Total Diz Protezi Uygulanan Hastalarda Video-Destekli Eğitimin Diz Fonksiyonu ve Yaşam Kalitesine Etkisi: Randomize Kontrollü Çalışma
Year 2024,
Volume: 27 Issue: 3, 171 - 181, 27.09.2024
Bedriye Biricik
,
Gülay Altun Uğraş
,
Recep Ünal
,
Servet Can Dönmez
,
Bahar Taşdelen
,
Volkan Öztuna
Abstract
Amaç: Bu araştırmanın amacı, total diz protezi (TDP) uygulanan hastalarda video-destekli hasta eğitiminin (VHE) diz fonksiyonları, yaşam kalitesi (YK) ve komplikasyonların azaltılmasına etkisini belirlemektir.
Yöntemler: Bu araştırma prospektif, parallel, iki kollu, randomize kontrollü çalışmadır. Bu araştırma ortopedi ve travmatoloji kliniğinde elektif TDP uygulanan 44 hasta ile gerçekleştirildi. VHE grubuna kliniğin rutin bakımına ek olarak TDP için erken postoperatif bakım, günlük yaşam aktiviteleri ve kademeli egzersiz programını kapsayan VHE uygulandı. Kontrol grubuna rutin bakım uygulandı. Araştırma verileri başlangıçta, TDP sonrası 1. ve 3. ayda Western Ontario ve McMaster Üniversiteleri Osteoartrit İndeksi (WOMAC) ve Kısa Form-36 (SF-36) ile toplandı.
Bulgular: VHE grubunun WOMAC ağrı, tutukluk ve fiziksel fonksiyon puan ortalamaları TDP sonrası 3. ayda kontrol grubuna göre anlamlı olarak düşüktü. TDP sonrası 3. ayda VHE grubunun SF-36'nın ağrı, emosyonel rol ve mental sağlık hariç tüm alt boyut puanları kontrol grubundan anlamlı olarak daha yüksekti.
Sonuç: VHE, TDP hastalarında diz fonksiyonlarını ve YK’yi arttırabilir. Hemşireler VHE yöntemini TDP sonrası diz fonksiyonlarının ve YK’nin geliştirilmesinde kullanabilir.
Ethical Statement
The study protocol was approved by Ethics Committee (Date:21.09.2017, No:266) and by the hospital management (Date:09.10.2017, No:74419321-903.99).
Project Number
2019-1-TP2-3299
References
- 1. OECD. Health at a Glance 2019: OECD Indicators. OECD Publishing, Paris. Online information available at https://www.oecd.org/health/health-systems/Health-at-a-Glance-2019-Chartset.pdf 2019 (accessed January 2023).
- 2. OECD. Hip and knee replacement. In Health at a Glance 2023: OECD Indicators. OECD Publishing, Paris. Online information available at, https://doi.org/10.1787/7a7afb35-en (accessed June 2024).
- 3. Bilik Ö. Preoperative and postoperative nursing care of the patients who underwent total knee replacement surgery. Turkiye Klin J Surg Nurs-Special Top. 2017;3:54-64.
- 4. Papakostidou I, Dailiana ZH, Papapolychroniou T, et al. Factors affecting the quality of life after total knee arthroplasties: A prospective study. BMC Musculoskelet Disord. 2012;13(1):1-9. https://doi.org/10.1186/1471-2474-13-116
- 5. Turhan Damar H, Bilik Ö. The total knee replacement surgery preparation program is based on Roy Adaptation Model. DEÜ Hemşirelik Yüksekokulu Elektronik Dergisi. 2014;7:321-329. https://dergipark.org.tr/tr/pub/deuhfed/issue/46806/586935
- 6. Vavro M, Ziakova E, Gazdikova K, Farkasova D. Does standard post-operative rehabilitation have its place after total knee replacement? Bratisl Lek Listy. 2016;117:605-608. https://doi.org/10.4149/bll_2016_117
- 7. McNaught J, Paul L. The use of adaptive equipment following total knee replacement. Br J Occup Ther. 2015;78: 187-195. https://doi.org/10.1177/0308022614562797
- 8. Chen M, Li P, Lin F. Influence of structured telephone follow-up on patient compliance with rehabilitation after total knee arthroplasty. Patient Prefer Adherence. 2016;10:257-264. https://doi.org/10.2147/PPA.S102156
- 9. Cetinkaya Eren O, Buker N, Tonak HA, Urguden M. The effect of video-assisted discharge education after total hip replacement surgery: A randomized controlled study. Scientific Report. 2022; 12(3067). https://doi.org/10.1038/s41598-022-07146-y
- 10. Pazar B, İyigün E. Use of information technology in patient education. Turkiye Klinikleri Journal of Surgery Nursing-Special Topics. 2016; 2 (1): 22-26.
