Pain relief may not lead to increased physical activity after knee replacement
Click Here to Manage Email Alerts
WASHINGTON — Pain in patients scheduled for total knee arthroplasty demonstrates no relation to physical activity, suggesting pain relief alone may not improve activity after the procedure, according to a speaker at ACR Convergence 2024.
“Published data suggest that physical activity uptake among persons with knee OA is low, and low physical activity has been attributed to pain,” Elena Losina, PhD, director of the Orthopedic and Arthritis Center for Outcomes Research, at Brigham and Women’s Hospital, told attendees. “Evolving evidence suggests that total knee arthroplasty recipients do not increase physical activity after total knee arthroplasty, despite pain relief. We set out to determine demographic, clinical, psychological and physical characteristics that correlate with uptake of physical activity in total knee arthroplasty recipients.”
To learn more about the factors that correlate with physical activity after total knee arthroplasty, Losina and colleagues conducted a cross-sectional analysis of data from the Knee Arthroplasty Activity Trial (KARAT). The analysis included 330 patients with OA (mean age, 65.8 years) scheduled for total knee arthroplasty who were willing to wear a movement monitoring device for at least 10 hours per day, for 4 to 7 days, during pre-screening.
Pain levels were assessed using the knee injury and osteoarthritis outcome score (KOOS), while physical activity was assessed via both average daily step count and weekly moderate-to-vigorous physical activity (MVPA), measured using a triaxial Actigraph. Using generalized linear models, the researchers additionally assessed connections between physical activity and demographic, clinical and psychosocial factors, such as pain catastrophizing and kinesophobia.
Overall, patients in the cohort spent a median of 54 minutes (IQR, 24-117) per week in MVPA and walked an average of 4,095 steps (standard deviation = 2,163) per day. According to the researchers, the analysis found no correlation between pain and physical activity, with Pearson correlations of –0.01 between KOOS pain score and average daily step count, and –0.03 between KOOS pain and weekly MVPA minutes.
The factors most strongly correlated with step count were age and sex. Lower MVPA time was associated with older age, higher BMI, being a woman, having very low quadricep strength and a slow walking speed. Men walked about a third of a standard deviation more steps per day than women, and those aged older than 75 years walked 2,501 steps on average vs. 4,372 among those aged younger than 65.
Lower average daily step counts were seen among slow walkers (3,263 steps), patients with kinesophobia (3,224 steps), and those with very low quadricep strength (2,983 steps), according to the researchers.
“Contrary to common perception, we did not find an association between pain severity and objectively measured physical activity,” Losina said. “This finding may explain the lack of increase in physical activity from pre- to post-TKA. Demographic, age, sex and clinical obesity factors play a more prominent role in uptake of physical activity than pain.
“Conducting performance tests may help to identify slow walkers and those at high risk for low physical activity,” she added. “Interventions addressing weight management and gait may help to improve physical activity in this population.”
Collapse
Losina E. Abstract #1667. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
Read more about
Click Here to Manage Email Alerts