Total knee arthroplasty rehabilitation Postoperative rehabilitation contributes significantly to patient outcomes following a total knee replacement. Currently there is no universally accepted rehabilitation protocol for patients follow- ing a TKA, and rehabilitation standards are often surgeon spe- cific. Protocols vary from surgeon to surgeon, but the majority aim to improve quadriceps strength, knee range of motion (ROM), gait, balance, and functional performance. Data collected from patients participating in physical therapy (PT) rehabilitation after TKA revealed the following open chain exercises were consistent- ly performed by most: straight leg raises, quadriceps sets, and short arc quadriceps. Those exercises were commonly progressed to the following closed chain exercises: squats, wall slides, and step-ups. Considerable variation existed in the remainder of exer- cises documented in the PT records, and in the timing of the ini- tiation of either open or closed chain exercises (Oatis et al., 2019). A 2020 clinical practice guideline (CPG) on the management of total knee arthroplasty was developed by the American Physical Therapy Association (APTA) based on a systematic review of published studies. The CPG recommended that: ● "Physical therapy management should start within 24 hours of surgery for patients who have undergone TKA. ● Physical therapists should engage and teach patients to im- plement passive, active assistive, and active ROM exercises for the involved knee to enhance patients’ potential to reach full functional mobility. ● Physical therapists should not use continuous passive motion (CPM) machines for patients who have undergone primary, uncomplicated TKA due to evidence to support that there is increased risk, harm, and cost. ● Physical therapists should design, implement, teach, and progress patients in high- intensity strength training starting in
the early post-acute period (i.e., within 7 days after surgery) to improve function, strength, and ROM. ● Physical therapists should include motor function training (e.g., balance, walking, movement symmetry) to improve par- ticipation in activities of daily living” (Jette et al., 2020). In addition to postoperative physical therapy, individuals who are status-post TKA can also benefit from occupational therapy, with concurrent aims to reduce pain, improve occupational perfor - mance, and improve overall functional outcomes (Torpil & Kaya, 2022). While there are not professionally endorsed clinical prac - tice guidelines for this patient population exclusive to occupation- al therapy, it is common for occupational therapy to be consulted after surgery and prior to discharge to educate on overall service delivery expectations and evaluate needs for activities of daily liv- ing (ADL) training, adherence to precautions, home modifications, and education on compensatory strategies (such as durable medi- cal equipment, adaptive equipment, or other assistive devices) to work around expected limitations of pain, limited range of mo- tion, strength, and motor function (Dorsey & Bradshaw, 2017; Hi- raga et al., 2019). The client-centered approach of occupational therapy can aim to improve physical health in conjunction with positive impacts on quality of life and satisfaction. A systematic review published by the American Occupational Therapy Asso- ciation (AOTA) by Dorsey and Bradsaw (2017) focused on the importance of investigating the effects of occupational therapy interventions for individuals with lower extremity musculoskeletal disorders and articulated a strong role for occupational therapy. Occupational therapy practitioners can maximize their role with individuals status-post TKA by demonstrating service competen- cy in yoga practice.
YOGA PREVALENCE
cations evaluating yoga as a health intervention. A majority (79%) of the publications were explicitly about yoga as a treatment for a health-related condition, most commonly mental health or mus- culoskeletal conditions. A vast majority (92%) of the articles were published in the past decade, and half were published in medical specialty journals. These findings suggest that the scientific com- munity has shifted beliefs about yoga from the realm of comple- mentary medicine into the mainstream healthcare system. a static state of holding. These holds are generally held anywhere from a few seconds (one or two breaths) up to five minutes. The names of asanas are Sanskrit words and usually correspond to the posture depicting the meaning of the word (e.g., downward-fac- ing dog – adho mukha svanasana ). A common misunderstanding is that yoga asanas predominantly focus on increasing flexibility; however, many poses emphasize appropriate postural alignment, musculoskeletal strength and endurance, and balance.
Yoga is a popular form of physical activity practiced worldwide. According to data from the 2017 National Health Interview Survey (NHIS), 12% of the U.S. population (35 million people) practice yoga. More notably, the survey revealed a 5% increase in practice since 2012 (Clarke et al., 2018). The growing popularity can be attributed to an increased awareness of the health and wellness benefits associated with yoga. In the past decade there has been a significant scientific exploration of yoga as a medical treatment. A search of the literature by Wieland et al. (2021) found 322 publi- Yoga asanas The majority of yoga practiced in today’s modern era is hatha yoga. Hatha means the physical practice of yoga. Some of the major styles of modern yoga—including Ashtanga yoga, Iyengar yoga, Bikram yoga, and Vinyasa yoga—are all practices of hatha yoga. Hatha yoga poses are referred to as asanas, which is Sanskrit for “posture.” Yoga asanas generally consist of the basic positions of standing, sitting, lying, forward bending, back bending, twist- ing, inversion, and balancing. They are typically slow, rhythmic movements of various joints and muscles to a definite posture for
Healthcare Consideration: Yoga is a complementary and alternative therapy. Techniques from this practice are not included in entry-level education programs certified by the Commission on Accreditation of Physical Therapy Education (CAPTE) or the Accreditation Council for Occupational Therapy Education (ACOTE). Therefore, most therapists learn about yoga through self- practice rather than through evidence-based education. Research suggests that more and more physical therapists are introducing yoga therapeutically in clinical practice and the home exercise program. The research reveals, however, that most practitioners learn about yoga through personal experiences, with safety being a primary concern when recommending yoga to patients (Wims et al., 2017). Compared to rehabilitation programs after knee replacement surgery, therapeutic yoga could provide superior compliance and benefit in the long term. Yoga poses, once instructed, may be easier for patients to remember and practice because the poses and their associated names are often universally recognized. Knowledge of safe and effective evidence-based yoga asanas for knee rehabilitation may provide an opportunity for therapists to expand treatment strategies and improve compliance after total knee replacement.
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Book Code: PTCA2624
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