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| Name | Class |
|---|---|
| The New England Baptist Hospital | OTHER |
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The purpose of this study is to determine how well an active motion device, Camoped, works compared to a continuous passive motion device, CPM, for rehabilitation after partial or total knee replacement. It is hypothesized that the Camoped active motion device will provide outcomes equal to or superior than the CPM. Patients undergoing either partial or total knee replacement will be given the opportunity to participate. If they elect to participate, preoperative data will be collected including demographics, measures of strength, balance and knee bending, as well as surveys regarding current physical and mental health, as well as knee function. After surgery, patients will be randomly selected to receive either the Camoped or the CPM for use during their rehabilitation. After discharge, participants will be asked to maintain a daily diary tracking their use of the assigned device, as well as their daily pain levels. At a visit 4 weeks after surgery, participants will be asked to complete a series of surveys pertaining to their health and knee function, as well as to perform tests of strength, balance and knee bending. These results will be used to determine if one device produces superior rehabilitation results following total or partial knee replacement surgery.
The purpose of this study is to determine how well an active motion device, Camoped, works compared to a continuous passive motion device, CPM, for rehabilitation after partial or total knee replacement. It is hypothesized that the Camoped active motion device will provide outcomes equal to or superior than the CPM. 110 patients will be randomized during the course of the study. Participation lasts approximately 4 weeks. Data for patients who begin the trial, but choose to drop out or are lost to follow up will not be included in analysis.
Patients who have elected to undergo surgery with one of the PIs, either a total knee replacement with Dr. Richard Scott or a partial knee replacement with Dr. Wolfgang Fitz, will be informed about the study and offered participation if they meet eligibility criteria. The PI will obtain written consent in the office for those who choose to participate. For participants, demographic data including height, weight, BMI, age and sex will be collected. Additionally, sit-to-stand, knee flexion, proprioception, strength and balance testing will be performed in the office by a physical therapist. Participant responses to the SF-36 physical and mental health surveys, knee function score, KSS and WOMAC questionnaires will also be collected.
Patients will be randomized to receive either the Camoped or CPM device after surgery. Patients will receive the device and its protocol for usage in the hospital following surgery. They will use the device for the duration of their hospital stay, and then take the device home. At home, patients will be asked to keep a daily diary tracking device usage as well as daily pain and medication intake. These results will be compared as part of the study analysis.
When patients return for their follow-up appointment four weeks after surgery, demographic data including height, weight, BMI, age and sex will be collected. Additionally, sit-to-stand, knee flexion, proprioception, strength and balance testing will be performed in the office. Participant responses to the SF-36 physical and mental health surveys, knee function score, KSS and WOMAC questionnaires will also be collected. These measures will be compared to the preoperative results.
Two-sample t-tests will be used to analyze the similarity between the two treatment groups before the intervention and to assess any differences afterwards. The Wilcoxon-Mann Whitney test will be performed as a non-parametric alternative to t-testing for any data sets found to be non-normal.
Data collection and management will be the responsibility of the PIs. All adverse events will be reported as necessary.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| active motion device | Active Comparator | An active motion device (CAM) known as a CAMOPED was given after surgery. The device was used for 3 sessions of 20 minutes for 3 weeks. |
|
| CPM passive motion device | Active Comparator | A continuous passive motion device (CPM) given after surgery. The device bends and moved the knee passively. It was used for 4 hours daily for 3 weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CAMOPED | Device | Camoped given after surgery |
| |
| CPM passive motion device |
| Measure | Description | Time Frame |
|---|---|---|
| Early Functional Outcome Strength | Quadriceps strength measurements using a hand held dynamometer | 4-6 weeks post-op |
| Early Functional Outcome by Sit to Stand Test | Sit-to-Stand test: After one demonstration of the sit-to-stand test, standing up from a seated position without support, two tests were timed and the better value recorded. Patient was asked to sit with back against chair and told to stand up without using any support. Arms were suggested to be folded in front of chest. Time started with recorded said "Go". | 4-6 weeks post-op |
| Early Functional Outcome Proprioception | Biodex Balance Machine Score. The system consists of a multiaxial standing platform with a maximum tilt of 20 degrees. All participants were tested on level 8, and a balance index was calculated using the time and deviation (in degrees) on the platform relative to a neutral position. The normal range for adults 54-71 is 1.79 - 3.35. Lower values indicate better/greater stability. | 4-6 weeks post-op |
| Early Function Outcome Kinesthesia | Kinesthesia was measured by recording the angle of the flexed knee and documenting how close the patient was able to reproduce the angle with closed eyes. The differences were recorded in degrees using an 8-inch goniometer. | 4-6 weeks post op |
| Early Functional Outcome Knee Flexion | Knee-flexion was measured using an 8-inch goniometer. | 4-6 weeks post op |
| Measure | Description | Time Frame |
|---|---|---|
| General Mental Orthopaedic Outcome Measures | Short form 36 mental health score. The scale is measured from 0-100. 0 is the lowest or worst possible level of functioning and 100 is the highest or best possible level of functioning. | 4-6 weeks post-op |
| General Activity Orthopaedic Outcome Measures |
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Inclusion Criteria:
• At least 18 years of age
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Wolfgang Fitz, MD | Brigham and Women's Hospital | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15866968 | Background | Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005 May;87(5):1047-53. doi: 10.2106/JBJS.D.01992. | |
| 20238330 | Background |
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1153 patients electing to undergo unilateral partial or total knee replacement at the New England Baptist Hospital from 03/2007-12/2010 were screened for participation. Of these patients, 110 elected to participate in the study and were randomized into one of the two study groups.
