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Response to Letter to the Editor on “Physical Activity Promotes Gait Improvement in Patients With Total Knee Arthroplasty”
The Journal of Arthroplasty xxx (2017) 1e2
Contents lists available at ScienceDirect
The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org
Response to Letter to the Editor on “Physical Activity Promotes Gait Improvement in Patients With Total Knee Arthroplasty”
In Reply: We thank the submitters for their inquiry regarding our article. We have carefully reviewed their Letter to the Editor and we would like to present the details and the basis regarding their concerns about the methods of physical activity measurement and the number of steps necessary to recover good walking ability at 6 months after total knee arthroplasty (TKA). First, we would like to describe the methods of physical activity measurement in more detail. The pedometer (ES-500, Yamasa) used in the present study has the function to automatically save the results for 30 days of steps/day and average steps/week for 30 weeks. The pedometer and the method used in this study have also been used in a previous study [1]. The subjects wore the pedometer for their activity of daily living, except when bathing and sleeping, and recorded the number of steps daily using a selfcompleted check sheet. Similarly, the subjects also left a record when they forgot to wear the pedometer or could not perform ordinary activities due to illness. We checked both the self-completed check sheet and the pedometer at 2, 3, and 6 months postoperatively with regular follow-ups. As necessary, we additionally confirmed the compliance of physical activity measurement by phone. The average number of steps (steps/day) was calculated during the 6 postoperative months excluding the days when the number of steps could not be measured. These methods were addressed to maintain compliance of pedometer measurements, and we consider that the method had validity and reliability. Secondly, the present study has aimed at predicting the number of steps necessary to recover good walking ability at 6 months after surgery. According to the sixth postoperative month timed up and go time, we divided the subjects into good (<9.1 seconds) and poor (9.1 seconds) walking ability groups, based on a previous study (Bade et al) [2]. In another study by Bade et al [3], the cutoff score of <10.1 seconds of preoperative TUG was suggested to predict poor postoperative physical performance. We noticed that there was an error in reference presentation, and the latter study by Bade was presented as a reference. Correctly, we have used the sixth postoperative month timed up and go time based on a previous study (Bade et al) [2]. Therefore, we consider that 3053 steps/day calculated as a cutoff value was appropriate. We apologize for the error and we are requesting an erratum to be presented for this. DOI of original article: http://dx.doi.org/10.1016/j.arth.2017.06.013. No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.06.011.
0883-5403/© 2017 Elsevier Inc. All rights reserved.
Tsonga et al [4] have reported that the average number of steps per day among the post-TKA patients was 2693 and 3518 steps at 3 and 6 months, respectively. Additionally, Kahn and Schwarzkopf [5] reported that <5% of TKA patients attained the physical activity level recommended by the American Physical Activity Guidelines, which confirmed that this recommendation was difficult for TKA patients to achieve. Thus, we considered that 3000 steps/day is not necessarily a small amount of physical activity for TKA patients. In the previous study by White et al [6], their participants were knee osteoarthritis patients, and not postoperative TKA patients. Review article by Tudor-Locke et al [7] recommended at least 30 minutes of moderate to vigorous physical activity in older adults. On the other hand, their article also described that those living with disability and/ or chronic illness display lower levels of background daily activity, and this could affect whole-day estimates of recommended physical activity. In the present study, physical activity was measured from the time the subjects started to walk in the hospital until the sixth postoperative month. Because the present study has reported the recommendation of physical activity focusing on the recovery period after TKA, we think it is conceivable rational that the result is different from the recommendation for knee osteoarthritis patients. In conclusion, we consider that the methods of physical activity measurement are rational and that physical activity of approximately 3000 steps/day is a realistic and appropriate goal for TKA patients.
