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

Purpose: 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). Method: 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. Conclusion: 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.

• Exercise
• knee arthroplasty
• physiotherapy
• rehabilitation
• walking skills

Acknowledgements

We would like to thank the physiotherapists at Bærum General Hospital, Vestre Viken Hospital Trust and Martina Hansen’s Hospital, and especially Anne Gunn Kallum and Mary Deighan Hansen, for their valuable assistance during the collection of the data for this study.