More than 350,000 adults elect primary Total Knee Replacement (TKR) surgery each year to eliminate knee arthritis pain that persists despite comprehensive medical treatment. The 2003 NIH TKR Consensus Panel concluded that TKR effectively eliminates knee pain with few complications. In contrast to the uniform surgical outcomes and pain relief, significant variation remains in functional outcome after TKR. An estimated 15-30 percent of patients report no clinically significant functional improvement at 12 months after. TKR. No one patient attribute or surgical factor satisfactorily accounts for this variation. Our pilot data documents that higher quantities of post-TKR exercise and stronger pre-TKR emotional health are associated with greater improvement in function after TKR. Based on evidence in non-surgical arthritis care, we hypothesize that a peri-TKR self-care support intervention designed to enhance patient self-efficacy for independent exercise and activity will significantly increase post-TKR physical function (measured by SF-36/ Physical Component Score) and knee function (measured by WOMAC score) at 6 and 12 months. In addition, we hypothesize that increased arthritis self-efficacy at 8 and 26 weeks post-TKR (measured by Stanford scale) and increased knee exercise (quantity, frequency) and activity (mean steps/day) at 8 and 26 weeks will be associated with improved 6 and 12 month function after TKR. The proposed research will develop a 12- session pre and post-TKR patient intervention (English and Spanish) incorporating proven arthritis self-care elements. Telephone delivery will accommodate patients' physical limitations. The program's efficacy will be tested in a surgeon blinded RCT allocating a stratified random sample to intervention (n=90) and usual care (n=90). The intervention is theory-based and extends successful health-behavior change intervention algorithms and established arthritis self-management strategies to the peri-TKR patient. This research is the first to extend behavioral science theory to the peri-operative TKR patient and extrapolates a chronic care model to orthopedic practice. This peri-TKR intervention changes the paradigm for TKR care to include patient self-management support for independent activity and exercise to assure uniform, optimal improvement in post- TKR function and patient autonomy- the ultimate goals of TKR. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
1R01AR054479-01A1
Application #
7314819
Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
Panagis, James S
Project Start
2007-09-17
Project End
2011-06-30
Budget Start
2007-09-17
Budget End
2008-06-30
Support Year
1
Fiscal Year
2007
Total Cost
$488,364
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Orthopedics
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655
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Oatis, Carol A; Li, Wenjun; DiRusso, Jessica M et al. (2014) Variations in Delivery and Exercise Content of Physical Therapy Rehabilitation Following Total Knee Replacement Surgery: A Cross-Sectional Observation Study. Int J Phys Med Rehabil Suppl 5:
Franklin, Patricia D; Rosal, Milagros C (2013) Can knee arthroplasty play a role in weight management in knee osteoarthritis? Arthritis Care Res (Hoboken) 65:667-8
Ayers, David C; Franklin, Patricia D; Ring, David C (2013) The role of emotional health in functional outcomes after orthopaedic surgery: extending the biopsychosocial model to orthopaedics: AOA critical issues. J Bone Joint Surg Am 95:e165
Ayers, David C; Li, Wenjun; Oatis, Carol et al. (2013) Patient-reported outcomes after total knee replacement vary on the basis of preoperative coexisting disease in the lumbar spine and other nonoperatively treated joints: the need for a musculoskeletal comorbidity index. J Bone Joint Surg Am 95:1833-7
Zheng, Hua; Rosal, Milagros C; Oatis, Carol A et al. (2013) Tailored system to deliver behavioral intervention and manage data in randomized trials. J Med Internet Res 15:e58
Rosal, Milagros C; Ayers, David; Li, Wenjun et al. (2011) A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement. BMC Musculoskelet Disord 12:226