Low-Load Unilateral and Bilateral Resistance Training to Restore Lower Limb Function in the Early Rehabilitation After Total Knee Arthroplasty: A Randomized Active-Controlled Clinical Trial

Abstract

Background: Continuous passive motion (CPM) is frequently used during rehabilitation following total knee arthroplasty (TKA). Low-load resistance training (LLRT) using continuous active motion (CAM) devices is a promising alternative. We investigated the effectiveness of CPM compared to LLRT using the affected leg (CAMuni) and both legs (CAMbi) in the early post-operative rehabilitation. Hypotheses: (I) LLRT (CAMuni and CAMbi) is superior to CPM, (II) additional training of the unaffected leg (CAMbi) is more effective than unilateral training (CAMuni).Materials and Methods: Eighty-five TKA patients were randomly assigned to three groups, respectively: (i) unilateral CPM of the operated leg; (ii) unilateral CAM of the operated leg (CAMuni); (iii) bilateral alternating CAM (CAMbi). Patients were assessed 1 day before TKA (pre-test), 1 day before discharge (post-test), and 3 months post-operatively (follow-up). Primary outcome: active knee flexion range of motion (ROMFlex). Secondary outcomes: active knee extension ROM (ROMExt), swelling, pain, C-reactive protein, quality of life (Qol), physical activity, timed-up-and-go performance, stair-climbing performance, quadriceps muscle strength. Analyses of covariances were performed (modified intention-to-treat and per-protocol).Results: Hypothesis I: Primary outcome: CAMbi resulted in a higher ROMFlex of 9.0° (95%CI −18.03–0.04°, d = 0.76) and 6.3° (95%CI −14.31–0.99°, d = 0.61) compared to CPM at post-test and follow-up, respectively. Secondary outcomes: At post-test, C-reactive protein was lower in both CAM groups compared with CPM. Knee pain was lower in CAMuni compared to CPM. Improved ROMExt, reduced swelling, better stair-climbing and timed-up-and-go performance were observed for CAMbi compared to CPM. At follow-up, both CAM groups reported higher Qol and CAMbi showed a better timed-up-and-go performance. Hypothesis II: Primary outcome: CAMbi resulted in a higher knee ROMFlex of 6.5° (95%CI −2.16–15.21°, d = 0.56) compared to CAMuni at post-test. Secondary outcomes: At post-test, improved ROMExt, reduced swelling, and better timed-up-and-go performance were observed in CAMbi compared to CAMuni.Conclusions: Additional LLRT of the unaffected leg (CAMbi) seems to be more effective for recovery of function than training of the affected leg only (CAMuni), which may be mediated by positive transfer effects from the unaffected to the affected limb (cross education) and/or preserved neuromuscular function of the trained, unaffected leg.Trial Registration:ClinicalTrials.gov Identifier: NCT02062138.

Physical Activity Training Methods to Improve the Physical Condition of Volleyball Players: A Systematic Review

“…Training the 11-year-old volleyball player unilaterally and bilaterally and combining the two exercises, found that the results varied. 13 of the 21 performance indicators showed significantly greater changes after 6 weeks of training when unilateral and lateral training were combined, compared to 6 and 3 for unilateral and bilateral training, respectively (Eliassen et al, 2018;Jacksteit et al, 2021;Ramirez-Campillo et al, 2018). To significantly improve performance during high-intensity, short-term explosive activity, a combination of these two exercises would be more beneficial (Gonzalo-Skok et al, 2019;Sun et al, 2018).…”

Effectiveness and therapeutic validity of physiotherapeutic exercise starting within one year following total and unicompartmental knee arthroplasty for osteoarthritis: a systematic review

“…The domain "selection of reported result" scored best, with 32 articles (92%) scoring "low RoB" [32-36, 38-47, 49-60, 63, 64, 66-68]. By contrast, the domain "deviations from the intended process" scored as "low RoB" in only 24% of the studies [41,44,51,55,56,61,62,65,68]. In total, three articles (8%) [51,56,68] achieved an overall low RoB score.…”

“…The 6-min walk test (6MWT) [33-35, 42, 43, 52, 55, 60] and the Timed Up and Go test (TUG) [33, 41, 44, 51, 58-60, 62, 64] were used in most studies to measure functional performance. Other studies measured and reported functional performance using subjects' maximal walking speed [38,39,49,51,59,64], the stair-climbing test [33,35,42,44,49,60,67], single-leg stance test [38, 49-51, 56, 60, 67, 68], figure-of-eight test [35,42,67,68], functional reach test [58,59], 10-min walk test [41,50,62], 30-s chair test [42,44,60], Berg balance scale [45,58], and subjects' step cadence [49,66]. The 50-foot walking test was reported in one article [36].…”

“…Other disease-specific tools included the Knee Injury and Osteoarthritis Outcome Score (KOOS) [35, 41-43, 46, 60, 68] and the knee society score (KSS) [41]. The following generic measuring instruments were also used frequently: Short Form Health Survey 12 (SF-12) [33,54,60], Late-Life Function & Disability Instrument (Late-Life FDI) [67,68], 5-level EQ-5D [67,68], Oxford knee score (OKS) [54,67,68], Physical Activity Scale for the Elderly (PASE) [67,68], Short Form Health Survey 36 (SF-36) [43,44,52], and Lower Extremity Functional Scale (LFSE) [60,65]. The Functional Independence Measure (FIM) [34], sleep efficiency score [35], KSS [41], and Canadian Occupational Performance Measure (COPM) [63] were reported in one article each.…”

“…The exact intervention for the CG was not reported in 20 studies [33,36,37,39,42,44,49,50,53,54,[56][57][58][60][61][62][63][64][65][66].…”