J Knee Surg 2022; 35(08): 922-931
DOI: 10.1055/s-0040-1721035
Original Article

Short-Term Effects of Isometric Quadriceps Muscle Exercise with Auditory and Visual Feedback on Pain, Physical Function, and Performance after Total Knee Arthroplasty: A Randomized Controlled Trial

Yasutaka Kondo
1   Department of Rehabilitation, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
2   Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
,
Yoshihiro Yoshida
1   Department of Rehabilitation, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
,
Takashi Iioka
3   Department of Orthopedic Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
,
Hideki Kataoka
2   Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
4   Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
,
2   Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
5   Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
,
Tatsuya Hirase
2   Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
5   Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
,
Yuichiro Honda
2   Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
5   Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
,
Atsushi Nawata
6   Medical Engineering Laboratory, ALCARE Co, Ltd, Tokyo, Japan
,
Minoru Okita
2   Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
5   Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
› Author Affiliations
Funding None.

Abstract

Severe acute pain after total knee arthroplasty (TKA) may cause delay in muscle strength and functional recovery, and it is a risk factor for chronic postoperative pain. Although pharmacological approaches are the typical firstline to treat acute pain; recently, nonpharmacological approaches such as exercise have been increasingly applied. The purpose of this investigation was to evaluate the effects of a rehabilitation program involving isometric quadriceps exercise with auditory and visual feedback to improve the short-term outcome after TKA. Sixty-two patients, planning a primary unilateral TKA, were randomly assigned to either an intervention group (n = 31) involving isometric quadriceps exercise with auditory and visual feedback in usual rehabilitation after TKA or a control group (n = 31) involving a standardized program for TKA. Patients in the intervention group performed the isometric quadriceps muscle exercise using the Quadriceps Training Machine from 2 to 14 days after TKA instead of the traditional quadriceps sets. Pain intensity, isometric knee extension strength, range of motion, timed up and go test (TUG), 10-m gait speed, 6-minute walking distance, the Western Ontario and McMaster University Osteoarthritis index (WOMAC), the hospital anxiety and depression scale, and the pain catastrophizing scale were assessed before TKA (baseline) and 1 to 3 weeks after TKA. Pain intensity significantly decreased in the intervention group than in the control group at 1 (p = 0.005), 2 (p = 0.002), and 3 (p = 0.010) weeks after TKA. Greater improvements in TUG (p = 0.036), 10-m gait speed (p = 0.047), WOMAC total score (p = 0.017), pain (p = 0.010), and function (p = 0.028) 3 weeks after TKA were observed in the intervention group. These results suggest that isometric quadriceps exercises with auditory and visual feedback provided early knee pain relief, possibly leading to better improvements in physical performance, and patient's perception of physical function in the early stages of postoperative TKA. Further studies should investigate whether this short-term effect is sustainable.



