Objective To explore the feasibility, fidelity, safety, and preliminary outcomes of a physical therapist–administered physical activity ( PA ) intervention after total knee replacement ( TKR ). Methods People who had undergone a unilateral TKR and were receiving outpatient physical therapy ( PT ) were randomized to a control or intervention group. Both groups received standard PT for TKR . The intervention included being provided with a Fitbit Zip, step goals, and 1 phone call a month for 6 months after discharge from PT . Feasibility was measured by rates of recruitment and retention, safety was measured by the frequency of adverse events, and fidelity was measured by adherence to the weekly steps/day goal created by the physical therapist and participant monitoring of steps/day. An Actigraph GT 3X measured PA , which was quantified as steps/day and minutes/week of engaging in moderate‐to‐vigorous PA . Our preliminary outcome was the difference in PA 6 months after discharge from PT between the control and intervention groups. Results Of the 43 individuals who were enrolled, 53.4% were women, the mean ± SD age was 67.0 ± 7.0 years, and the mean ± SD body mass index was 31.5 ± 5.9 kg/m 2 . For both the control and intervention groups, the recruitment and retention rates were 64% and 83.7%, respectively, and adherence to the intervention ranged from 45% to 60%. No study‐related adverse events occurred. The patients in the intervention group accumulated a mean 1,798 more steps/day (95% confidence interval [95% CI ] 240, 3,355) and spent 73.4 more minutes/week (95% CI –14.1, 160.9) engaging in moderate‐to‐vigorous PA at 6 months than those in the control group. Conclusion A physical therapist–administered PA intervention is feasible and safe, demonstrates treatment fidelity, and may increase PA after TKR . Future research is needed to establish the effectiveness of the intervention.
Abstract Objective To explore primary care physicians’ (PCPs’) experience with and barriers to prescribing exercise for people with knee osteoarthritis (OA). Design A qualitative descriptive study using semistructured interviews. Setting Ontario. Participants Twelve PCPs recruited from academic and community family health practices. Methods Twelve 30- to 60-minute, one-on-one interviews were conducted using a purposive sampling of PCPs. Data were analyzed using a constant comparison approach. Main findings Of the 12 interviews, 11 were analyzed and organized in relation to the primary finding that PCPs often assigned a low priority both to OA as a disease and to exercise as a treatment. It was discovered that exercise, the main treatment for OA, is often not perceived as a “real” medical treatment; prescribing exercise is perceived as being outside of most PCPs’ scope of practice; and PCPs often account for success or failure of prescribed exercise as being the function of individual patient motivation. Conclusion Although knee OA often affects incidence of and complicates other comorbidities, in general, PCPs consider knee OA to be lower in importance relative to other diseases they manage. Improved awareness of OA and its effect on other chronic conditions might improve uptake of OA treatment, including exercise. If additional guidance on exercise is needed, referring patients to a physiotherapist is a potential solution.
The definitive treatment for knee osteoarthritis is a total knee replacement, which results in a clinically meaningful improvement in pain and physical function. However, evidence suggests that physical activity (PA) remains unchanged after total knee replacement (TKR).The objective of this study is to investigate the efficacy, fidelity, and safety of a physical therapist-administered PA intervention for people after TKR.This study will be a randomized controlled trial.The setting is an outpatient physical therapy clinic.The participants are 125 individuals who are over the age of 45 and are seeking outpatient physical therapy following a unilateral TKR.In addition to standardized physical therapy after TKR, the intervention group will receive, during physical therapy, a weekly PA intervention that includes a wearable activity tracking device, individualized step goals, and face-to-face feedback provided by a physical therapist.The control group will receive standardized physical therapy alone after TKR.The efficacy of the intervention will be measured as minutes per week spent in moderate to vigorous PA at enrollment, at discharge, and at 6 months and 12 months after discharge from physical therapy. The fidelity and safety of the intervention will be assessed throughout the study.Participants will not be masked, PA data will be collected after randomization, and the trial will be conducted at a single site.The goal of this randomized controlled trial is to increase PA after TKR. A protocol for investigating the efficacy, fidelity, and safety of a physical therapist-administered PA intervention for people after TKR is presented. The findings will be used to support a large multisite clinical trial to test the effectiveness, implementation, and cost of this intervention.
