Efficacy of preoperative progressive resistance training in patients undergoing total knee arthroplasty: 12-month follow-up data from a randomized controlled trial.

OBJECTIVE: The aim of this study was to investigate the effect of adding four weeks preoperative progressive resistance training (PRT) to four weeks postoperative PRT on patient function, muscle strength, and other outcomes 12 months after total knee arthroplasty (TKA). DESIGN: Twelve-month follow-up data from a previously published randomized controlled trial. SETTING: Aarhus University Hospital, Silkeborg Regional Hospital, and Aarhus University. SUBJECTS: A total of 59 patients scheduled for TKA were enrolled in a single-blinded, clinical randomized controlled trial. INTERVENTIONS: Participants were randomized to preoperative PRT (intervention group) or to a control group who "lived as usual" the last four weeks before TKA. The intervention group completed four weeks preoperative and four weeks postoperative PRT, whereas the control group only completed four weeks postoperative PRT. Main follow-up measures were as follows: the 30-second Chair Stand Test (primary outcome), Timed Up and Go Test, walk tests, knee extensor, and knee flexor muscle strength and patient-reported outcomes. Statistical analyses were performed according to the intention-to-treat principle. RESULTS: No significant group differences were observed for the primary outcome 30-second Chair Stand Test (4.0 repetitions versus 2.4 repetitions, P = 0.067) or for other functional performance outcomes. The intervention group had significantly higher weight-normalized knee extensor muscle strength (0.5 Nm/kg versus 0.2 Nm/kg, P = 0.002) and knee flexor muscle strength (0.3 Nm/kg versus 0.2 Nm/kg, P = 0.042) in the operated leg when compared to the control group. No significant group differences for patient-reported outcomes. CONCLUSION: The study supports the use of short-term high-intensity resistance training before TKA as it induces a long-lasting effect on muscle strength, while it may have no discernible effect on functional performance.

Progressive resistance training before and after total hip and knee arthroplasty: a systematic review.

OBJECTIVE: To investigate the effect of progressive resistance training (PRT) on muscle strength and functional capacity before and/or after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The effects of THA and TKA upon quality of life and the rate of adverse events were also investigated. DATA SOURCES: Literature from nine databases. REVIEW METHODS: Studies were included if 1) the effect of a PRT intervention was compared with no intervention or another type of intervention; 2) the outcomes included muscle strength and/or functional capacity; 3) all participants were scheduled for or had just undergone THA or TKA; 4) they were randomized, controlled trials (RCT); and 5) only full-length papers in English were studied. Data on patient characteristics, training regime, controls, and outcome measures were extracted. RESULTS: Four RCT studies on PRT and THA including 136 patients and three RCT studies on PRT and TKA including 284 patients were identified and rated according to the PEDro scale. The general methodological quality of the studies was low. No adverse events were reported in any of the studies. Weak evidence of a beneficial effect of PRT before and/or after THA on muscle strength and functional capacity was found. No effect of PRT before TKA on muscle strength and functional capacity was found. The results of postoperative PRT were too heterogeneous to allow conclusions. CONCLUSION: PRT is safe and feasible before and/or after THA. PRT is safe, but the methodological quality of existing evidence permits no conclusion on the effectiveness of PRT before and/or after TKA.

The effects of various respiratory physiotherapies after lung resection: a systematic review.

Purpose: The purpose of this review was to investigate the effect of respiratory physiotherapy after lung resection on mortality, postoperative pulmonary complications (PPC), length of stay, lung volumes, and adverse events. Material and methods: Randomized or quasi-randomized controlled trials were searched in CENTRAL, PubMed, EMBASE, Cinahl, PEDro, and hand searching of related studies. Various respiratory physiotherapy interventions were compared to standard care, sham treatment, or no treatment. Two reviewers assessed eligibility and quality of studies using Cochrane guidelines. Meta-analyses were undertaken on subgroups of intervention. Results: Various types of positive pressure breathing, deep breathing exercises, and strength and aerobic exercises as a supplement to standard care did not show any significant effect over standard care in preventing mortality or PPC, reducing length of stay, or improving lung volumes. Conclusion: Prophylactic continuous positive airway pressure does not seem to affect rate of mortality and PPC, when compared with standard care embodying respiratory physiotherapy such as airway clearance techniques and assistance with early ambulation. However, further research is still needed to make a final conclusion. The effect of standard respiratory physiotherapy as a package is still unknown, and may or may not be effective in preventing PPC among patients undergoing lung resection.

Physical activity and low-back pain in schoolchildren.

