Kent Brown

Predictors of functional task performance among patients scheduled for total knee arthroplasty.

Brown, K, Kachelman, J, Topp, R, Quesada, PM, Nyland, J, Malkani, A, and Swank, AM. Predictors of functional task performance among patients scheduled for total knee arthroplasty. J Strength Cond Res 23(2): 436-443, 2009-Osteoarthritis (OA) is a common health problem affecting more than 7 million Americans. Declines in strength, flexibility, and knee joint pain reduce functional ability and contribute to decisions for total knee arthroplasty (TKA). This study describes predictors of functional ability among knee patients scheduled for TKA and proposes a preoperative exercise program to improve functional ability. A total of 82 knee OA patients (average age = 62.7 ± 7.48 years, 70% women) were recruited from a single orthopedic surgeons office. Muscular fitness assessments included knee flexion, extension strength, and range of motion (ROM) of the surgical and nonsurgical knees. Functional ability was assessed by 6-minute walk, number of chair rises in 30 seconds, and time required to ascend and descend 2 flights of stairs. Perceived functional ability and pain were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Correlation matrices determined which measures of muscular fitness, pain, and perceptions were associated with measures of functional ability. Significant correlates were entered into regression equations that determined the significant predictors of the functional tasks. These regression equations identified flexion strength of the nonsurgical knee as predicting 24-45% of the variance of functional ability assessments that involved independent or consecutive knee movement. Other variables that, to a lesser degree, predicted performance of the functional ability assessments included knee joint ROM and body mass index. Because functional ability after TKA is strongly dependent on presurgical functional ability, future investigators may wish to examine the impact of improving presurgical functional ability of TKA patients through resistance training, particularly closed-kinetic chain exercises that transfer fewer forces through the knee joint.

Prehabilitation versus usual care before total knee arthroplasty: A case report comparing outcomes within the same individual.

This case report compared pre- and postoperative functional ability, knee strength, and pain of a female who underwent two separate total knee arthroplasty (TKA) procedures. The female patient was part of a larger research study. The first surgery on the right knee was preceded with usual care and the second surgery on the left knee was preceded by prehabilitation. Functional ability was assessed by a 6-minute walk, chair raises, and the time required to ascend and descend stairs. Knee extension and flexion isokinetic strength was assessed using the KinCom Isokinetic Dynamometer. Pain was assessed using the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC). Functional abilities, knee strength, and pain were assessed at baseline measurements 4 weeks before surgery, 1 week before surgery, and at 1 and 3 months post surgery during each TKA procedure. Results indicate that the prehabilitation intervention had a favorable impact on improving functional ability up to 30%, increasing knee strength by 50% and decreasing pain prior to the left knee TKA. For this patient, prehabilitation increased functional ability and strength prior to surgery. Gains in strength were maintained in the nonsurgical knee after surgery. These findings indicate that prehabilitation may be effective at facilitating the rehabilitation following a TKA.

Prehabilitation and Quality of Life Three Months after Total Knee Arthroplasty: A Pilot Study

Knee osteoarthritis (OA), which affects over 27 million Americans, decreases the individuals quality of life through decreasing mobility, deconditioning, reducing functional ability, and increasing knee pain. The present aim was to assess whether such patients engaging in exercise prior to surgery (“prehabilitation”; preoperative exercise intervention) rate higher quality of life 3 mo. after their surgery compared with ratings by patients who did not engage in prehabilitation. Standard populations consist of OA patients that do not participate in any preoperative exercise programs, such as a prehabilitation exercise intervention. 18 knee osteoarthritis patients were randomly assigned to a control or a prehabilitation group. The latter group participated in an exercise intervention three times per week, once at home and twice at the physical therapy lab, for 8 wk. prior to their surgery. The control group participated in their usual preoperative care prescribed by the physician for all patients. Eight health-related quality of life domains were assessed at 3 mo. post surgery. These preliminary findings suggest efficacy of prehabilitation in facilitating quality of life of total knee arthroplasty (TKA) patients 3 mo. after surgery.

Prehabilitation Influences Exercise-Related Psychological Constructs Such as Self-efficacy and Outcome Expectations to Exercise

