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Published on: July 22, 2019
Association of Psychosocial Factors With Physical Activity and Function After Total Knee Replacement: An Exploratory
Gregory M Dominick1, Joseph A Zeni2, Daniel K White2
1Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE.
Objectives:
To examine the association between self-efficacy, social support, and fear of movement with physical activity and function at baseline and after 12 weeks of physical therapy.
Design:
Nonrandomized cohort study, repeated-measures design.
Setting:
Outpatient rehabilitation clinic within the general community.
Participants:
Adults (N=49) undergoing outpatient physical therapy for total knee replacement (TKR).
Interventions:
Not applicable.
Main Outcome Measures:
Self-efficacy for exercise (SEE), fear of movement, leisure-time physical activity (LTPA), 6-minute walk test (6MWT), and Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) were assessed at baseline and 12 weeks.
Results:
Mean functional change scores significantly increased at 12 weeks for the 6MWT (95% confidence interval [CI], 42.3-106.2), KOS-ADLS (95% CI, 12.7-23.3), and LTPA (95% CI, 6.5-26.1). Self-efficacy and fear of movement were not significantly associated with function at baseline or 12 weeks. Participants with lower SEE had 6 fewer metabolic equivalents per week of improvement in LTPA than those with high self-efficacy (95% CI, -27.9 to 14.8), and those with high fear of movement had 26.1m less improvement in the 6MWT than those with low fear of movement (95% CI, -42.2 to 94.5). Most participants reported having no family or peer support for exercise.
Conclusions:
Physical therapy for TKR improves physical function and self-reported physical activity. High fear of movement and low SEE may be associated with less improvement in physical activity and function over time.
