Authors (including presenting author) :
YIP KS(1), TAM MP(1), CHAN YM(2), CHAN LC(1), SUEN MY(2)
Affiliation :
(1)Department of Physiotherapy, Pok Oi Hospital,(2)Department of Physiotherapy, Tin Shui Wai Hospital
Introduction :
With the increase in aging population, the number of patients waiting for total knee replacement (TKR) operations in NTWC has been increased sharply in the past few years. Pre-operative physiotherapy was showed to have better improvement in terms of pain level and function in the early post-operative phase (Wang et al., 2016). A comprehensive prehabilitaion program was established for TKR patients in Pok Oi Hospital (POH) and Tin Shui Wai Hospital (TSWH) since July 2017 to optimise both their physical and psychological aspects before the operation. This study aims to evaluate the effectiveness of this program in terms of hospital length of stay and patient outcomes upon discharged from post-operative physiotherapy treatment at out-patient department.
Objectives :
(1) To investigate the effectiveness of physiotherapy prehabilitation program on the functional outcomes for patients with TKR operation. (2) To evaluate the potential of prehabilitation program to shorten the length of stay of TKR patients.
Methodology :
Patients showing willingness to join the prehabilitation program during the TKR pre-admission assessment at POH were recruited as the study group. Patients who had received knee joint replacement and only post-operative physiotherapy treatment at POH or TSWH out-patient physiotherapy department were recruited as the control group. The prehabilitation program incorporated various exercise training including cardiovascular training, strengthening exercise, stretching exercise, hydrotherapy, education on the post-operative exercises, ambulatory training with walking aids and pain relief management. Outcomes of the two groups were compared after the patients had been discharged from post-operative physiotherapy treatment from POH or TSWH. Outcomes including pain level by Numeric Pain Rating Scale (NPRS), Numeric Global Rate of Change Scale (NGRCS), training time, 30 seconds chair rise and walking speed were compared between study and control group. The mean of outcomes of the pre- and post- difference was calculated and compared between groups. The length of stay (LOS) of patients with perhabiliation program was also compared with all the patients undergone TKR operation.
Result & Outcome :
From March 2019 to December 2019 in POH or TSWH, a total of 10 patients as the study group had completed the prehabilitation program and post-operative rehabilitation and there were 19 patients as the control group had completed the post-operative rehabilitation. It was found that the average post-operative training time of the study and control group were 8.86 ±2.59 and 10.01 ±2.88 weeks respectively. The improvement in outcomes as charted by NPRS, NGCRS, 30 seconds chair rise and walking speed had no significant difference between study and control group. Furthermore, it was found that the mean of LOS for patients who completed the prehabilitation program was shorter (6.43 ±1.91 days) as compared to the mean of LOS (8.96 ±6.47 days) of TKR patients in POH. In conclusion, patients who attended prehabilitation program require less training time to achieve similar functional outcomes. It also reduced the LOS of patients after TKR surgery. Therefore, patients who will undergo TKJ operation are highly recommended to attend the prehabilitation program in order to recover faster.
