목적 : 본 연구는 무릎관절 치환술 환자를 위한 작업치료 임상 가이드라인을 체계적으로 개발하고자 하였다. 전 세계적으로 무릎관절 치환술을 받은 환자들의 회복과 지역사회 복귀에 있어 작업치료의 역할이 매우 중요하다는 문헌이 보고되고 있으나, 우리나라에서는 관절 치환술 환자를 위한 작업치료가 거의 제공되지 않는다는 현실이 있다. 본 연구에서는 무릎관절 치환술 환자를 위한 근거기반 작업치료 중재를 확인하고 이것을 가이드라인을 통해 제안하고자 한다. 연구방법 : 가이드라인 개발 방법은 영국 작업치료사협회의 ｢Practice guideline development manual(4th edition)｣에서 소개한 절차를 따랐다. Patient/Population, Intervention, Comparison and Outcomes(PICO) 임상 질문 설정은 이해관계자의 의견을 수렴하여 한국의 보건·의료제도를 고려하여 설정하고 이를 바탕으로 체계적 고찰을 진행하였다. 데이터베이스에서 총 7,241건의 논문을 추출하였으며 논문의 질 평가 및 비평적 읽기를 통해 최종 66편의 근거 논문을 선정하였다. 논문의 중재를 바탕으로 가이드라인 내용을 구성하고 권고 강도는 Grading of Recommendations, Assessment, Development, and Evaluations(GRADE) approach 체계를 활용하여 [권고]와 [제안]으로 구분하였다. 결과 : 무릎관절 치환술 환자를 위한 작업치료 임상 가이드라인 권고 내용은 ‘환자 중심’과 ‘서비스 제공 중심’으로 범주화하였다. ‘환자 중심’범주에는 ‘일상생활 활동기능 향상’, ‘정신건강의 안정(불안, 우울 등)’, ‘환자 만족도 증가’, ‘지역사회복귀 향상’을, ‘서비스 제공 중심’범주에는 ‘작업치료사를 포함한 다학제 재활팀 구성’과 ‘작업치료 를 통한 병원 입원 기간 단축’을 위한 내용을 포함하였다. 결론 : 무릎관절 치환술 환자를 위한 작업치료 임상 가이드라인은 수술환자들의 안정적인 지역사회 복귀와 입원 기간 단축에 기여할 것이다. 또한 정형외과 작업치료사 역량 강화를 위한 교육자료로 활용될 수 있으며 의료비 용 감소를 위한 정책 마련에 근거 자료가 될 것이다.

This study aims to identify the effect of home physical therapy on patients who left the hospital after total knee arthroplasty, compared to the Daily living group, when it was applied to them, under the guidance of physical therapists. As research subjects, 20 patients that were scheduled to leave the hospital after unilateral total knee arthroplasty, were chosen, and they were randomly divided into a home physical therapy group(10 patients) and an Daily living group(10 patients) in order to conduct an experiment. During the 4-week research, home physical therapy was offered for 40 mins once for 5 days a week, and muscular strength, gait components were measured. For muscular strength, quadriceps muscle strength, hamstring muscle strength were measured, and as gait components, endurance, speed, step time, single-limb support were analysed. For this experiment, pre- and post-measurement were performed, and collected data were analyzed using SPSS ver. 18.0 statistical program. From the analysis of data, the following study results were obtained. Home physical therapy group and Daily living group both showed significant improvements in quadriceps muscle strength, hamstring muscle strength, and quadriceps muscle strength, hamstring muscle strength of home physical therapy group more significantly improved than Daily living group's. In relation to gait components, gait endurance, gait speed, step time significantly improved in both of home physical therapy group and Daily living group, whereas home physical therapy group only showed significant improvements in single-limp support. According to the comparison between two groups, gait speed, single-limp support and step time improved more significantly in the home physical therapy group than in the Daily living group. In conclusion, positive results were revealed in both home physical therapy group and Daily living group, with regard to muscular recovery of lower limbs of patients discharged from the hospital after total knee arthroplasty and walking, but considering the comparison results between two groups, it seems that applying home physical therapy is more effective than maintaining a daily life.

The purpose of this study was to determine the effect of electrical stimulation biofeedback on motor learning of quadriceps muscle isometric exercise in 3 patients who have undergone total knee replacement surgery. A multiple baseline design across subjects was used. The electrical stimulation biofeedback was provided with each patient during quadriceps isometric exercise, which last 10 to 14 sessions with 10 repetitions each sessions. After training patients received 4 retention tests. Maximum muscle activity was measured pre- and post- electrical stimulation biofeedback training and retention test to evaluate the effect of biofeedback training. Maximum isometric muscle activity of quadriceps was increased after electrical stimulation biofeedback training in all subjects. The results indicate that a electrical stimulation biofeedback training is a useful method to improve motor learning of quadriceps isometric exercise in total knee replacement.