Abstract Brown, K, Loprinzi, PD, Brosky, JA, and Topp, R. Prehabilitation influences exercise-related psychological constructs such as self-efficacy and outcome expectations to exercise. J Strength Cond Res 28(1): 201–209, 2014—Osteoarthritis (OA) is a clinical condition affecting more than 27 million Americans. There is no known cure for OA other than replacing the diseased joint with a joint prosthesis, a process called total knee arthroplasty (TKA). The TKA projections for the year 2016 are 1,046,000, and this number is predicted to increase by 600% to more than 3.4 million cases by 2030. The purpose of this study was to determine whether knee OA patients who engage in guided exercise (prehabilitation) before their TKA report higher levels of self-efficacy to exercise (SEE) and higher outcome expectations for exercise (OEE) than those who do not. Thirty-one participants were randomized into 2 groups (16 in prehabilitation group [PRE] and 15 in control group [CON]), all participants completed the protocol (22 women and 9 men). The PRE group participated in an exercise intervention (prehabilitation) 3 times per week for 8 weeks before TKA. One-way repeated measures analysis of variance was used to investigate the effects of group (PRE vs. CON), time (baseline T1, T2, T3, and T4), and the interaction of group and time on the dependent variables of SEE and OEE. This analysis indicated that SEE did not change over time (p = 0.62) or between the groups (p = 0.86). The analysis of the OEE indicated a significant time effect (p = 0.008). Post hoc analysis indicated that the CON group significantly declined between T2 and T4. The PRE group did not significantly change their OEE over the 4 data collection points of the study.

Association between depression and tinnitus in a nationally representative sample of US older adults

Objectives: Few population-based studies examining the association between tinnitus and depression among older adults have been conducted. Therefore, the purpose of this study was to examine the association between tinnitus and depression among a nationally representative sample of US older adults. Methods: Data from the 2005–2006 National Health and Nutrition Examination Survey was used. 696 older adults (70–85 yr) completed questionnaires on tinnitus and depression, with depression assessed using the Patient Health Questionnaire-9. Results: After controlling for firearm use, age, gender, race–ethnicity, cardiovascular/stroke history, diabetes, smoking status, body mass index, physical activity, noise exposure and elevated blood pressure, there was a significant positive association (beta coefficient: 1.28, 95% CI: 0.26–2.29, p = 0.01) between depression and tinnitus being at least a moderate problem, suggesting that those who perceived their tinnitus to be a moderate problem were more likely to be depressed than those perceiving it to be a small or no problem. Additionally, after adjustments, those who were bothered by tinnitus when going to bed were 3.06 times more likely to be depressed than those who were not bothered by tinnitus when going to bed (OR = 2.44, 95% CI: 1.03–5.76, p = 0.04). Conclusion: These findings suggest that individuals who perceive their tinnitus to be a problem or have problems with tinnitus when going to bed may be in need of intervention to prevent or reduce their depression symptoms so as to ensure that other areas of their life are not negatively influenced.

Free-living physical activity characteristics, activity-related air trapping and breathlessness, and utilization of transtheoretical constructs in COPD: A pilot study

OBJECTIVE Many patients with Chronic Obstructive Pulmonary Disease (COPD) experience air trapping at rest and during exercise. This study examined the relationship between air trapping and air hunger breathlessness during acute physical activity (PA) engagement. In addition, we examined free-living movement patterns of COPD patients, as well as their utilization of psycho-behavioral factors known to influence PA behavior. METHODS Ten current or former smokers with COPD (M age=70 years) participated. Baseline pulmonary function measurements were gathered and participants completed a graded exercise test (2, 2.5, and 3 mph; 5 min each). At each stage, air hunger breathlessness was rated using the Multidimensional Dyspnea Profile (MDP). Inspiratory capacity (IC) measurements were also collected to monitor air trapping. Data regarding PA and sedentary behavior was measured over 7 days using accelerometry. RESULTS The results (mean [SD]) showed air trapping during exercise. IC levels across baseline and the 3 stages, respectively, were 1.66 (.62) L, 1.33 (.52) L, 1.35 (.58) L, and 1.28 (.57) L. A significant difference occurred between baseline and stage 1 (p=.01). Coincident low-to-moderate air-hunger breathlessness was observed across baseline and the 3 stages (Likert scale 0-10): 0.44 (1.01), 1.44 (2.12), 2.33 (2.59), and 2.67 (2.64). Participants utilized few PA-related psycho-behavioral strategies and spent the majority (67.4%) of their waking hours in sedentary behavior, while only engaging 5 min a day of moderate intensity PA and 0 min at vigorous-intensity PA. CONCLUSIONS These COPD patients were intolerant to low levels of exercise intensity, resulting in little PA engagement, and also utilized few PA-related psycho-behavioral strategies.

The Association Between Physical Activity and Breast Cancer Recurrence and Survival

Recreational physical activity improves the prognosis of women who have been diagnosed with breast cancer. Numerous studies reveal that the level of prediagnostic recreational physical activity has a linear relationship with survival after diagnosis. Risk of recurrence of cancer also drops in women who exercised prediagnosis. Women who continue or start exercising after diagnosis also receive a significant protective benefit from mortality and recurrence. However, the physiological mechanisms of and the influence of menopause on these prognostic benefits have yet to be clearly defined.