A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: a comparison of eccentric versus concentric cycling ergometry

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dc.contributor.advisorPosthumus, Michaelen_ZA
dc.contributor.advisorAlbertus, Yumnaen_ZA
dc.contributor.advisorCollins, Malcolmen_ZA
dc.contributor.authorBakkum, Amandaen_ZA
dc.date.accessioned2016-01-21T11:06:31Z
dc.date.available2016-01-21T11:06:31Z
dc.date.issued2015en_ZA
dc.descriptionIncludes bibliographical referencesen_ZA
dc.description.abstractPurpose: The predominant impairment to function following a total knee arthroplasty (TKA) is a distinctive reduction in quadriceps muscle strength. It has been suggested that eccentric rehabilitation may be more beneficial than traditional concentric only rehabilitation at improving muscle strength, physical functioning and quality of life in this population. The aim of this study was therefore to determine if an eccentric cycling ergometry rehabilitation intervention (a) was feasible in participant's early after TKA surgery (Study 1), (b) resulted in greater improvements in muscle strength and endurance, as well as muscle activity and muscle volume (Study 2) and, (c)resulted in greater knee functional ability, health related quality of life and physical activity levels (Study 3), when compared to an concentric cycling ergometry rehabilitation intervention. Finally, knee and hip kinematics, ground reaction force and muscle activity was described during the sit-to-stand transfer within this population (Study 4). Methods: Eighteen age- and sex-matched participants', three to nine month's post-TKA were recruited and randomly divided into either an eccentric or concentric cycling rehabilitation intervention. The participants were required to perform three exercise sessions a week, over a period of eight weeks. Isokinetic strength and muscle activity of the quadriceps and hamstring muscles, sit-to-stand motion capture analysis and knee functional ability and health related quality of life questionnaires (Knee Injury and Osteoarthritis Outcome Score, SF-36Health Survey and Tegner Activity Scale) were assessed pre and post- rehabilitation intervention. Data Analysis: Two-way repeated-measures analysis of variance were used to analyse the effects of time and the ECC and CON intervention groups and the group/time interaction for each of the dependent variables. Results: The eccentric rehabilitation intervention was well tolerated with regards to pain levels in participants' as early as three months post-TKA, the peak level of pain perceived per session, never exceeding a "mild" classification. The eccentric intervention resulted in greater power (P= 0.029) and work output (P ≤ 0.001) with a reduced overall heart rate (P= 0.014) ; moderate decreases in biceps femoris (BF) muscle activity (-3.2%) and increases in the lean thigh volume (+807.32) of the uninvolved limb; as well as improvements in the physical fun ctioning (+12.2%) and physical role functioning SF-36 scores (+22.2%) and the level of physical activity (+0.9) (Tegner activity scale). The concentric intervention resulted in decreases in vastus lateralis (VL) muscle activity (-8.17%) and work fatigue (-7.34%) and increases in the lean thigh volume (+677.49) and the hip abduction angle (+ 2.67°) (sit-to-stand) of the involved limb. Conclusion: The eccentric rehabilitation intervention is well tolerated with regards to pain and is characterised by significantly greater power output produced and work performed at significantly lower heart rates. Eccentric cycling ergometry matched in perceived exertion and duration, is associated with greater improvements in physical functioning outcome scores, physical activity level and knee flexion muscle efficiency during concentric contractions, when compared with concentric cycling ergometry. However, knee extensor muscle endurance and efficiency during concentric contractions, as well as muscle volume of the involved limb increased more significantly after concentric training in comparison to eccentric training, Further research is required to establish which training modality is the most feasible and effective in restoring knee function in participant's three months post-TKA.en_ZA
dc.identifier.apacitationBakkum, A. (2015). <i>A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: a comparison of eccentric versus concentric cycling ergometry</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,MRC/UCT RU for Exercise and Sport Medicine. Retrieved from http://hdl.handle.net/11427/16477en_ZA
dc.identifier.chicagocitationBakkum, Amanda. <i>"A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: a comparison of eccentric versus concentric cycling ergometry."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,MRC/UCT RU for Exercise and Sport Medicine, 2015. http://hdl.handle.net/11427/16477en_ZA