- 11. Turhan Damar H, Bilik, Ö. Effects of video-based education program on pain, physical function, and quality of life ın patients wıth total knee replacement. Journal of Inonu University Health Services Vocational School. 2022;10(1):96-115. https://doi.org/10.33715/inonusaglik.1026363
- 12. Kanat C, Altun Uğraş G, Ünal R, Dönmez SC, Taşdelen B, Öztuna FV. The effect of video-assisted training on upper extremity problems and functions after rotator cuff repair: A randomized controlled trial. Turkish Journal of Medical Sciences. 2024; 54 (1): 165-174. https://doi.org/10.55730/1300-0144.5777
- 13. Yeşilyurt DS, Fındık ÜY. Effect of preoperative video information on anxiety and satisfaction in patients undergoing abdominal surgery. CIN: Computers, Informatics, Nursing. 2019; 37 (8): 430- 436. https://doi.org/10.1097/CIN.0000000000000505
- 14. Jerome JTJ, Mercier F, Mudgal CS, et al. Perspectives and consensus among international orthopaedic surgeons during initial and mid-lockdown phases of coronavirus disease. J Hand Microsurg. 2020;12:135-162. https://doi.org/10.1055/s-0040-1713964
- 15. Phuphanich ME, Sinha KR, Truong M, Pham QG. Telemedicine for musculoskeletal rehabilitation and orthopedic postoperative rehabilitation. Phys Med Rehabil Clin N Am. 2021;32:319-353. https://doi.org/10.1016/j.pmr.2020.12.004
- 16. Fusco F, Turchetti G. Telerehabilitation after total knee replacement in Italy: costeffectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care. BMJ Open 6. 2016; e009964. https://doi.org/10.1136/bmjopen-2015-009964
- 17. Tousignant M, Moffet H, Nadeau S, et al. Cost analysis of in-home telerehabilitation for post-knee arthroplasty. J Med Internet Res. 2015;17:e83. https://doi.org/10.2196/jmir.3844
- 18. Çığlı B, Altun Uğraş G. The effect of video-assisted education on hip function and activities of daily living in patients with total hip replacement: Randomized controlled trial. Turkiye Klinikleri Journal of Nursing Sciences. 2022;14(4):954-964. https://doi.org/10.5336/nurses.2022-90035
- 19. Shen WX, Wang YX, Ning YY, Peng JX, Wei HQ et al. Influence of mobile education on joint function and quality of life in patients after total hip arthroplasty. Chinese Nursing Research. 2017;4(2):71-74. https://doi.org/10.1016/j.cnre.2017.02.002
- 20. Zhao W, Zhang Y, Zhang L. The effect of micro-video education combined with active psychological management on the rehabilitation effect of hip replacement. Chinese Journal of Practical Nursing. 2021;(36):594-599. https://doi.org/10.3760/cma.j.cn211501-20200408-01742
- 21. Tüzün EH, Eker M, Aytar AB, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005;3:28-33. https://doi.org/10.1016/j.joca.2004.10.010
- 22. WOMAC Osteoarthritis Index. WOMAC 3.1 index. Online information available at http://www.womac.org/womac/index.htm , 2016 (accessed January 2023).
- 23. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Form 36’nın (KF-36) Türkçe versiyonunun güvenirliği ve geçerliliği. İlaç ve Tedavi Derg. 1999;12:102-106.
- 24. Ware JE, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-483.
- 25. Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey manual and interpretation guide. The Health Inst. 1993;6:1-22.
