Effects of proprioceptive neuromuscular facilitation stretching technique on knee motions in patients with total knee arthroplasty - Randomized contro trails
Date Issued
2009
Date
2009
Author(s)
Lin, Shiun-Jeng
Abstract
Research design： double-blinded randomized control trial, prospective studyackground： Proprioceptive neuromuscular facilitation（PNF） stretching technique is a therapeutic technique applying the PNF concept and skills to the related muscles either to increase neuro-inhibition mechanism for releasing muscle spasm and elongating muscle length, or to increase neuro-excitation mechanism for enhancing muscle strength. Improvement in range of motion through PNF stretching technique has been documented superior to other techniques in previous literature, but those studies have only been done in healthy adults. Less is known in the effect of PNF stretching on improvement in joint restriction. Range of motion limitation usually disturbed the patients with total knee arthroplasty. PNF stretching techniques are commonly used in the treatment for patients with total knee arthroplasty to increase range of motion effectively and reduce knee pain during exercises. However, there is no evidence-based research in such a treatment strategy. This research, therefore, explored application of PNF stretch in changes of knee flexion, pain, muscle strength, and function of the lower extremity following total knee arthroplasty.urposes： To investigate immediate and short-term effects on angle of knee flexion, intensity of pain, strength of the knee extensor, and function of the lower extremity by using PNF stretching technique in patients with total knee arthroplasty as compared to those using passive stretching technique. ethod： Sixty-four patients who received total knee arthroplasty in National Taiwan University Hospital were recruited in this study. They were randomly allocated into either experimental or control groups with 32 participants in each. Conventional physical therapy programs were given to all participants. Besides, the experimental group assumed 3-session PNF stretching technique from the third post-operative day to the day of discharge while the control group receiving same-time passive stretching technique, instead. The outcome measures were taken before and after the first session treatment on the same day, on the day of discharge, and one month after the operation. The variables measured included knee flexion angle measured, maximum voluntary isometric strength of the knee extensor, pain score, timed up and go test, and Knee Injury and Osteoarthritis Outcome Score (KOOS).esults： The participants who received PNF stretching technique significantly increased knee flexion angle, enhanced muscle strength of the knee extensor, relieved pain at knee joint, and improved function of the lower extremities as compared to the controls, either immediately after PNF stretching, or on the day of being discharged from the hospital, or at one-month follow-up. onclusions：mmediate increase in knee flexion angle and decrease in pain during motion were noted for patients receiving unilateral TKA following one-session application of PNF stretch technique. After receiving three-session treatment during hospitalization, the knee flexion angle in patients receiving PNF stretch technique was significantly greater than those receiving passive stretching technique. The fact that PNF stretching technique achieved their goals for discharge earlier in the experimental group might save medical cost and manpower. This effect continuing to improve until one-month follow-up resulted in reaching the condition which was only present one year after operation in previous literature. This is the first study in the world to apply the PNF stretching technique in patients with total knee arthroplasty. The randomized-control-trial nature of this study provides a strong evidence in clinical application of PNF technique.
Subjects
proprioceptive neuromuscular facilitation stretching technique
total knee arthroplasty
range of motion
muscle strength
pain
knee function
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