Design of the experiment is to study the cross-sectional sample with retrospective information. The objective is to identify the types of physical activity associated with the decreased occurrence of low-back pain (LBP) in schoolchildren. Physical activity may be hypothesized to possess a potential for LBP prevention. The possible connection between LBP and specific sports activities is however sparsely documented. A total of 546, 15- to 16-year-old schoolchildren filled a questionnaire on current physical activities and LBP occurrence and severity. In multiple logistic regressions, the association of LBP with exposure variables was corrected for body height and weight (data from school health service files) and for anthropometric and school furniture parameters. More than half of the children reported pain or discomfort in the low-back region during the preceding 3 months, and 1/4 experienced a decreased functioning or need of care because of LBP. LBP correlated with physical inactivity, e.g. time spent on homework and hours watching TV or video, and with a series of sports activities, e.g. jogging, handball playing and gymnastics. Among sports activities, only swimming and the number of hours per week participating in soccer were associated with a decreased LBP prevalence. With the exception of swimming and soccer, the types of sport reported by this schoolchild population do not offer themselves for consideration as tools for LBP prevention. Based on the associations found with indicators of physical inactivity, attempts to motivate the children to increase their general physical activity level should be considered for trial.

No Exacerbation of Knee Joint Pain and Effusion Following Preoperative Progressive Resistance Training in Patients Scheduled for Total Knee Arthroplasty: Secondary Analyses From a Randomized Controlled Trial.

BACKGROUND: Preoperative progressive resistance training (PRT) is controversial in patients scheduled for total knee arthroplasty (TKA), because of the concern that it may exacerbate knee joint pain and effusion. OBJECTIVE: To examine whether preoperative PRT initiated 5 weeks prior to TKA would exacerbate pain and knee effusion, and would allow a progressively increased training load throughout the training period that would subsequently increase muscle strength. DESIGN: Secondary analyses from a randomized controlled trial (NCT01647243). SETTING: University Hospital and a Regional Hospital. PATIENTS: A total of 30 patients who were scheduled for TKA due to osteoarthritis and assigned as the intervention group. METHODS: Patients underwent unilateral PRT (3 sessions per week). Exercise loading was 12 repetitions maximum (RM) with progression toward 8 RM. The training program consisted of 6 exercises performed unilaterally. MAIN OUTCOME MEASURES: Before and after each training session, knee joint pain was rated on an 11-point scale, effusion was assessed by measuring the knee joint circumference, and training load was recorded. The first and last training sessions were initiated by 1 RM testing of unilateral leg press, unilateral knee extension, and unilateral knee flexion. RESULTS: The median pain change score from before to after each training session was 0 at all training sessions. The average increase in knee joint effusion across the 12 training sessions was a mean 0.16 cm ± 0.23 cm. No consistent increase in knee joint effusion after training sessions during the training period was found (P = .21). Training load generally increased, and maximal muscle strength improved as follows: unilateral leg press: 18% ± 30% (P = .03); unilateral knee extension: 81% ± 156% (P < .001); and unilateral knee flexion: 53% ± 57% (P < .001). CONCLUSION: PRT of the affected leg initiated shortly before TKA does not exacerbate knee joint pain and effusion, despite a substantial progression in loading and increased muscle strength. Concerns for side effects such as pain and effusion after PRT seem unfounded. LEVEL OF EVIDENCE: I.

The effects of respiratory physiotherapy after lung resection: Protocol for a systematic review.

BACKGROUND: The main treatment of lung cancer (stage 1 and 2) is lung resection surgery. The risk of postoperative pulmonary complications is high and therefore standard postoperative care involves respiratory physiotherapy. The purpose of this systematic review is to create an overview of the evidence on respiratory physiotherapy after lung resection surgery on mortality rate (within 30 days) and postoperative pulmonary complications. METHODS AND ANALYSIS: The review will include randomized or quasi-randomized controlled studies investigating the effect of all types of respiratory physiotherapy on mortality and postoperative pulmonary complications after lung resection surgery. Furthermore, the effect of respiratory physiotherapy is evaluated on secondary outcomes such as length of hospital stay, lung volumes and function, and adverse events. The method of the planned review is described in this paper. The literature search will include the databases PubMed, Cochrane (Central), Embase, Cinahl and PEDro. The literature search is being performed in 2017. If meta-analyses are not undertaken, a narrative synthesis of the available data will be provided. The protocol was registered in PROSPERO on the 10th of October 2016 (registration number CRD42016048956). ETHICS AND DISSEMINATION: Conclusion of this systematic review is expected available in the second half of 2017.