- 26. Total diz protezi uygulanan hastalar için egzersiz ve hareket kitapçığı. Online information available at, https://docplayer.biz.tr/19438784-Total-diz-protezi-uygulanan-hastalar-icin-egzersiz-ve-hareket-kitapcigi.html (accessed March 2018).
- 27. OrthoInfo, from the American Academy of Orthopaedic Surgeons. Total Knee Replacement. Online information available at, https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/ (accessed March 2018).
- 28. Ayoğlu T, Akyolcu N. Kas-iskelet sisteminin cerrahi hastalıkları ve bakımı. In: Akyolcu N, Kanan N, Aksoy G (eds) Cerrahi Hemşireliği II, 1. Baskı, Nobel Tıp Kitapevleri Tic. Ltd. Şti. İstanbul 2018:433-513.
- 29. İlçe A. Kas iskelet sistemi hastalıkları. In: Çelik S (ed) Güncel Yöntemlerle Cerrahi Hastalıklarda Bakım, 1. Baskı, Çukurova Nobel Tıp Kitapevi, Antalya 2018:462-503.
- 30. Köse G, Güler Demir S. Kas iskelet sistemi cerrahisinde bakım. In:Karadağ M, Bulut H (ed) Cerrahi Hemşireliği Kavram Haritası ve Akış Şemalı, 1. Baskı, Vize Yayıncılık, Ankara 2019: 821-882.
- 31. Ekşioğlu E, Gürçay E. Rehabilitation after total knee arthroplasty. J Ist Faculty Med. 2013;76: 17-21.
- 32. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310: 2191-2194. https://doi.org/10.1001/jama.2013.281053
- 33. Koekenbier K, Leino-Kilpi H, Cabrera E, et al. Empowering knowledge and its connection to health-related quality of life: A cross-cultural study. Appl Nurs Res. 2016; 29:211-216. https://doi.org/10.1016/j.apnr.2015.05.004
- 34. Reslan HA, Moustafa SM, Saghieh S, Sharara ES, Badr LK. Does intervention improve the outcomes of patients after total knee replacement surgery? Int J Orthop Trauma Nurs. 2018;31: 26-31. https://doi.org/10.1016/j.ijotn.2018.08.001
- 35. Jahic D, Omerovic D, Tanovic A, Dzankovic F, Campara M. The effect of prehabilitation on postoperative outcome in patients following primary total knee arthroplasty. Medical Arch. 2018;72: 439-443. https://doi.org/10.5455/medarh.2018.72.439-443
- 36. Lin YH, Lee SY, Su WR, Kao CC, Tai TW, Chen TB. Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement. J Clin Nurs. 2018; 27:1836-1845. https://doi.org/10.1111/jocn.14368
- 37. Park KH, Song MR. The effects of post discharge telephone counseling and short message service on the knee function, activities of daily living, and life satisfaction of patients undergoing total knee replacement. Orthop Nurs. 2017;36:229-236. https://doi.org/10.1097/NOR.0000000000000332
- 38. Baysal E, Budak M, Atılgan, E, Tarakçı, D. Comparison of different rehabilitation approaches effectiveness in individuals with knee osteoarthritis. J Exerc Thre Rehabil. 2019;6: 32-41. http://doi.org/10.1136/annrheumdis-2019-eular.7960
- 39. Correia FD, Nogueira A, Magalhães I, et al. Medium-term outcomes of digital versus conventional home-based rehabilitation after total knee arthroplasty: Prospective, parallel-group feasibility study. JMIR Rehabil Assist Technol. 2019;6:1-15. https://doi.org/10.2196/13111
- 40. Huang L, Guo B, Xu F, Zhao J. Effects of quadriceps functional exercise with isometric contraction in the treatment of knee osteoarthritis. Int J Rheum Dis. 2017;21:952-959. https://doi.org/10.1111/1756-185X.13082
- 41. Buhagiar MA, Naylor JM, Harris IA, Xuan W, Adie S, Lewin A. Assessment of outcomes of inpatient or clinic-based vs home-based rehabilitation after total knee arthroplasty a systematic review and meta-analysis. JAMA Netw Open. 2019;2:e192810. https://doi.org/10.1001/jamanetworkopen.2019.2810
- 42. Skou ST, Roos EM, Laursen MB, et al. A randomized, controlled trial of total knee replacement. N Engl J Med Overseas Ed. 2015;373:1597-1606. https://doi.org/10.1056/NEJMoa1505467
The Effect of Video-Assisted Education on Knee Function and Quality of Life after Total Knee Replacement: A Randomized Controlled Trial
Year 2024,
Volume: 27 Issue: 3, 171 - 181, 27.09.2024
Bedriye Biricik
,
Gülay Altun Uğraş
,
Recep Ünal
,
Servet Can Dönmez
,
Bahar Taşdelen
,
Volkan Öztuna
Abstract
Objective: This study aims to investigate the effect of video-assisted patient education (VPE) on knee functions, quality of life (QoL) and decrease complications in total knee replacement (TKR) patients.
