Improving Physical Activity and Gait Symmetry After Total Knee Arthroplasty
Improving Physical Activity and Gait Symmetry After Total Knee Arthroplasty
The purpose of this pilot study is to examine the effectiveness of the Physical Activity and
 Symmetry (PAS) program, compared to an attention (ATT)control group, for patients with
 post-total knee arthroplasty (TKA). The investigators hypothesize that the PAS treatment will
 result in meaningful improvements in physical activity (PA) and joint loading symmetry
 compared to the ATT group.
Background and Significance: Total knee arthroplasty (TKA) has been shown to decrease pain
 and to improve range of motion and some aspects of physical function. However, accumulating
 evidence shows that patients have persistent deficits in other critical outcomes following
 TKA. First, the majority of patients do not substantially increase physical activity beyond
 levels prior to TKA, remaining well below Department of Health and Human Services
 recommendations and levels of healthy individuals. This has serious negative implications for
 both joint health and overall health. Second, studies show that gait asymmetries are common
 following TKA, such that patients continue to load the non-surgical leg more heavily during
 walking, even when the post-surgical leg is pain free. This places the contralateral limb at
 risk for developing or worsening osteoarthritis. Other research shows there is large
 variability in post-TKA rehabilitation, along with sub-optimal exercise content.
 Collectively, these findings emphasize the critical need to improve the post-TKA
 rehabilitation process. However, there are currently no evidence-based approaches to improve
 overall physical activity and deficits in joint loading symmetry that have been identified
 following TKA.

 Study Aims: This research project will provide important preliminary information on the novel
 post-TKA PAS program through achieving the following specific aims: 1) Obtain preliminary
 data on the efficacy of the PAS program with respect to the change in objectively assessed
 physical activity, measured via accelerometers; 2) Obtain preliminary data on the efficacy of
 the PAS program with respect to change in peak load symmetry during walking, measured by a
 novel 3-sensor insole device; 3) Assess the feasibility and acceptability of the PAS program
 following TKA.

 Study Description: Investigators will conduct an exploratory randomized controlled study,
 with n=72 patients >=18 years receiving post-TKA physical therapy (PT) at a UNC Healthcare
 System clinic. Patients will be equally allocated to the PAS intervention or an attention
 (ATT) control group.
Inclusion Criteria:

 -  Patients receiving post-total knee arthroplasty (TKA) physical therapy (PT) at a
 University of North Carolina (UNC) Healthcare System clinic

 Exclusion Criteria:

 -  significant cognitive impairment

 -  neurological disorders affecting gait

 -  systemic rheumatic disease

 -  hospitalization for a cardiovascular condition the past six months

 -  psychosis

 -  substance abuse disorder

 -  lower extremity surgery in the past year

 -  any other health conditions determined to be contraindications to a home exercise
 program