgery.

      Objective:

        1. Primary endpoint: To study the effect of a pre-surgery neuromuscular PT compared to an
           attention control program on lower extremity function measured by the Chair stands test
           (observed function) and the KOOS score (reported function).

        2. Secondary endpoints will be muscle strength, walking time and mobility.

      Hypothesis:

      The investigators hypothesize that patients undergoing pre-surgery PT will be significantly
      quicker in performing the chair stands test and report a significant improvement in the KOOS
      at 3 months after surgery compared to controls.

      Methods:

      80 patients from a waiting list for unilateral TKR will be randomized to neuromuscular PT or
      an attention control group intervention in a single-blinded randomized controlled trial.
      Assessments will be at baseline, at 3 months after surgery and at 12 months after surgery.

      Intervention:

      The neuromuscular PT group will receive a minimum of 8 and a maximum of 24 training sessions;
      all patients, including the control group, will receive 4 sessions of the Knee School.

      Significance:

      Given the demographic change with an increase in the older segment of the population there
      will be a rise in the absolute number of TKRs. It is therefore warranted to study pre-surgery
      neuromuscular PT to help patients get the most out of their joint replacement.
    

Detailed description: 
      Due to the demographic change with a significant increase in the older segment of the
      population, recent estimates in the United States suggest that the rate of TKR surgery will
      rise exponentially over the next decade. A similar trend is expected in Switzerland with a
      marked increase in the absolute number of TKR surgery. Today, patients waiting for TKR
      surgery in Switzerland are neither routinely participating in an active training program to
      reduce pain and improve function nor in an educational program to increase coping skills
      before surgery.

      The intervention group will receive neuromuscular training as well as 4 sessions of the Knee
      OA School. Both will be offered in group sessions separate from the control group.

      a) The neuromuscular training will take place under the supervision of an experienced
      physiotherapist, 2 sessions a week of 60 minutes each. The training program, based on
      neuromuscular and biomechanical principles, according to the possibilities of the patient.
      The training sessions consists of three parts: warming up (ergometer cycling), a circuit
      program, and cooling down (walking, stretching, mobility). The circuit program comprises four
      exercise circles with the key elements of core stability, postural function, functional
      alignment, lower extremity muscle strength, and functional exercises.

      b) The Knee School is an educational program and takes place in three group sessions and one
      individual follow-up session. Patients receive information about: anatomy and physiology of
      the knee (first group session); proposed physical activity and pain self-management (second
      group session); and the rehabilitation phase after surgery (third group session).

      The control group will receive the Knee School sessions without the neuromuscular PT separate
      from the intervention group to avoid interaction between the groups.
    

Intervention name(s): preoperative neuromuscular training; knee OA School
Intervention type(s): Other; Behavioral
Intervention description(s): The neuromuscular training group will receive a minimum of 8 and a maximum of 24 training sessions; as well as 4 sessions of the Knee OA School.; The education group will only receive 4 sessions of the Knee OA School.
Other intervention name(s): exercise; knee school
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: neuromuscular training; preoperative exercise; physiotherapy; total knee replacement; knee osteoarthritis