Efficacy of Preoperative Progressive Resistance Training on Postoperative Outcomes in Patients Undergoing Total Knee Arthroplasty.

OBJECTIVE: To investigate the efficacy of 4 weeks of preoperative and 4 weeks of postoperative progressive resistance training (PRT), compared to 4 weeks of postoperative PRT only on functional performance, muscle strength, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA). METHODS: In total, 59 patients were randomized to 4 weeks of preoperative PRT (intervention group) or to a group who lived as usual (control group). Both groups performed 4 weeks of PRT after TKA. At 6 weeks and 1 week before TKA, and at 1, 6, and 12 weeks after TKA, performance-based measures (30-second chair stand test [30sCST], timed-up-and-go [TUG], and walking tests), knee extensor and flexor muscle strength (dynamometry), patient-reported functional performance, health-related quality of life, and pain scores were evaluated. RESULTS: When comparing the changes from baseline to the primary test point 6 weeks after TKA, a significant group difference in favor of the intervention group was found for the 30sCST (2.5 repetitions [95% confidence interval (95% CI) 0.9, 4.1] versus -1.1 repetitions [95% CI -2.8, 0.7]; P < 0.004), the TUG (-0.7 seconds [95% CI -1.6, 0.1] versus 0.8 seconds [95% CI -0.1, 1.7]; P = 0.015), normalized knee extensor muscle strength (-0.2 Nm/kg [95% CI -0.3, -0.1] versus -0.4 Nm/kg [95% CI -0.5, -0.3]; P = 0.002), and normalized knee flexor muscle strength (0.1 Nm/kg [95% CI 0.0, 0.2] versus 0.0 Nm/kg [95% CI -0.1, 0.1]; P = 0.016). No differences were found between groups on patient-reported outcomes. CONCLUSION: Supervised preoperative PRT is an efficacious and safe intervention for improving postoperative functional performance and muscle strength, but improvements in patient-reported outcomes were not detected.

Functional performance is associated with both knee extensor and flexor muscle strength in patients scheduled for total knee arthroplasty: A cross-sectional study.

OBJECTIVE: To determine whether muscle strength in patients scheduled for total knee arthroplasty is: (i) strongly associated with both measured functional performance and patient-reported measures; (ii) more closely associated with functional performance when measured during concentric than during isometric contractions; and (iii) more strongly related to the 30-s chair stand test than to the timed-up-and-go and walking measures. DESIGN: Cross-sectional-study. PATIENTS: Fifty-nine patients (36 women, 23 men), mean age 70.4 years. METHODS: Associations between muscle strength, measured functional performance, and patient-reported measures were calculated. RESULTS: Both knee extensor and knee flexor strength were associated with performance-based measures. In general, concentric knee flexor muscle strength was more strongly associated with functional performance than was isometric knee flexor strength. Concentric and isometric knee extensor strength were of equal importance. The 30-s chair stand test was better than the timed-up-and-go and the walking tests at determining muscle strength. CONCLUSION: Future rehabilitation programmes should include both the knee extensor muscles and the knee flexor muscles in order to improve functional performance. The 30-s chair stand test is a valid and clinical relevant proxy measure of knee extensor and knee flexor muscle strength.

Low back pain in 15- to 16-year-old children in relation to school furniture and carrying of the school bag.

STUDY DESIGN: Cross-sectional sample with longitudinal information. OBJECTIVE: To estimate the relationship between the occurrence of low back pain (LBP) and various types of school furniture and anthropometric dimensions in schoolchildren, and physical loading by school bag carrying. SUMMARY OF BACKGROUND DATA: Some types of school furniture may be hypothesized to prevent or cause LBP. Despite strong opinions in the public debate about a possible relationship between use of various types of school furniture and LBP, scientific research on this matter is sparse. METHODS: Five hundred forty-six schoolchildren aged 14 to 17 years answered a questionnaire about sitting positions during school hours and the presence and severity of LBP. Furthermore, the anthropometric dimensions and the weight of the school bags were measured. The types and dimensions of the school furniture were described and measured. In multivariate analyses was adjusted for physical activity and other possible risk factors. RESULTS: More than half of the adolescents experienced LBP during the preceding 3 months, and 24.2% reported reduced daily function or care seeking because of LBP. LBP occurrence was not associated with the types or dimensions of the school furniture or body dimensions, but was positively associated with carrying the school bag on 1 shoulder [OR: 2.06 (1.29-3.31)]. CONCLUSION: The present study does not support the hypothesis of different types of school furniture being a causative or preventing factor for LBP. Carrying the school bag in an asymmetric manner may play a role.