Methods: This study is designed as a prospective, parallel, two-arm, randomized clinical trial. It included 44 patients who underwent elective TKR at an orthopedics and traumatology clinic. The VPE group received VPE including early postoperative care for TKR, activities of daily living, and gradual exercise program in addition to the existing routine care at the clinic. The control group received only routine care. The results were collected with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF-36) scores measured at baseline, 1st and 3rd months after TKR.
Results: The mean scores of the VPE group on the pain, stiffness, and physical function of the WOMAC were significantly lower in 3rd month after TKR than the control group. The VPE group had significantly higher scores than the control group on SF-36 of all subcategories except pain, emotional role, and mental health in 3rd month after TKR.
Conclusion: The VPE can improve knee function and QoL in TKR patients. Nurses can use the VPE method in patients to improve knee functions and QoL after TKR.
Ethical Statement
The study protocol was approved by Ethics Committee (Date:21.09.2017, No:266) and by the hospital management (Date:09.10.2017, No:74419321-903.99).
Supporting Institution
This work was supported by the Mersin University Scientific Research Projects Unit
Project Number
2019-1-TP2-3299
Thanks
The authors would like to thank all the participants and nurses in the orthopedics surgery unit of of Mersin University Faculty Hospital.
References
- 1. OECD. Health at a Glance 2019: OECD Indicators. OECD Publishing, Paris. Online information available at https://www.oecd.org/health/health-systems/Health-at-a-Glance-2019-Chartset.pdf 2019 (accessed January 2023).
- 2. OECD. Hip and knee replacement. In Health at a Glance 2023: OECD Indicators. OECD Publishing, Paris. Online information available at, https://doi.org/10.1787/7a7afb35-en (accessed June 2024).
- 3. Bilik Ö. Preoperative and postoperative nursing care of the patients who underwent total knee replacement surgery. Turkiye Klin J Surg Nurs-Special Top. 2017;3:54-64.
- 4. Papakostidou I, Dailiana ZH, Papapolychroniou T, et al. Factors affecting the quality of life after total knee arthroplasties: A prospective study. BMC Musculoskelet Disord. 2012;13(1):1-9. https://doi.org/10.1186/1471-2474-13-116
- 5. Turhan Damar H, Bilik Ö. The total knee replacement surgery preparation program is based on Roy Adaptation Model. DEÜ Hemşirelik Yüksekokulu Elektronik Dergisi. 2014;7:321-329. https://dergipark.org.tr/tr/pub/deuhfed/issue/46806/586935
- 6. Vavro M, Ziakova E, Gazdikova K, Farkasova D. Does standard post-operative rehabilitation have its place after total knee replacement? Bratisl Lek Listy. 2016;117:605-608. https://doi.org/10.4149/bll_2016_117
- 7. McNaught J, Paul L. The use of adaptive equipment following total knee replacement. Br J Occup Ther. 2015;78: 187-195. https://doi.org/10.1177/0308022614562797
- 8. Chen M, Li P, Lin F. Influence of structured telephone follow-up on patient compliance with rehabilitation after total knee arthroplasty. Patient Prefer Adherence. 2016;10:257-264. https://doi.org/10.2147/PPA.S102156
- 9. Cetinkaya Eren O, Buker N, Tonak HA, Urguden M. The effect of video-assisted discharge education after total hip replacement surgery: A randomized controlled study. Scientific Report. 2022; 12(3067). https://doi.org/10.1038/s41598-022-07146-y
- 10. Pazar B, İyigün E. Use of information technology in patient education. Turkiye Klinikleri Journal of Surgery Nursing-Special Topics. 2016; 2 (1): 22-26.
