Does the brake response time of the right leg change after left total knee arthroplasty? A prospective study
Introduction
Total knee arthroplasty reduces pain, enhances function, and improves the health-related quality of life in individuals with knee impairment and disability secondary to osteoarthritis or rheumatoid arthritis [1], [2], [3]. After surgery, patients often ask their physicians when they can safely start driving again. An early return to car driving can obviously improve mobility in daily activities during the first stages of the rehabilitation process, reducing dependency and social isolation.
Driving is a complex activity involving cognitive and motor skills. In traffic accident prevention research, the brake response time has been used as an adequate expression of drivers' psychomotor performance [4], [5], [6]. Many factors influence brake response time, e.g. ergonomic factors in the car such as the pedal layout, [7], [8] human factors such as age [9] or vision, [10], [11], [12] and environmental factors such as the type of brake lights [13].
There is little evidence available on which physicians can rely when advising patients about when they can safely resume car driving after TKA. With a computerized systematic literature search performed on Pubmed, Embase and Science Direct, two studies [14], [15] focusing on this topic were identified. The limitations of the literature concerning the time period that patients should wait before resuming driving after left total knee arthroplasty are (1) the small sample sizes (left TKA n = 6 [14], [15]), (2) the time that has elapsed before the first postoperative measurement (four [14] and three [15] weeks after surgery) and, (3) the results: in the first study [14] no differences were reported between preoperative brake response time values and those measured four weeks after surgery for the patients in the left TKA group, in the second study [15] the side on which surgery was performed was not taken into consideration regarding the effect on brake response time – all patients were considered as one group, i.e. patients who had undergone left TKA received the same recommendation as patients after right TKA.
The objective of the current study was to investigate the effects of left TKA on the brake response time of the right leg 10 days after surgery. An extension of this objective was then to determine whether an increase in task complexity would increase the brake response time. We hypothesized that there would be no differences between the mean brake response time, reaction time and movement time values before and 10 days after left TKA, and that an increase in task complexity would increase reaction time and therefore also increase brake response time.
Section snippets
Materials and methods
To determine the effects of left TKA on brake response time of the right leg a prospective study with a repeated-measures design was used. The components of brake response time (reaction time and movement time) were assessed in a car simulator. The measurements took place one day before surgery (the admission day) and 10 days after surgery (the day the patients left the clinic).
On the day of admission, the patients were informed about the study and asked to participate. All patients who agreed
Results
The data of 24 patients (13 men, 11 women) who underwent left TKA were pooled for analysis. The mean age of the patients in the sample was 63.2 ± 8.5 years. The sample demographic data is presented in Table 1.
The results of our hypothesis testing are presented in Table 2. Ten days after primary left TKA there were no statistically significant differences between the preoperative mean brake response time, reaction time and movement time values and the values measured 10 days after surgery in both
Discussion
In the present study we compared preoperative and postoperative brake response time, reaction time and movement time values of 24 patients undergoing primary left TKA in order to find out whether left TKA has negative effects on the brake response time of the right leg 10 days after surgery. For organizational reasons, during the patient recruitment period, we could not inform all patients admitted for left TKA about the study. Also the fact that a great percentage of the patients were not
Conclusions
Driving is a complex activity involving perceptual, decision-making, reaction and movement skills. The results of this study show that brake response time, reaction time and movement time were not affected ten days after left TKA. Task complexity increased reaction time and consequently brake response time. Our results suggest that patients who have undergone left total knee arthroplasty may be able to resume car driving 10 days after surgery.
Acknowledgments
We thank Klaus Rippe, of the Technical Department at the ENDO-Klinik, for the design of the car simulator; and Alexander Greiner, PT; Ulrike Tillmann, PT; Veito Kaul, PT; and Inken Hansen, PT, of the Physical Therapy and Rehabilitation Department at the ENDO-Klinik for their invaluable assistance.
We also thank the Foundation “ENDO-Verein Gemeinnütziger Förderverein der ENDO-Stiftung e.V.” for the funds granted to cover the costs related to the equipment used.
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