Analysis Of Factors Influencing Patients’ Early Functional Rehabilitation After Total Knee Arthroplasty

Objective:To study the changes of early functional rehabilitation for patients undergoing total knee arthroplasty due to knee osteoarthritis,and to study the effects of the high-intensity rehabilitation guidance.Evaluate the effects of factors such as age,gender,BMI,type of caregiver,education of the caregiver,hypertension,diabetes,cerebrovascular disease history,knee mobility,knee flexion limit,and film and television data on functional rehabilitation.Hope to better guide clinical work.Methods:A prospective cohort study was performed in this study.From February 2019 to July 2019,a total of 50 patients with knee osteoarthritis as the primary diagnosis were enrolled in Qilu Hospital of Shandong University.The patient’s age,gender,BMI,type of caregiver,education of the caregiver,hypertension,diabetes,history of cerebrovascular disease,knee mobility,limited degree of knee flexion,and film and television data were counted.Patients in the observation group received high-intensity rehabilitation guidance:before surgery,2 days after surgery,before discharge(5-7 days after surgery),2 weeks after surgery,5 weeks after surgery,and 8 weeks after surgery.Interventions were given after the 11th week.The control group received general rehabilitation guidance(3 times):before operation,2 days after operation and 5-7 days before discharge(usually after operation).Fill in WOMAC,Lysholm,IKDC,knee muscle strength and knee function,and service satisfaction scores before surgery,3 weeks after surgery,6 weeks after surgery,9 weeks after surgery,and 12 weeks after surgery.Knee function is expressed by WOMAC function score,muscle strength is expressed by KSS function,pain score is expressed by WOMAC pain score,and service satisfaction is expressed by "0-10 points" table.Comparison between groups,analysis of the impact of high-intensity rehabilitation guidance on patients after total knee arthroplasty,and the impact of various factors on each score,and explore the relationship between knee function,muscle strength,pain and knee satisfaction.Results:(1)WOMAC scores of both the observation group and the control group were negatively correlated with time,and the Lysholm score and IKDC score were positively correlated with time.WOMAC and Lysholm scores were statistically significant at 3,6,and 12 weeks after surgery;IKDC scores were statistically significant at 3 and 6 weeks after surgery,but they were not significant at 12 weeks Difference(P=0.068).One-way analysis of variance,we can find that the observation group and control group of WOMAC,Lysholm,IKDC score comparisons at each time(P=0.000),the difference is significant.There was no significant difference in service satisfaction scores between the observation group and the control group before discharge(P=0.552)and 12 weeks after operation(P=0.131).(2)The knee joint function score can find that the patient has a more obvious sustained functional recovery;the pain is significantly relieved than before surgery,and the pain gradually decreases with time;through muscle strength analysis,it can be found in the third week after surgery.Muscle strength was significantly reduced compared to preoperative time;as time progressed,the patient’s satisfaction with the knee joint gradually increased.Univariate analysis of variance revealed significant differences in knee function,muscle strength,pain,and satisfaction scores(P=0.000).(3)Correlation analysis,preoperative:muscle strength was related to knee function,pain,and knee satisfaction;knee function scores were all related to muscle strength,pain.Knee satisfaction is mainly related to muscle strength.The third week after operation:muscle strength was related to pain and knee function score;knee function score was related to knee satisfaction.The sixth week after operation:muscle strength is related to pain and knee function score;knee satisfaction is related to muscle strength and knee function score.The twelfth week after operation:muscle strength was related to knee function score;knee satisfaction was related to muscle strength and knee function score.(4)Univariate analysis,knee mobility,knee flexion,and knee flexion before surgery had an effect on WOMAC,Lysholm,and IKDC scores,and the differences were statistically significant(P<0.05).Age differences affected patients’ knee satisfaction,knee mobility,knee flexion limitation,and knee flexion before surgery affected knee function(P<0.05).Conclusions:(1)Both high-intensity rehabilitation guidance and conventional rehabilitation guidance were beneficial to patients ’functional rehabilitation after surgery,and high-intensity rehabilitation guidance was more beneficial to patients’early functional rehabilitation;meanwhile,the patient’s service satisfaction wasn’t significant difference between before discharge and at 12 weeks.(2)The patient’s knee function,muscle strength,pain,and knee satisfaction gradually improved with time;the 12th week after surgery was not the end point of rehabilitation,and it took longer time to exercise;Muscle strength would decrease significantly in the 3rd week after operation compared with that before operation and then recovered slowly.(3)Multiple comparisons showed that knee function in the third week after surgery was not significantly improved compared with that before surgery(P>0.05);pain relief was slower in the third week after surgery than in the sixth week after surgery(P>0.05),and knee satisfaction was similar(P>0.05).(4)During the functional rehabilitation of patients,there was a correlation between muscle strength and pain;the most important factor affecting patient satisfaction was muscle strength and knee function.(5)The degree of knee flexion before surcery affected the patient’s functional recovery,and this effect gradually disappeared with time.Knee joint mobility and knee flexion were important factors affecting functional rehabilitation.Factors such as age,type of caregiver,education of the caregiver,and diabetes had no effect on the patient’s functional recovery.Preoperative hypertension and cerebrovascular disease had significance at some moments.(6)The knee joint flexion limitation before operation,after operation and knee joint activity have the greatest impact on the recovery of knee joint function.Age,diabetes,cerebrovascular disease,and knee flexion had a greater effect on patients’ knee satisfaction.Knee joint mobility and degree of flexion before and after surgery,cerebrovascular disease had a certain effect on muscle strength.Age,BMI,knee mobility before and after surgery,and knee flexion had some effects on pain.