The Effection Of Postoperative Kinesiophobia On The Rehabilitation Outcome Of Patients With Unilateral Total Knee Replacement

ObjectiveTo investigate the influence of postoperative kinesiophobia on the rehabilitation outcome of patients with unilateral total knee replacement;to survey the occurrence of postoperative kinesiophobia in patients with unilateral total knee replacement status;and torealize the present situation of occurrence of postoperative kinesiophobia in patients with total knee replacement,and to relize the correlation between the fear of movement disorder and rehabilitation outcome after total knee arthroplasty.To implement the targeted intervention to the patients and provide evidence based medical science for clinical medical staff to guide patients to effective rehabilitation.Method1.According to the study’s include and exclude selection standard,we conducted a prospective longitudinal cohort study which included 244 patients admitted to the Department of orthopedics,the First Affiliated Hospital of Zhengzhou University from September 2015 to May 2016.2.All patients underwent baseline information collected within 48 h and biochemical indexes such as fasting blood glucose,hemoglobin,and we use the Tampa Scale of Kinesiophobia to evaluate the total knee arthroplasty patients,based on the standard that TSK scores >37 indicating patients with kinesiophobia,in order to assess that whether he or she is fear of movement.3.For 244 cases of patients,researchers will take follow-up survey in 2th week postoperatively(in hospital),4th week postoperatively,3th month postoperatively,6th month postoperatively.In 2th week postoperatively,4th week postoperatively,researchers use the numerical rating scale and protractor to assess the degree of postoperative patients with knee joint pain and knee flexion degree.In 3th month postoperatively and 6th month postoperatively,in addition to collect the above information,researchers still need to use American Knee Society Score to evaluate patients with knee joint function.4.Using SPSS19.0 software for statistical analysis of the data,the use of descriptive statistical analysis of the general data of patients described.Chi square test was used to compare the proportion of variables between groups.Repeated measures analysis of variance was used to determine the trend of outcome variables.Pearson correlation test was used to analyze the correlation between the degree of postoperative pain and knee pain,knee flexion and knee function in patients with unilateral total knee arthroplasty.If P<0.05,we can think that there exist a significant statistical significance.Results1.The study conducted 244 patients who were with unilateral total knee replacement.Patients’ average age was 66.95±7.53 years old.Among them,179 cases of female patients accounted for 74.27%,213 cases patients who were married accounted for 88.38%.Patients’ Tampa Scale of Kinesiophobia scored an average of 36.80±10.89,the average body mass index was 24.98±3.67,the average fasting blood-glucose was 4.82±0.77 mmol/L.Through six months of follow-up for the patients,there were 3 cases lost to follow-up,the rate of the defaulters was 1.23%.We conducted 241 participants practically.2.The state of occurrence of postoperatively kinesiophobia in patients with total knee replacement: This study included 241 participants.There were 67 patients who was with fear of movement,174 patients were without fear of movement,the incidence of postoperatively kinesiophobia is about 27.80%.3.Comparison of postoperative pain degree between the kinesiophobia group and the group without kinesiophobia: In 2th week,4th week,3th month,and 6th month after the operation,count patients’ knee joint pain intensity in two groups,we used ANOVA for repeated measurement to statistical analysis the data,it turned out that the pain intensity of the fear group was significantly higher than that of the group without kinesiophobia at each time points,and there exist a significant statistical significance(P<0.05).4.Comparison of postoperative knee flexion in the patients with the kinesiophobia group and the group without kinesiophobia: In 2th week,4th week,3th month,and 6th month after the operation,count patients’ knee flexion in two groups,we used ANOVA for repeated measurement to statistical analysis the data,it turned out that the movement intensity of the kinesiophobia group was significantly lower than that of the group without kinesiophobia,and there exist a significant statistical significance(P<0.05).5.Comparison of postoperative knee function score between the kinesiophobia group and the group without kinesiophobia: At 3th month and 6th month after operation,count patients’ AKSS score in two groups,we used two independent samples t test to statistical analysis the data,it turned out that,at each time point,the knee function score of the kinesiophobia group was significantly lower than that of the group without kinesiophobia,and there exist a significant statistical significance(P<0.05).6.As time goes on,two groups of patients with pain intensity and joint flexion were improved.We used ANOVA for repeated measurement in two groups of patients with knee joint pain intensity and knee flexion degree through statistical analysis.According to the results,we can see that,there exist difference between two groupsat all time points in pain intensity.The knee pain degree of patients who were with postoperativly kinesiophobia is higher than the other group.The differences between two groups possess statistically significant(P<0.05).Patients who were in the kinesiophobia group were different of the other group at all time points in terms of degree of knee flexion.Patients without kinesiophobia could move larger degree than those who were with kinesiophobia.The differences between two groups possess statistically significant(P<0.05).From 2th week to 4th week after surgery,patients without kinesiophobia were obviously improved in knee joint pain intensity and degree of knee flexion(P<0.05).From 4th week postoperatively to 3th month postoperatively,3th month postoperatively to 6th month postoperatively,there exist no statistical difference in two groups of patients’ degree of improvement with postoperative knee pain intensity(P>0.05).In addition,from 2th week to 4th week after surgery,patients who were without kinesiophobia improved significantly after his operation in knee flexion degree(t=2.654,P<0.05).From 4th week to 3th month after surgery,patients who was with kinesiophobia postoperatively improved significantly in knee flexion degree(t=2.763,P<0.05).7.The correlation of postoperative kinesiophobia and the rehabilitation outcome of total knee replacementAt all the time points,there was negative correlation between TSK score and joint flexion.The correlation was highly at 2th week after surgery(r=-0.72,P<0.05).The correlation was moderately at 4th week,3th month,6th month after surgery(P<0.05).At all the time points,there was positive correlation between TSK score and the degree of knee pain.The correlation was highly at 4th week after surgery(r=0.76,P<0.05).The correlation was moderately at 2th week,3th month after surgery(P<0.05).The correlation turned weak at 6th month after surgery(r=0.24,P<0.05).There is a moderate negative correlation between TSK score and AKSS score.The correlation was moderately at 3th month postoperatively(r=-0.33,P<0.05),the correlation turned weak at 6th month after surgery(r=-0.28,P<0.05).Conclusions1.Postoperative kinesiophobia negatively impact on the rehabilitation outcome of patients with total knee replacement.2.No fear of movement is more conducive to the rehabilitation of patients with total knee replacement.3.According to the rehabilitation exercise of patients to implement targeted intervention.At the same time,to provide evidence based medical evidence for clinical medical staff to guide the rehabilitation of patients.