Yoeri Bemelmans

Chapter 9 146 Table 4. Mean (±SD) pre- and 6-wks postoperative PROMs and RoM for both pathways. ERP OS p-value OKS Pre 34.8 (7.6) 32.0 (10.3) n.s. 6-wks 25.4 (1.8) 29.0 (8.2) n.s. WOMAC Pre 49.0 (14.8) 49.2 (25.7) n.s. 6-wks 70.8 (11.9) 76.7 (18.1) n.s. EQ-5D Pre 0.79 (0.04) 0.63 (0.24) n.s. 6-wks 0.87 (0.10) 0.75 (0.26) n.s. NRS-pain Pre 4.7 (1.6) 5.2 (2.5) n.s. 6-wks 2.6 (2.1) 2.6 (2.2) n.s. RoM Pre 120.6 (11.3) 115.9 (24.0) n.s. 6-wks 104.3 (17.2) 106.2 (20.0) n.s. Discussion The most important finding of the present study was that OS was not inferior but equal compared to ERP regarding physical activity of daily life, PROMs and RoM as it was hypothesized. Both groups did not reach preoperative levels of physical activity during the 6th postoperative week. Physical activity after TKA has a positive impact on the early recovery and length of stay after arthroplasty [4, 7, 20, 21, 30]. At thismoment, there are no data to suggest the effect of OS on early postoperative physical activity after TKA. In this study, OSwas not clearly superior to ERPwith respect to physical activity directly after TKA during the first week and 6th postoperative week. Both groups in this study improved with comparable physical activity at a minimum 6 weeks follow-up. It has been stated that PROMs represent the best subjectivemeasurement of clinical outcome [31]. Studies have shown that patients who followed enhanced recovery pathways after arthroplastywere as satisfied or evenmore satisfied compared to patients who followed conventional pathways, with regard to the PROMs at 3, 4 and 12months postoperative [11, 22–24]. However, there is no single best outcome measurement tool after TKA. Beside the positive results of PROMs on enhanced recovery pathways, various scores are not capturing the changes due to a lack of power of the scores as averse to a lack of change (e.g. floor and ceiling effects) [8]. For example, pain during the early recovery phase can conceal the functional changes [33]. The PROMs in this study failed to detect subjective changes after an early rehabilitation period of 6 weeks. In order to characterize the objective changes in physical activity after TKA in detail, the AM was used to capture changes over time and to detect potential objective differences (e.g. activity, steps, sit– stand transfers, cadence) between both pathways during the early recovery phase [2,