Comparison of High Intensity Strength Training and Muscle Energy Techniques in TKR Patients

The main objective of this study is to compare two different rehabilitation strategies: Muscle Energy Techniques with Balance Exercises and High Intensity Strength Training with Balance Exercises. The research aims to maximize postoperative results for patients who have undergone total knee replacement surgery.

The focus on resistance exercises intended to improve muscle strength and power is what defines high intensity strength training, or HIST. Research has indicated that HIST is beneficial in enhancing joint stability, muscle function, and overall functional outcomes across a range of orthopedic groups. Its precise use and effect on patients recovering from TKR surgery, however, need further investigation. In order to increase joint mobility, lessen pain, and improve neuromuscular control, patients who get Muscle Energy Techniques (MET) actively participate in targeted muscle contractions. MET has demonstrated potential in treating muscular imbalances.

• High Intensity Strength Training (Other): * High-intensity workouts to strengthen the quadriceps and enhance knee function; * Knee flexion and extension 10 lbs. * 10RM of hip flexion and extension * 10RM hip adduction and abduction * Standing with feet aligned for one minute*2, standing on one leg's forefoot and the other leg's heel for two minutes*2, standing on one foot for three seconds*15, and walking ten meters in a straight line for four minutes * 4-week program; 3 days/week; Conventional Treatment: Exercises for range of motion, mobility and weight bearing, muscle stretching, static quadriceps exercise, quadriceps exercise, and straight leg raising
• Muscle Energy Technique (Other): The Muscle Energy Technique (MET) to strengthen and flex your quadriceps and hamstrings. * After maintaining an isometric contraction for ten seconds, a little stretch was maintained for thirty seconds. * Four contractions every treatment, separated by three seconds of rest. Standing with feet parallel for one minute*2, standing on one leg's forefoot and the other leg's heel for two seconds*2, standing on the forefoot for three seconds*15 * Move in a 10 m by 4 straight line. * 4-week program; 3 days/week Conventional Treatment: Exercises for range of motion, mobility and weight bearing, muscle stretching, static quadriceps exercise, quadriceps exercise, and straight leg raising

Primary outcomes

• ROM [4th week]: An instrument called a goniometer will be used to measure angles or rotate objects into desired positions. In orthopedics, it is primarily used to quantify joint angles. Changes from the baseline was taken.
• Functional Status: Knee Injury and Osteoarthritis outcome score [4th week]: The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a questionnaire designed to assess short and long-term patient-relevant outcomes following knee injury. Scores are transformed to a 0-100 scale, with zero representing extreme knee problems and 100 representing no knee problems as common in orthopedic scales, and generic measures. Scores between 0 and 100 represent the percentage of the total possible score achieved.
• Pain : Numeric Pain Rating Scale [4th week]: A simple tool for measuring pain intensity is the Numeric Pain Rating Scale. This grading system has eleven points: zero represents no pain, and ten represents the "worst pain imaginable or highest level of discomfort. Changes from the baseline was taken.

Sex: All, ages: 45 Years to 75 Years

Inclusion Criteria:

* Individuals between the ages of 45 and 75
* Patients should be within a certain timeframe following surgery (e.g., post op day 0-day) to ensure homogeneity throughout the rehabilitation phase.
* Patients who have had primary total knee replacement
* To take part in the RCT, participants must give informed consent
* they must be able and willing to follow the study protocol's instructions for post-rehabilitation care.

Exclusion Criteria:

* Comorbidities: Individuals with significant comorbidities affecting rehabilitation, such as severe cardiovascular disease or neuromuscular disorders, may be excluded.
* Allergies/Contraindications: Patients with allergies or contraindications to specific exercises or techniques used in the study.
* Inadequate Cognitive Function: Participants with cognitive impairments that prevent them from comprehending and adhering to the rehabilitation protocols.
* Other Knee Surgeries: Patients who have had other knee surgeries or have had bilateral knee replacements may be excluded due to variations in recovery and rehabilitation.

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• Hafiza Amna Tariq, DPT, Principal investigator, Riphah International University