dc.identifier.citationBakkum, A. 2015. A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: a comparison of eccentric versus concentric cycling ergometry. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Bakkum, Amanda AB - Purpose: The predominant impairment to function following a total knee arthroplasty (TKA) is a distinctive reduction in quadriceps muscle strength. It has been suggested that eccentric rehabilitation may be more beneficial than traditional concentric only rehabilitation at improving muscle strength, physical functioning and quality of life in this population. The aim of this study was therefore to determine if an eccentric cycling ergometry rehabilitation intervention (a) was feasible in participant's early after TKA surgery (Study 1), (b) resulted in greater improvements in muscle strength and endurance, as well as muscle activity and muscle volume (Study 2) and, (c)resulted in greater knee functional ability, health related quality of life and physical activity levels (Study 3), when compared to an concentric cycling ergometry rehabilitation intervention. Finally, knee and hip kinematics, ground reaction force and muscle activity was described during the sit-to-stand transfer within this population (Study 4). Methods: Eighteen age- and sex-matched participants', three to nine month's post-TKA were recruited and randomly divided into either an eccentric or concentric cycling rehabilitation intervention. The participants were required to perform three exercise sessions a week, over a period of eight weeks. Isokinetic strength and muscle activity of the quadriceps and hamstring muscles, sit-to-stand motion capture analysis and knee functional ability and health related quality of life questionnaires (Knee Injury and Osteoarthritis Outcome Score, SF-36Health Survey and Tegner Activity Scale) were assessed pre and post- rehabilitation intervention. Data Analysis: Two-way repeated-measures analysis of variance were used to analyse the effects of time and the ECC and CON intervention groups and the group/time interaction for each of the dependent variables. Results: The eccentric rehabilitation intervention was well tolerated with regards to pain levels in participants' as early as three months post-TKA, the peak level of pain perceived per session, never exceeding a "mild" classification. The eccentric intervention resulted in greater power (P= 0.029) and work output (P ≤ 0.001) with a reduced overall heart rate (P= 0.014) ; moderate decreases in biceps femoris (BF) muscle activity (-3.2%) and increases in the lean thigh volume (+807.32) of the uninvolved limb; as well as improvements in the physical fun ctioning (+12.2%) and physical role functioning SF-36 scores (+22.2%) and the level of physical activity (+0.9) (Tegner activity scale). The concentric intervention resulted in decreases in vastus lateralis (VL) muscle activity (-8.17%) and work fatigue (-7.34%) and increases in the lean thigh volume (+677.49) and the hip abduction angle (+ 2.67°) (sit-to-stand) of the involved limb. Conclusion: The eccentric rehabilitation intervention is well tolerated with regards to pain and is characterised by significantly greater power output produced and work performed at significantly lower heart rates. Eccentric cycling ergometry matched in perceived exertion and duration, is associated with greater improvements in physical functioning outcome scores, physical activity level and knee flexion muscle efficiency during concentric contractions, when compared with concentric cycling ergometry. However, knee extensor muscle endurance and efficiency during concentric contractions, as well as muscle volume of the involved limb increased more significantly after concentric training in comparison to eccentric training, Further research is required to establish which training modality is the most feasible and effective in restoring knee function in participant's three months post-TKA. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: a comparison of eccentric versus concentric cycling ergometry TI - A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: a comparison of eccentric versus concentric cycling ergometry UR - http://hdl.handle.net/11427/16477 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16477
dc.identifier.vancouvercitationBakkum A. A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: a comparison of eccentric versus concentric cycling ergometry. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,MRC/UCT RU for Exercise and Sport Medicine, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/16477en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentMRC/UCT RU for Exercise and Sport Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherExercise Scienceen_ZA
dc.titleA randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: a comparison of eccentric versus concentric cycling ergometryen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMSc (Med)en_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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