Publication History

Received: 01 October 2019

Accepted: 05 October 2020

Article published online:
25 November 2020

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  • References

  • 1 Carr AJ, Robertsson O, Graves S. et al. Knee replacement. Lancet 2012; 379 (9823): 1331-1340
  • 2 Skou ST, Roos EM, Laursen MB. et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015; 373 (17) 1597-1606
  • 3 Andersen LØ, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H. Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 2009; 64 (05) 508-513
  • 4 Chan EY, Blyth FM, Nairn L, Fransen M. Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis Cartilage 2013; 21 (09) 1257-1263
  • 5 Buvanendran A, Della Valle CJ, Kroin JS. et al. Acute postoperative pain is an independent predictor of chronic postsurgical pain following total knee arthroplasty at 6 months: a prospective cohort study. Reg Anesth Pain Med 2019; 15: rapm-2018-100036
  • 6 Puolakka PA, Rorarius MG, Roviola M, Puolakka TJ, Nordhausen K, Lindgren L. Persistent pain following knee arthroplasty. Eur J Anaesthesiol 2010; 27 (05) 455-460
  • 7 Stevens JE, Mizner RL, Snyder-Mackler L. Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res 2003; 21 (05) 775-779
  • 8 Robbins SM, Rastogi R, McLaughlin TL. Predicting acute recovery of physical function following total knee joint arthroplasty. J Arthroplasty 2014; 29 (02) 299-303
  • 9 Wu CL, Rowlingson AJ, Partin AW. et al. Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Reg Anesth Pain Med 2005; 30 (06) 516-522
  • 10 Chughtai M, Elmallah RD, Mistry JB. et al. Nonpharmacologic pain management and muscle strengthening following total knee arthroplasty. J Knee Surg 2016; 29 (03) 194-200
  • 11 Vaegter HB, Handberg G, Graven-Nielsen T. Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain 2014; 155 (01) 158-167
  • 12 Koltyn KF, Umeda M. Contralateral attenuation of pain after short-duration submaximal isometric exercise. J Pain 2007; 8 (11) 887-892
  • 13 Coudeyre E, Jegu AG, Giustanini M, Marrel JP, Edouard P, Pereira B. Isokinetic muscle strengthening for knee osteoarthritis: a systematic review of randomized controlled trials with meta-analysis. Ann Phys Rehabil Med 2016; 59 (03) 207-215
  • 14 Shakespeare D, Kinzel V. Rehabilitation after total knee replacement: time to go home?. Knee 2005; 12 (03) 185-189
  • 15 Van Damme S, Legrain V, Vogt J, Crombez G. Keeping pain in mind: a motivational account of attention to pain. Neurosci Biobehav Rev 2010; 34 (02) 204-213
  • 16 Legrain V, Bruyer R, Guérit JM, Plaghki L. Involuntary orientation of attention to unattended deviant nociceptive stimuli is modulated by concomitant visual task difficulty. Evidence from laser evoked potentials. Clin Neurophysiol 2005; 116 (09) 2165-2174
  • 17 Paris TA, Misra G, Archer DB, Coombes SA. Effects of a force production task and a working memory task on pain perception. J Pain 2013; 14 (11) 1492-1501
  • 18 Schmitt YS, Hoffman HG, Blough DK. et al. A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. Burns 2011; 37 (01) 61-68
  • 19 Schulz KF, Altman DG, Moher D. CONSORT Group. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 2010; 63 (08) 834-840
  • 20 Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther 2012; 92 (02) 210-226
  • 21 Boeckstyns ME, Backer M. Reliability and validity of the evaluation of pain in patients with total knee replacement. Pain 1989; 38 (01) 29-33
  • 22 Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39 (02) 142-148
  • 23 Evensen NM, Kvåle A, Braekken IH. Reliability of the timed up and go test and ten-metre timed walk test in pregnant women with pelvic girdle pain. Physiother Res Int 2015; 20 (03) 158-165
  • 24 Bautmans I, Lambert M, Mets T. The six-minute walk test in community dwelling elderly: influence of health status. BMC Geriatr 2004; 4: 6
  • 25 Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15 (12) 1833-1840
  • 26 Hashimoto H, Hanyu T, Sledge CB, Lingard EA. Validation of a Japanese patient-derived outcome scale for assessing total knee arthroplasty: comparison with Western Ontario and McMaster Universities osteoarthritis index (WOMAC). J Orthop Sci 2003; 8 (03) 288-293
  • 27 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
  • 28 Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 524-532
  • 29 Schroer WC, Diesfeld PJ, Reedy ME, LeMarr AR. Isokinetic strength testing of minimally invasive total knee arthroplasty recovery. J Arthroplasty 2010; 25 (02) 274-279
  • 30 Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39 (02) 175-191
  • 31 Russo LR, Benedetti MG, Mariani E, Roberti di Sarsina T, Zaffagnini S. The Videoinsight® Method: improving early results following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (09) 2967-2971
  • 32 Myles PS, Myles DB, Galagher W. et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2017; 118 (03) 424-429
  • 33 Legrain V, Damme SV, Eccleston C, Davis KD, Seminowicz DA, Crombez G. A neurocognitive model of attention to pain: behavioral and neuroimaging evidence. Pain 2009; 144 (03) 230-232
  • 34 Slapsinskaite A, Razon S, Balagué Serre N, Hristovski R, Tenenbaum G. Local pain dynamics during constant exhaustive exercise. PLoS One 2015; 10 (09) e0137895
  • 35 Bantick SJ, Wise RG, Ploghaus A, Clare S, Smith SM, Tracey I. Imaging how attention modulates pain in humans using functional MRI. Brain 2002; 125 (Pt 2): 310-319
  • 36 Knittle KP, De Gucht V, Hurkmans EJ. et al. Effect of self-efficacy and physical activity goal achievement on arthritis pain and quality of life in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2011; 63 (11) 1613-1619
  • 37 Ploeger HE, Takken T, de Greef MH, Timmons BW. The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. Exerc Immunol Rev 2009; 15: 6-41
  • 38 Balducci S, Zanuso S, Nicolucci A. et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis 2010; 20 (08) 608-617
  • 39 Si HB, Yang TM, Zeng Y. et al. Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty. BMC Musculoskelet Disord 2017; 18 (01) 265
  • 40 Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. J Pain 2013; 14 (05) 502-515
  • 41 Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2015; 114 (04) 551-561
  • 42 Burns LC, Ritvo SE, Ferguson MK, Clarke H, Seltzer Z, Katz J. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review. J Pain Res 2015; 8: 21-32
  • 43 Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52 (02) 69-77
  • 44 Ha CW, Park YB, Song YS, Kim JH, Park YG. Increased range of motion is important for functional outcome and satisfaction after total knee arthroplasty in asian patients. J Arthroplasty 2016; 31 (06) 1199-1203
  • 45 Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN. Kinemax Outcomes Group. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?. J Arthroplasty 2003; 18 (03) 286-294
  • 46 Williams VJ, Piva SR, Irrgang JJ, Crossley C, Fitzgerald GK. Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports Phys Ther 2012; 42 (08) 716-723
  • 47 Sibia US, King PJ, MacDonald JH. Who is not a candidate for a 1-day hospital-based total knee arthroplasty?. J Arthroplasty 2017; 32 (01) 16-19