- 11. Turhan Damar H, Bilik, Ö. Effects of video-based education program on pain, physical function, and quality of life ın patients wıth total knee replacement. Journal of Inonu University Health Services Vocational School. 2022;10(1):96-115. https://doi.org/10.33715/inonusaglik.1026363
- 12. Kanat C, Altun Uğraş G, Ünal R, Dönmez SC, Taşdelen B, Öztuna FV. The effect of video-assisted training on upper extremity problems and functions after rotator cuff repair: A randomized controlled trial. Turkish Journal of Medical Sciences. 2024; 54 (1): 165-174. https://doi.org/10.55730/1300-0144.5777
- 13. Yeşilyurt DS, Fındık ÜY. Effect of preoperative video information on anxiety and satisfaction in patients undergoing abdominal surgery. CIN: Computers, Informatics, Nursing. 2019; 37 (8): 430- 436. https://doi.org/10.1097/CIN.0000000000000505
- 14. Jerome JTJ, Mercier F, Mudgal CS, et al. Perspectives and consensus among international orthopaedic surgeons during initial and mid-lockdown phases of coronavirus disease. J Hand Microsurg. 2020;12:135-162. https://doi.org/10.1055/s-0040-1713964
- 15. Phuphanich ME, Sinha KR, Truong M, Pham QG. Telemedicine for musculoskeletal rehabilitation and orthopedic postoperative rehabilitation. Phys Med Rehabil Clin N Am. 2021;32:319-353. https://doi.org/10.1016/j.pmr.2020.12.004
- 16. Fusco F, Turchetti G. Telerehabilitation after total knee replacement in Italy: costeffectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care. BMJ Open 6. 2016; e009964. https://doi.org/10.1136/bmjopen-2015-009964
- 17. Tousignant M, Moffet H, Nadeau S, et al. Cost analysis of in-home telerehabilitation for post-knee arthroplasty. J Med Internet Res. 2015;17:e83. https://doi.org/10.2196/jmir.3844
- 18. Çığlı B, Altun Uğraş G. The effect of video-assisted education on hip function and activities of daily living in patients with total hip replacement: Randomized controlled trial. Turkiye Klinikleri Journal of Nursing Sciences. 2022;14(4):954-964. https://doi.org/10.5336/nurses.2022-90035
- 19. Shen WX, Wang YX, Ning YY, Peng JX, Wei HQ et al. Influence of mobile education on joint function and quality of life in patients after total hip arthroplasty. Chinese Nursing Research. 2017;4(2):71-74. https://doi.org/10.1016/j.cnre.2017.02.002
- 20. Zhao W, Zhang Y, Zhang L. The effect of micro-video education combined with active psychological management on the rehabilitation effect of hip replacement. Chinese Journal of Practical Nursing. 2021;(36):594-599. https://doi.org/10.3760/cma.j.cn211501-20200408-01742
- 21. Tüzün EH, Eker M, Aytar AB, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005;3:28-33. https://doi.org/10.1016/j.joca.2004.10.010
- 22. WOMAC Osteoarthritis Index. WOMAC 3.1 index. Online information available at http://www.womac.org/womac/index.htm , 2016 (accessed January 2023).
- 23. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Form 36’nın (KF-36) Türkçe versiyonunun güvenirliği ve geçerliliği. İlaç ve Tedavi Derg. 1999;12:102-106.
- 24. Ware JE, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-483.
- 25. Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey manual and interpretation guide. The Health Inst. 1993;6:1-22.
- 26. Total diz protezi uygulanan hastalar için egzersiz ve hareket kitapçığı. Online information available at, https://docplayer.biz.tr/19438784-Total-diz-protezi-uygulanan-hastalar-icin-egzersiz-ve-hareket-kitapcigi.html (accessed March 2018).
