An Experimental Study to Assess the Effectiveness of Pre-operative Strengthening Exercises on Functional Outcome of Patients after Total Knee Replacement Surgery

STATEMENT OF PROBLEM: An Experimental Study to Assess the Effectiveness of Pre-operative Strengthening Exercises on Functional Outcome of Patients after Total Knee Replacement Surgery. OBJECTIVES: 1. To assess the level of functional outcome between the control and the experimental groups of patients after Total Knee Replacement Surgery 2. To determine the effectiveness of pre-operative strengthening exercises on functional outcome by comparing the control and the experimental groups of patients after Total Knee Replacement Surgery 3. To assess the level of satisfaction of patients on pre-operative strengthening exercises among experimental group of patients after Total Knee Replacement Surgery 4. To find out the association between selected demographic variables and functional outcome among the control and the experimental groups of patients after Total Knee Replacement Surgery 5. To assess the association between selected clinical variables and functional outcome among the control and the experimental groups of patients after Total Knee Replacement Surgery The Conceptual framework of the present study was based on King’s Goal Attainment theory (Martha, 2013) given by Imogene King which was modified for the study. The study variables were pre-operative strengthening exercises and functional outcome. An extensive literature review and guidance by the experts formed the foundations for the development of the demographic variable proforma, clinical variable proforma, WOMAC score and rating scale on the level of satisfaction about pre-operative strengthening exercises. A quasi experimental research approach was used for achieving the objectives of the study. The present study was conducted in Apollo Main Hospitals. A sample size of 60 patients who met the inclusion criteria were chosen for the study. By purposive sampling technique, 30 patients in each group viz. the control and the experimental group were selected by the researcher for data collection. The investigator used the demographic and clinical variables proforma of patients to obtain the baseline data. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used for assessing the scale of difficulty with sub scales on pain, stiffness and physical function and rating scale for assessing the level of satisfaction of patients regarding pre-operative strengthening exercises. The data collection tools were validated and reliability was established. After the pilot study, the data collection of the main study was conducted for a period of 6 weeks. The level of satisfaction regarding administration of pre-operative strengthening exercises was then assessed. The collected information was tabulated and analyzed by using appropriate descriptive and inferential statistics. The Major Findings of the Study were, 1. A significant percentage of the patients scheduled for TKR were in the age group of 61-70 years (40%, 46.6%) with the mean age and SD of 62.5+/- SD 9.7, 61.6 +/- 8.4, were females (66.6%, 60%), married (86.6%, 93.3%), non-vegetarian (60%, 80%), moderate workers (43.3%, 46.6%) with monthly family income Rs.50,000 - 1,00,000 (53.3%,56.6%) and graduates (53.3%, 53.3%) in control and experimental groups of patients respectively. 2. Most of the patients scheduled for TKR had no previous history of surgery within 5 years (80%, 80%), no history of trauma (83.3%, 86.6%), had OA in the past 5-10 years (73.3%, 66.6%), had body mass index (80%, 86.6 %) within 22-25 in the control and the experimental groups respectively. Nearly half of the patients (43.3%, 50%) had no co-morbidity in both the groups. Only very few patients had knee pain for 8-12 hours (16.6%, 13.3%), had taken NSAID (50%, 56.3%) and analgesics (50%, 46.6%) and had not used any narcotics for pain in control and experimental groups respectively. 3. The control group and the experimental group had average level of functional outcome (80%, 100%) in the first observation. 4. In the second observation, 93.3% of the experimental group had achieved good functional outcome whereas the entire control group had only average level (100%) of functional outcome. But the experimental group of patients had average level of functional outcome of 6.6%. There was no one in poor level of functional outcome in the second observation. 5. The mean and the standard deviation of WOMAC scale of difficulty on functional outcome in the first observation was (M = 49.9, SD = 3.67) for the experimental group whereas the mean and the standard deviation of the control group was M =59.9, SD = 4.05. This was found to be statistically significant at p < 0.001. 6. In the second observation, the mean and the standard deviation of WOMAC scale of difficulty on functional outcome (M= 28.0, SD = 2.80) in experimental group was less than that of the control group (M= 39.3, SD = 3.03). This was found to be statistically significant at p < 0.001 in the first and the second observations. This may be attributed to the effectiveness of the pre-operative strengthening exercises on functional outcome of patients after Total Knee Replacement surgery. Hence, the null hypothesis HO1 “There will be no significant difference in the functional outcome with pre-operative strengthening exercises among the control and the experimental groups of patients after Total Knee Replacement Surgery” was rejected. 7. A majority of the patients in the experimental group were highly satisfied with the method of teaching pre-operative strengthening exercises (96.6%), the effectiveness of the therapy (100%) and the approach of researcher (100%). 8. There was no significant association between the selected demographic variables, namely, age, gender, educational, marital status, nature of work, monthly family income and dietary habits in the control and the experimental groups of patients. Hence, the null hypothesis HO2 “There will be no significant association between selected demographic variables and functional outcome of patients among the control and experimental groups of patients after Total Knee Replacement Surgery” was retained. 9. There was no significant association between selected clinical variables like co-morbidity, previous history of surgery within 5 years, BMI, history of trauma, duration of OA, frequency of exercises, duration of exercise, duration of knee pain in 24 hours and medication taken for pain in the control and the experimental groups of patients. Hence, the null hypothesis HO3 with regard to these variables was retained. Recommendations The researcher recommends the following: 1. A similar study could be undertaken on a larger scale for more valid generalization. 2. This study could be replicated in different settings. 3. The study could be conducted for comparing different modalities of teaching exercises as eg. Simulation. 4. The study could be conducted by using a variety of tools to assess the functional outcome. 5. The study could be replicated by comparing individual and group methods of teaching exercises. 6. This study could be replicated with a long term follow up