Activity-pacing and outcomes of total knee arthroplasty: A longitudinal study

Abstract Background: Psychological factors may induce chronic pain and lead to inactivity after total knee arthroplasty (TKA). The impact of excessive variations in physical activity on psychological factors remains unclear. Aims/Objectives: This study investigated the impact of wide variations in physical activity during occupational therapy (OT) in the early period after TKA. Materials and Methods: We enrolled 30 TKA patients. Activities were measured postoperatively for 1 week. Patients were assigned to “good-pacing” or “poor-pacing” groups based on the correlation between physical activity and OT day. The outcome indices were Canadian occupational performance measure, pain (resting and walking), pain catastrophizing (rumination, helplessness, and magnification), anxiety, depression, and pain self-efficacy. Results: Twenty (66.6%) patients demonstrated good pacing, while ten (33.3%) showed poor pacing. The good-pacing group showed increased physical activity as the OT day increased. On the contrary, physical activity did not increase with OT day in the poor-pacing group, and these patients exhibited significantly higher walking pain, anxiety, and depression than those in the good-pacing group (p < 0.05). Conclusion: TKA patients with excessive variation in physical activity during OT demonstrated higher pain, anxiety, and depression. Significance: Physical activity variations could improve the postoperative outcomes of TKA patients.