”Patients with RA have lower expectations about postsurgical outcomes after TKA”. So says a new study by researchers at the Hospital for Special Surgery (HSS) in New York City published on November 6, 2011.
LegTutor used for post total knee surgery physical rehabilitation in Arthritis patients (RA) (OA)
In a studypresented at the annual meeting of the American College of Rheumatology osteoarthritis patients compared to rheumatoid arthritis who undergo total knee replacement (TKR) surgery have lower expectations about their postsurgical outcomes. This can cause some patients is the OA group to reduce their postsurgical rehabilitation leading to worse outcomes.
Lisa Mandl from the hospitla said that if patients have lower expectations, then maybe they don’t push themselves during their physical therapy.
It is well reported that rheumatoid arthritis (RA) who undergo a TKR – total knee replacement are often very satisfied with the surgery. This is contrary to the inferior outomes that RA patiens show compared to OA. Because satisfaction is not only determined by reduction is in pain but also the meeting of pre-operative expectations, investigators looked to determine if the expectations of the two patient groups differed. TKR is also known as total knee arthroplasty. Roughly 90 percent of patients who undergo TKA have osteoarthritis.
The outcome measures that the group used where:
Lower Extremity Activity Score (LEAS) score.
Pain, stiffness and function prior to surgery, can be measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC).
Expectations prior to surgery measured using the Hospital for Special Surgery Expectations Survey
Intensive exercise practice is proven to improve functional movement ability following orthopedic and neurological injury and disease including post TKR, TKA and THR, THA. Patient motivation and control of the exercise practice are the fundamental factors that are required for optimum functional recovery. Traditional practice is mostly based on low technology tools that intrinsically lack features to challenge and motivate the patient to intensive exercise training. In addition low technology tools do not provide sufficient resolution that allow the physical and occupational therapist to completely control the required exercise performance.
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The Tutors consist of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice after TKR and THR and other knee and hip surgery. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. For instance when the patient following TKR does a squat exercise the knee may rotate inwards. In this case the physical therapist using the LegTutor will encourage the patient to do repetitive squatting exercises that do not have compensatory knee rotation. During the practice the physiotherapist and the patient is provided with biofeedback information on the rotation of the knee. In this way, the patient will learn how to do the exercise and properly strengthen the knee without the accompanying knee rotation. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.
The new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified.