Are priorities of younger patients with knee pain addressed by PROMs? A qualitative study.

OBJECTIVES: To describe the impact of knee pain and dysfunction in young adults and determine whether current patient reported outcome measures (PROMs) address their recovery priorities. DESIGN: Qualitative. SETTING: Outpatient rehabilitation center. PARTICIPANTS: Young adults, 23-30 years. MAIN OUTCOME MEASURES: 1:1 semi-structured interviews were held and analyzed with NVivo version 11. The Lower Extremity Functional Scale (LEFS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) were compared to participant identified functional limitations. RESULTS: 9 themes were identified in 7 interviews: Incomplete Recovery as Acceptable, Motivation for Adequate Long Term Function, Guidance Needed to Facilitate Recovery, Sports: To Play or Not to Play, Pain, Therapy Participation and Interventions, Impact on Life, Decreased Knowledge and Condition Management, and A Wide Range of Functional Limitations. The LEFS captured 23/26 identified functional activities, the KOOS 22/26, the IKDC 16/26, and the WOMAC 13/26. CONCLUSIONS: Incomplete recovery as an acceptable outcome was the most unique theme found in this study. LEFS captured the most relevant functional activities reported by this group. Physical Therapists should consider these findings in PROM selection to better inform meaningful outcome measurement.

Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement.

OBJECTIVE: To determine the effects of using a continuous passive motion (CPM) device for individuals with poor range of motion (ROM) after a total knee replacement (TKR) admitted for postacute rehabilitation. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation facility (IRF). PARTICIPANTS: Adults (N=141) after TKR with initial active knee flexion <75° on admission to the IRF. INTERVENTION: Two randomized groups: group 1 (n=71) received the conventional 3 hours of therapy per day, and group 2 (n=70) received the addition of daily CPM use for 2 hours throughout their length of stay. MAIN OUTCOME MEASURES: The primary outcome measure was active knee flexion ROM. Secondary outcome measures included active knee extension ROM length of stay, estimate of function using the FIM and Timed Up and Go test, girth measurement, and self-reported Western Ontario and McMaster Universities Osteoarthritis Index scores. RESULTS: All subjects significantly improved from admission to discharge in all outcome measures. However, there were no statistically significant differences in any of the discharge outcome measures of the CPM group compared with the non-CPM group. CONCLUSIONS: CPM does not provide an additional benefit over the conventional interventions used in an IRF for patient after TKR, specifically in patients with poor initial knee flexion ROM after surgery.

Effectiveness of continuous passive motion in an inpatient rehabilitation hospital after total knee replacement: a matched cohort study.

OBJECTIVE: To examine the use of continuous passive motion (CPM) as an adjunct to physical therapy after total knee replacement in patients who were transferred to an inpatient rehabilitation facility (IRF) and to compare the effectiveness of CPM on active range of motion (AROM), functional tasks, destination after discharge, the need for home care services, and the ambulation device at discharge. DESIGN: Matched cohort study. SETTING: IRF. PARTICIPANTS: Patients admitted to a rehabilitation setting after total knee replacement surgery with an initial AROM for knee flexion of less than 75° at admission to the IRF. From this initial population, a matched sample of 61 patient pairs was included in the analysis (61 who used the CPM and 61 who did not receive the adjunct therapy). INTERVENTION: Use of CPM for 2 hours per day as an adjunct to the 3 hours of physical and occupational therapy customary in an IRF. MAIN OUTCOMES: Primary outcomes were discharge active knee flexion ROM and flexion gain. Secondary outcomes were motor, cognitive, and total Functional Independence Measure scores; discharge ambulation device; destination after discharge; and the need for home care services after the inpatient stay. RESULTS: The outcome variables of 61 matched pairs of CPM users and non-CPM users were reported. No statistically significant differences were found in any of the outcome variables that were compared in this matched case design, including AROM knee, flexion gain, discharge to the community, need for home care services after discharge, and discharge with cane/no device. No significant difference was found in all functional scores as measured by the Functional Independence Measure scale. CONCLUSION: For this population, we determined at one facility that less than 30% are provided with a CPM as an adjunct to physical therapy. Using a matched cohort design, we compared CPM use with non-CPM use and determined that the application of CPM may not significantly influence ROM gain.