A daily adjustable progressive resistance exercise protocol and functional training to increase quadriceps muscle strength and functional performance in an elderly homebound patient following a total knee arthroplasty

Background and purpose: There is no routinely prescribed protocol to address quadriceps weakness and functional impairments following a total knee arthroplasty (TKA). The purpose of this case report is to introduce and describe the early use of a daily adjustable progressive resistance exercise (DAPRE) protocol as an adjunct to standard rehabilitation to maximize quadriceps muscle strength and functional performance in an elderly homebound patient following a TKA. Case description: A 61-year-old female was referred to home care physical therapy for 6 weeks following left TKA due to functional deficits and inability to activate the weak left quadriceps muscle. In phase I, the patient received three visits with emphasis on edema management, improving left knee range of motion, and reducing pain. Phase II consisted of two main components: (1) a DAPRE protocol aimed at maximizing the quadriceps strength and (2) functional training aimed at improving normal gait patterns, transfers, and dynamic balance. Outcomes: The patient made substantial improvements in both quadriceps muscle strength and functional performance in the first seven weeks following the TKA. The patient had a pain free return to daily living activities. Discussion: The results suggest that early initiation of a DAPRE protocol was free of adverse events and improved quadriceps strength and functional performance for this patient.