- 27. OrthoInfo, from the American Academy of Orthopaedic Surgeons. Total Knee Replacement. Online information available at, https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/ (accessed March 2018).
- 28. Ayoğlu T, Akyolcu N. Kas-iskelet sisteminin cerrahi hastalıkları ve bakımı. In: Akyolcu N, Kanan N, Aksoy G (eds) Cerrahi Hemşireliği II, 1. Baskı, Nobel Tıp Kitapevleri Tic. Ltd. Şti. İstanbul 2018:433-513.
- 29. İlçe A. Kas iskelet sistemi hastalıkları. In: Çelik S (ed) Güncel Yöntemlerle Cerrahi Hastalıklarda Bakım, 1. Baskı, Çukurova Nobel Tıp Kitapevi, Antalya 2018:462-503.
- 30. Köse G, Güler Demir S. Kas iskelet sistemi cerrahisinde bakım. In:Karadağ M, Bulut H (ed) Cerrahi Hemşireliği Kavram Haritası ve Akış Şemalı, 1. Baskı, Vize Yayıncılık, Ankara 2019: 821-882.
- 31. Ekşioğlu E, Gürçay E. Rehabilitation after total knee arthroplasty. J Ist Faculty Med. 2013;76: 17-21.
- 32. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310: 2191-2194. https://doi.org/10.1001/jama.2013.281053
- 33. Koekenbier K, Leino-Kilpi H, Cabrera E, et al. Empowering knowledge and its connection to health-related quality of life: A cross-cultural study. Appl Nurs Res. 2016; 29:211-216. https://doi.org/10.1016/j.apnr.2015.05.004
- 34. Reslan HA, Moustafa SM, Saghieh S, Sharara ES, Badr LK. Does intervention improve the outcomes of patients after total knee replacement surgery? Int J Orthop Trauma Nurs. 2018;31: 26-31. https://doi.org/10.1016/j.ijotn.2018.08.001
- 35. Jahic D, Omerovic D, Tanovic A, Dzankovic F, Campara M. The effect of prehabilitation on postoperative outcome in patients following primary total knee arthroplasty. Medical Arch. 2018;72: 439-443. https://doi.org/10.5455/medarh.2018.72.439-443
- 36. Lin YH, Lee SY, Su WR, Kao CC, Tai TW, Chen TB. Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement. J Clin Nurs. 2018; 27:1836-1845. https://doi.org/10.1111/jocn.14368
- 37. Park KH, Song MR. The effects of post discharge telephone counseling and short message service on the knee function, activities of daily living, and life satisfaction of patients undergoing total knee replacement. Orthop Nurs. 2017;36:229-236. https://doi.org/10.1097/NOR.0000000000000332
- 38. Baysal E, Budak M, Atılgan, E, Tarakçı, D. Comparison of different rehabilitation approaches effectiveness in individuals with knee osteoarthritis. J Exerc Thre Rehabil. 2019;6: 32-41. http://doi.org/10.1136/annrheumdis-2019-eular.7960
- 39. Correia FD, Nogueira A, Magalhães I, et al. Medium-term outcomes of digital versus conventional home-based rehabilitation after total knee arthroplasty: Prospective, parallel-group feasibility study. JMIR Rehabil Assist Technol. 2019;6:1-15. https://doi.org/10.2196/13111
- 40. Huang L, Guo B, Xu F, Zhao J. Effects of quadriceps functional exercise with isometric contraction in the treatment of knee osteoarthritis. Int J Rheum Dis. 2017;21:952-959. https://doi.org/10.1111/1756-185X.13082
- 41. Buhagiar MA, Naylor JM, Harris IA, Xuan W, Adie S, Lewin A. Assessment of outcomes of inpatient or clinic-based vs home-based rehabilitation after total knee arthroplasty a systematic review and meta-analysis. JAMA Netw Open. 2019;2:e192810. https://doi.org/10.1001/jamanetworkopen.2019.2810
- 42. Skou ST, Roos EM, Laursen MB, et al. A randomized, controlled trial of total knee replacement. N Engl J Med Overseas Ed. 2015;373:1597-1606. https://doi.org/10.1056/NEJMoa1505467