术前体力活动量大的患者恢复到基线的时间更长

Surgeries Pub Date : 2024-04-04 DOI:10.3390/surgeries5020021
Roberta E. Redfern, David A. Crawford, Adolph V. Lombardi, K. Tripuraneni, David C. Van Andel, Michael B. Anderson, Jason M. Cholewa
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引用次数: 0

摘要

建议终末期骨关节炎患者参加体育锻炼(PA)以减轻疼痛和改善功能,但患者可能会因关节疼痛而避免参加体育锻炼。我们的目标是研究全髋关节置换术(THA)患者的患者报告结果和客观活动度指标(步数)与术前体力活动水平的关系。共有 1647 名患者参加了一项多中心前瞻性队列研究,该研究调查了基于智能手机的自主康复护理管理平台,并将接受全髋关节置换术的患者纳入分析范围。整个队列的步数被分为四等分,将患者的基线PA分为低、中、高三个等级。通过方差分析比较了不同活动组的疼痛、EQ-5D-5L、HOOS JR 和步数等结果。高基线 PA 组的术前疼痛评分最低,改善幅度最小。低活动量组患者的 EQ-5D-5L 改善最大,而 EQ-VAS、HOOS JR 和满意度的变化在各组之间相似。低度和中度 PA 患者在六周内增加了体力活动,分别达到术前步数的 180% 和 114%;而高度 PA 患者直到术后一年才恢复到完整步数。接受 THA 手术的高水平 PA 患者术前的疼痛程度较低,功能较高,但术后一年内 PA 的改善程度可能较低。这些结果可能有助于在术前对患者的期望进行适当的咨询。
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Patients with High Pre-Operative Physical Activity Take Longer to Return to Baseline
Patients with end-stage osteoarthritis are recommended to engage in physical activity (PA) to reduce pain and improve function but may avoid PA due to joint pain. Our goal was to investigate patient-reported outcomes and objective mobility metrics (step counts) in total hip arthroplasty (THA) patients as a function of pre-operative PA levels. In total, 1647 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation that underwent THA and were included in analysis. The entire cohort’s step count was divided into quartiles to categorize patients with low, moderate, and high baseline PA. Outcomes including pain, EQ-5D-5L, HOOS JR, and step counts were compared according to activity group by ANOVA. Pre-operative pain scores were lowest, with smallest improvements, in the high-baseline PA group. Low-PA patients demonstrated the greatest improvements in EQ-5D-5L, while changes in EQ-VAS, HOOS JR, and satisfaction were similar between groups. Low- and moderate-PA patients increased physical activity by six weeks, reaching 180% and 114% of pre-operative steps; high-PA patients did not return to full step counts until one-year post-operation. Patients who perform high levels of PA undergoing THA report lower levels of pain and higher function pre-operatively but may appreciate less improvement in PA up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations prior to surgery.
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