Background: Kinesio taping (KT) is an intervention method used to improve early function after surgery; however, the effect of KT varies depending on the intervention method. Objectives: To investigated systematically review and quantitatively analyze the effect of KT randomized controlled trials (RCTs) applied to Total knee arthroplasty (TKA) to determine the value of the treatment method for TKA patients. Design: A systemic review and meta-analysis. Methods: Studies were identified by searching multiple electronic databases from January 2023 to February 2023. We selected RCTs comparing KT or no treatment, standard physical therapy, multimodal therapeutic approaches. When possible, we pooled data using random-effects meta-analysis. The Cochrane Bias Method Group's seven-item risk of bias (RoB) assessment tool was used for RCTs. The main outcomes were pain, swelling, and ROM. Results: Three trials (290 patients) provided sufficient data and were similar enough to be pooled for meta-analysis. The standardized mean difference for a reduction of pain was SMD = -1.02, 95 % CI -1.93 to -0.12; p= 0.03; I2= 92 %. The standardized mean difference for a reduction of swelling was SMD= - 0.23, 95 % CI -0.50 to -0.05; p= 0.10; I2= 58 %. The standardized mean difference for ROM was SMD= 1.06, 95 % CI -0.08 to 2.20; p= 0.07; I2= 95 %. Conclusion: KT has a large effect on pain reduction in TKA patients and could be used as an additional treatment option, but a small effect was observed in swelling and ROM.

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.

Background: Total knee arthroplasty (TKA) recovers the alignment of the knee joint, but fails to automatically restore the alignment and function of the hip and ankle joints. It may affect the alignment and stability of the knee joint, therefore therapeutic intervention in hip and ankle joint is necessary for the rehabilitation process after TKA. Objects: The aim of this study was to comparison of the effects of the two exercise methods on the coronal plane alignment after TKA. This study conducted an experiment by dividing subjects into a lower extremity isometric co-contraction group (LEIC) and a quadriceps isolated isometric contraction (QIIC) group. Methods: A total of 37 subjects were randomly assigned to the LEIC (n1=19) or the QIIC (n2=18). Exercise was applied to five times per week for three weeks, starting on the eighth day after surgery. Range of motion exercises were performed as a common intervention and then each group performed quadriceps isometric contraction exercises with 10 sets of 5 repetitions. Radiological imaging was performed prior to surgery, one month and six months after surgery. In addition, the hip-knee-ankle angle (HKA) and tibiotalar angle (TTA) were measured. Results: The HKA was close to neutral in the LEIC rather than the QIIC (p<.05). The LEIC showed varus and the QIIC exhibited valgus TTA (p<.05). In a comparison of HKA and TTA over time, there was no significant change in either group (p>.05). According to the comparison of the TTA before surgery, the LEIC showed significant changes in the varus direction (p<.05), while there was no significant change in the QIIC (p>.05). Conclusion: The LEIC method triggered changes in the TTA and brought the HKA close to the neutral. Thus, LEIC is more effective than QIIC in creating stability in the coronal plane alignment of the knee and ankle joints after TKA.

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.

임상 결과의 측정에서 새로운 관점을 갖는 것은 중요하다. 의료 재활은 심리적 측정의 질들(표준화, 신뢰도, 타당도)에서 충분한 노력에 수행되어지지 않아 왔기 때문에 환자와 프로그램 사이에 일반화된 기능적인 평가 범위가 부족하다. 장애의 적절한 측정을 위한 요구는 기능적인 상태에서 변화들을 알리고 치료의 필요성을 평가하고 치료를 계획하고 결과를 예측하고 보상 방법을 측정하기 위한 환자의 치료와 임상 연구에서 모두 나타난다. 세계적으로 사용되어지고 있는 기