Masashi Taniguchi, RPT, MSc* Division of Physical Therapy, Rehabilitation Units Shiga University of Medical Science Hospital Otsu-city, Shiga, Japan Development and Rehabilitation of Motor Function Department of Physical Therapy Graduate School of Medicine, Kyoto University Kyoto, Japan Shinichiro Sawano, RPT Masato Kugo, RPT Shoji Maegawa, RPT Division of Physical Therapy, Rehabilitation Units Shiga University of Medical Science Hospital Otsu-city, Shiga, Japan Taku Kawasaki, MD, PhD Department of Rehabilitation, Shiga University of Medical Science Hospital, Otsu-city, Shiga, Japan Noriaki Ichihashi, RPT, PhD Development and Rehabilitation of Motor Function Department of Physical Therapy Graduate School of Medicine, Kyoto University Kyoto, Japan
2
M. Taniguchi et al. *
Reprint requests: Masashi Taniguchi, RPT, MSc, Division of Physical Therapy, Rehabilitation Units Shiga University of Medical Science Hospital Tsukinowa-cho, Seta Otsu-city, Shiga 520-2192, Japan. http://dx.doi.org/10.1016/j.arth.2017.06.011
References [1] Nishiguchi S, Yamada M, Tanigawa T, Sekiyama K, Kawagoe T, Suzuki M, et al. 12-Week physical and cognitive exercise program can improve cognitive function and neural efficiency in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc 2015;63:1355e63.
[2] Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 2010;40: 559e67. [3] Bade MJ, Wolfe P, Zeni JA, Stevens-Lapsley JE, Snyder-Mackler L. Predicting poor physical performance after total knee arthroplasty. J Orthop Res 2012;30: 1805e10. [4] Tsonga T, Kapetanakis S, Papadopoulos C, Papathanasiou J, Mourgias N, Georgiou N, et al. Evaluation of improvement in quality of life and physical activity after total knee arthroplasty in Greek elderly women. Open Orthop J 2011;5:343e7. [5] Kahn TL, Schwarzkopf R. Does total knee arthroplasty affect physical activity levels? Data from the osteoarthritis initiative. J Arthroplasty 2015;30:1521e5. [6] White DK, Tudor-Locke C, Zhang Y, Fielding R, LaValley M, Felson DT, et al. Daily walking and the risk of incident functional limitation in knee osteoarthritis: an observational study. Arthritis Care Res (Hoboken) 2014;66:1328e36. [7] Tudor-Locke C, Craig CL, Aoyagi Y, Bell RC, Croteau KA, De Bourdeaudhuij I, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 2011;8:80.
Contents lists available at ScienceDirect
The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org
Response to Letter to the Editor on “Physical Activity Promotes Gait Improvement in Patients With Total Knee Arthroplasty”
In Reply: We thank the submitters for their inquiry regarding our article. We have carefully reviewed their Letter to the Editor and we would like to present the details and the basis regarding their concerns about the methods of physical activity measurement and the number of steps necessary to recover good walking ability at 6 months after total knee arthroplasty (TKA). First, we would like to describe the methods of physical activity measurement in more detail. The pedometer (ES-500, Yamasa) used in the present study has the function to automatically save the results for 30 days of steps/day and average steps/week for 30 weeks. The pedometer and the method used in this study have also been used in a previous study [1]. The subjects wore the pedometer for their activity of daily living, except when bathing and sleeping, and recorded the number of steps daily using a selfcompleted check sheet. Similarly, the subjects also left a record when they forgot to wear the pedometer or could not perform ordinary activities due to illness. We checked both the self-completed check sheet and the pedometer at 2, 3, and 6 months postoperatively with regular follow-ups. As necessary, we additionally confirmed the compliance of physical activity measurement by phone. The average number of steps (steps/day) was calculated during the 6 postoperative months excluding the days when the number of steps could not be measured. These methods were addressed to maintain compliance of pedometer measurements, and we consider that the method had validity and reliability. Secondly, the present study has aimed at predicting the number of steps necessary to recover good walking ability at 6 months after surgery. According to the sixth postoperative month timed up and go time, we divided the subjects into good (<9.1 seconds) and poor (9.1 seconds) walking ability groups, based on a previous study (Bade et al) [2]. In another study by Bade et al [3], the cutoff score of <10.1 seconds of preoperative TUG was suggested to predict poor postoperative physical performance. We noticed that there was an error in reference presentation, and the latter study by Bade was presented as a reference. Correctly, we have used the sixth postoperative month timed up and go time based on a previous study (Bade et al) [2]. Therefore, we consider that 3053 steps/day calculated as a cutoff value was appropriate. We apologize for the error and we are requesting an erratum to be presented for this. DOI of original article: http://dx.doi.org/10.1016/j.arth.2017.06.013. No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.06.011.
