Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Connelly, Denise M

Abstract

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are orthopaedic surgeries to manage end-stage osteoarthritis. A year after undergoing TKA or THA, some patients report physical function limitations and unmet physical activity expectations. Limited knowledge of physical function recovery beyond the first year post-surgery is available. To describe physical function recovery in adults during year two after undergoing TKA or THA, two studies were completed using quantitative measures and individual interviews. In both studies, group scores improved significantly for the 30s-CST, and only in the TKA study for the TUG. In both studies, many participants who self-reported improvement at 18-months achieved a minimum clinically important difference (MCID) on the 30s-CST. MCID were achieved only in the TKA study for participants self-reporting improvement at 24-months post-surgery on the TUG, SCT, and 6MWT. In the TKA study, a minority achieved MCID on the OKS, DASI, and UCLA. OHS and UCLA were significantly improved for participants self-reporting improvement at 24-months, but not at the MCID level. Two years after undergoing TKA or THA, all participants reported return to meaningful activity, including community programs, however many returned to light-intensity activities only. In the TKA study, reframing success and acceptance of function aligned with the large range in performance scores. A shift in focus from impairment to living well was a clear transition in recovery in the THA study. A third qualitative study addressed the gap in understanding about how physiotherapists and family physicians refer patients to community exercise programs after undergoing TKA or THA. While all clinicians attempted to connect patients to community-based exercise programs, educated patients on the importance of physical activity post-surgery, and revisited patient readiness to engage in exercise, they often lacked time, knowledge and connection with programs for successful referral. The clinical implications of the findings include that physical function recovery may extend beyond one-year post-surgery, MCID values for performance-based and patient-reported outcome measures are available to assist clinicians with interpretation of patient scores and/or identify patients at risk of decline, and primary care practitioners need support to promote physical function recovery in patients after undergoing TKA or THA.

Summary for Lay Audience

Limited knowledge is available about recovery of physical function in adults after undergoing total hip or total knee joint replacement beyond the first year after surgery. Some patients are unable to do the physical activities they had expected to be able to do after having these surgeries because they are not recovered fully. To measure recovery, there are outcome measures based on patient performance and self-reported questionnaires. In this thesis, two studies were completed using a combination of selected outcome measures to measure recovery and interviews to learn about individual recovery experiences in groups of adults after undergoing total hip or total knee joint replacement surgery. Many participants in both studies who self-reported they had improved at 18- and 24-months post-surgery achieved minimum clinically important difference scores for stair climbing, sit-to-stand, functional mobility and balance, knee or hip joint specific function, and increased activity level. In both studies, walking for a distance and walking fast remained difficult for participants. Additionally, all participants in both studies returned to activities they considered meaningful to them, including community exercise programs, but most returned to light activities or activities of daily living only.

A third study was completed to understand how physiotherapists and family physicians provide referrals to community-based exercise programs for their patients after undergoing total knee or total hip replacement. While these health care providers educated their patients about the importance of physical activity post-surgery and tried to understand whether patients were ready to participate in a community exercise program, they lacked the time, knowledge about the exercise programs and a connection with the exercise program leaders to make the referrals successfully. The findings from these studies suggest that there is recovery in physical function for some patients during the second year post-surgery, the amount of improvement in physical function can be determined by comparing patient scores to increments of important change available for many outcome measures, and that a system needs to be developed to help connect patients interested in participating in physical activity with community-based programs over the longer term to support any further potential recovery in physical function.

Download

Share

COinS