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| ID | Title | Description |
|---|---|---|
| FG000 | Active Motion Device | Patients assigned to this group receive the active motion device (CAM, Camoped) after surgery. |
| FG001 | Passive Motion Device | Patients assigned to this group receive the continuous passive motion device (CPM) after surgery. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
137 patients agreed to participate, 27 did not meet the inclusion criteria and 110 signed the informed consent form. Following allocation to their group, we excluded 24 patients (20 using CAM and 7 CPM) who did not finish the study due to non-compliance, leaving a total of 83 patients.
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| ID | Title | Description |
|---|---|---|
| BG000 | Active Motion Device | Patients assigned to this group receive the active motion device (CAM, Camoped) after surgery. |
| BG001 | Passive Motion Device | Patients assigned to this group receive the continuous passive motion device (CPM) after surgery. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Early Functional Outcome Strength | Quadriceps strength measurements using a hand held dynamometer | Posted | Mean | Standard Deviation | newton meter | 4-6 weeks post-op |
|
|
Adverse event data was collected while patients were participating the study. Patients were followed up at 4 weeks after surgery and any adverse events were noted.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Active Motion Device | Patients assigned to this group receive the active motion device (CAM, Camoped) after surgery. |
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We ran into an unexpected problem in recruiting patients for this study. Many did not want to participate in this study, as they did not want to use the passive device and were not willing to use it 4 hours each day.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Wolfgang Fitz MD | Brigham and Women's Hospital | 617-732-9500 | wfitz@partners.org |
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| Device |
passive motion device given after surgery |
|
Western Ontario and McMaster Universities Arthritis Index is measured on a scale of 0-68. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations. |
| 4-6 weeks post-op |
| General Functional Orthopaedic Outcome Measures | Knee society score is an objective patient reported outcome survey to measure a patient's functional ability before and after knee arthroplasty. It is measured on a scale of 1-100. A score between 80-100 indicated excellent functioning, a score between 70-79 indicates good functioning, a score between 60-69 indicates fair functioning, and a score below 60 indicates poor functioning. | 4-6 weeks post-op |
| General Pain | Self-reported total pain medication consumption was recorded by patients and at the end of the four-week period converted into standard units for comparison as "oxycodone equivalent dosage". | 4-6 weeks post-op |
| Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD004260. doi: 10.1002/14651858.CD004260.pub2. |
| 16558529 | Background | Arnold BL, Schmitz RJ. Examination of balance measures produced by the biodex stability system. J Athl Train. 1998 Oct;33(4):323-7. |
| 20801047 | Background | Gstoettner M, Raschner C, Dirnberger E, Leimser H, Krismer M. Preoperative proprioceptive training in patients with total knee arthroplasty. Knee. 2011 Aug;18(4):265-70. doi: 10.1016/j.knee.2010.05.012. Epub 2010 Aug 30. |
| 12360022 | Background | Wada M, Kawahara H, Shimada S, Miyazaki T, Baba H. Joint proprioception before and after total knee arthroplasty. Clin Orthop Relat Res. 2002 Oct;(403):161-7. doi: 10.1097/00003086-200210000-00024. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Kinesthesia | Kinesthesia was measured by recording the angle of the flexed knee and documenting how close the patient was able to reproduce the angle with closed eyes. The differences were recorded in degrees using an 8-inch goniometer. | Mean | Standard Deviation | degrees |
|
| Quadriceps Strength | Mean | Standard Deviation | newton meter |
|
| Balance | Biodex Balance Machine Score. The system consists of a multiaxial standing platform with a maximum tilt of 20 degrees. All participants were tested on level 8, and a balance index was calculated using the time and deviation (in degrees) on the platform relative to a neutral position. The normal range for adults 54-71 is 1.79 - 3.35. Lower values indicate better/greater stability. | Mean | Standard Deviation | units on a scale |
|
| Knee Flexion | Knee-flexion was measured using an 8-inch goniometer. | Mean | Standard Deviation | degrees |
|