0883-5403/© 2017 Elsevier Inc. All rights reserved.
Tsonga et al [4] have reported that the average number of steps per day among the post-TKA patients was 2693 and 3518 steps at 3 and 6 months, respectively. Additionally, Kahn and Schwarzkopf [5] reported that <5% of TKA patients attained the physical activity level recommended by the American Physical Activity Guidelines, which confirmed that this recommendation was difficult for TKA patients to achieve. Thus, we considered that 3000 steps/day is not necessarily a small amount of physical activity for TKA patients. In the previous study by White et al [6], their participants were knee osteoarthritis patients, and not postoperative TKA patients. Review article by Tudor-Locke et al [7] recommended at least 30 minutes of moderate to vigorous physical activity in older adults. On the other hand, their article also described that those living with disability and/ or chronic illness display lower levels of background daily activity, and this could affect whole-day estimates of recommended physical activity. In the present study, physical activity was measured from the time the subjects started to walk in the hospital until the sixth postoperative month. Because the present study has reported the recommendation of physical activity focusing on the recovery period after TKA, we think it is conceivable rational that the result is different from the recommendation for knee osteoarthritis patients. In conclusion, we consider that the methods of physical activity measurement are rational and that physical activity of approximately 3000 steps/day is a realistic and appropriate goal for TKA patients.
Masashi Taniguchi, RPT, MSc* Division of Physical Therapy, Rehabilitation Units Shiga University of Medical Science Hospital Otsu-city, Shiga, Japan Development and Rehabilitation of Motor Function Department of Physical Therapy Graduate School of Medicine, Kyoto University Kyoto, Japan Shinichiro Sawano, RPT Masato Kugo, RPT Shoji Maegawa, RPT Division of Physical Therapy, Rehabilitation Units Shiga University of Medical Science Hospital Otsu-city, Shiga, Japan Taku Kawasaki, MD, PhD Department of Rehabilitation, Shiga University of Medical Science Hospital, Otsu-city, Shiga, Japan Noriaki Ichihashi, RPT, PhD Development and Rehabilitation of Motor Function Department of Physical Therapy Graduate School of Medicine, Kyoto University Kyoto, Japan
2
M. Taniguchi et al. *
Reprint requests: Masashi Taniguchi, RPT, MSc, Division of Physical Therapy, Rehabilitation Units Shiga University of Medical Science Hospital Tsukinowa-cho, Seta Otsu-city, Shiga 520-2192, Japan. http://dx.doi.org/10.1016/j.arth.2017.06.011
References [1] Nishiguchi S, Yamada M, Tanigawa T, Sekiyama K, Kawagoe T, Suzuki M, et al. 12-Week physical and cognitive exercise program can improve cognitive function and neural efficiency in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc 2015;63:1355e63.
[2] Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 2010;40: 559e67. [3] Bade MJ, Wolfe P, Zeni JA, Stevens-Lapsley JE, Snyder-Mackler L. Predicting poor physical performance after total knee arthroplasty. J Orthop Res 2012;30: 1805e10. [4] Tsonga T, Kapetanakis S, Papadopoulos C, Papathanasiou J, Mourgias N, Georgiou N, et al. Evaluation of improvement in quality of life and physical activity after total knee arthroplasty in Greek elderly women. Open Orthop J 2011;5:343e7. [5] Kahn TL, Schwarzkopf R. Does total knee arthroplasty affect physical activity levels? Data from the osteoarthritis initiative. J Arthroplasty 2015;30:1521e5. [6] White DK, Tudor-Locke C, Zhang Y, Fielding R, LaValley M, Felson DT, et al. Daily walking and the risk of incident functional limitation in knee osteoarthritis: an observational study. Arthritis Care Res (Hoboken) 2014;66:1328e36. [7] Tudor-Locke C, Craig CL, Aoyagi Y, Bell RC, Croteau KA, De Bourdeaudhuij I, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 2011;8:80.