| SF-36 Mental Health Score | Short form 36 mental health score. The scale is measured from 0-100. 0 is the lowest or worst possible level of functioning and 100 is the highest or best possible level of functioning. | Mean | Standard Deviation | units on a scale |
|
| Knee Society Score | Knee society score is an objective patient reported outcome survey to measure a patient's functional ability before and after knee arthroplasty. It is measured on a scale of 1-100. A score between 80-100 indicated excellent functioning, a score between 70-79 indicates good functioning, a score between 60-69 indicates fair functioning, and a score below 60 indicates poor functioning. | Mean | Standard Deviation | units on a scale |
|
| WOMAC | Western Ontario and McMaster Universities Arthritis Index is measured on a scale of 0-68. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations. | Mean | Standard Deviation | units on a scale |
|
| Sit-to-Stand Test | After one demonstration of the sit-to-stand test, standing up from a seated position without support, two tests were timed and the better value recorded.The patient was directed to sit with his/her back against the chair and arms crossed in front. Time started when timer said "Go". | Mean | Standard Deviation | seconds |
|
| SF-36 Physical Health Score | Short form 36 is a patient reported outcome survey used to asses physical health. The scale is 0-100. Lower scores indicate more disability and higher scores indicate less disability. | Mean | Standard Deviation | units on a scale |
|
| Counts |
|---|
| Participants |
|
|
| Primary | Early Functional Outcome by Sit to Stand Test | Sit-to-Stand test: After one demonstration of the sit-to-stand test, standing up from a seated position without support, two tests were timed and the better value recorded. Patient was asked to sit with back against chair and told to stand up without using any support. Arms were suggested to be folded in front of chest. Time started with recorded said "Go". | Posted | Mean | Standard Deviation | seconds | 4-6 weeks post-op |
|
|
|
| Primary | Early Functional Outcome Proprioception | Biodex Balance Machine Score. The system consists of a multiaxial standing platform with a maximum tilt of 20 degrees. All participants were tested on level 8, and a balance index was calculated using the time and deviation (in degrees) on the platform relative to a neutral position. The normal range for adults 54-71 is 1.79 - 3.35. Lower values indicate better/greater stability. | Posted | Mean | Standard Deviation | units on a scale | 4-6 weeks post-op |
|
|
|
| Primary | Early Function Outcome Kinesthesia | Kinesthesia was measured by recording the angle of the flexed knee and documenting how close the patient was able to reproduce the angle with closed eyes. The differences were recorded in degrees using an 8-inch goniometer. | Posted | Mean | Standard Deviation | degress | 4-6 weeks post op |
|
|
|
| Primary | Early Functional Outcome Knee Flexion | Knee-flexion was measured using an 8-inch goniometer. | Posted | Mean | Standard Deviation | degrees | 4-6 weeks post op |
|
|
|
| Secondary | General Mental Orthopaedic Outcome Measures | Short form 36 mental health score. The scale is measured from 0-100. 0 is the lowest or worst possible level of functioning and 100 is the highest or best possible level of functioning. | Posted | Mean | Standard Deviation | units on a scale | 4-6 weeks post-op |
|
|
|
| Secondary | General Activity Orthopaedic Outcome Measures | Western Ontario and McMaster Universities Arthritis Index is measured on a scale of 0-68. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations. | Posted | Mean | Standard Deviation | units on a scale | 4-6 weeks post-op |
|
|
|
| Secondary | General Functional Orthopaedic Outcome Measures | Knee society score is an objective patient reported outcome survey to measure a patient's functional ability before and after knee arthroplasty. It is measured on a scale of 1-100. A score between 80-100 indicated excellent functioning, a score between 70-79 indicates good functioning, a score between 60-69 indicates fair functioning, and a score below 60 indicates poor functioning. | Posted | Mean | Standard Deviation | units on a scale | 4-6 weeks post-op |
|
|
|
| Secondary | General Pain | Self-reported total pain medication consumption was recorded by patients and at the end of the four-week period converted into standard units for comparison as "oxycodone equivalent dosage". | Posted | Mean | Standard Deviation | mg | 4-6 weeks post-op |
|
|
|
| 0 |
| 38 |
| 0 |
| 38 |
| 0 |
| 38 |
| EG001 | Passive Motion Device | Patients assigned to this group receive the continuous passive motion device (CPM) after surgery. | 0 | 45 | 0 | 45 | 0 | 45 |
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