The Effects of Balance Training on Balance Performance and Functional Outcome Measures Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

The Effect of Combined Balance Exercise on Knee Range of Motion, Balance, Gait, and Functional Outcomes in Acute Phase Following Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial

Background and Objectives: Total knee arthroplasty (TKA) improves balance performance in patients with osteoarthritis; however, balance deficit and fall incidence after TKA have been reported. This study aimed to determine the effects of combined balance exercises on knee range of motion (ROM), balance, gait, and functional outcomes during the acute phase after TKA. Materials and Methods: A total of 42 participants were randomly assigned to either the combined balance group (n = 21) or the general physical therapy (control) group (n = 21). The combined balance exercise group performed exercise programs for 30 min per session, five times a week for 4 weeks (20 sessions), and the control group completed general physical therapy, which included active simple exercise. Measurements were performed before and after the 4 weeks of training to assess changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee joint ROM, static balance, timed up-and-go (TUG), and 10 m walk test (10 MWT). Results: The combined balance exercise group demonstrated significant improvements post intervention (p < 0.05) for all outcomes. The time × group interaction effect for the WOMAC scores showed statistically significant interaction effects for pain, stiffness, and physical function; the static and dynamic balance values showed statistically significant interaction effects for CEA, PL, AV, and TUG; and gait ability showed a significant interaction effect for the 10 m walk test (p < 0.05). Conclusions: This study confirmed that combined balance training with general physical therapy has a positive effect on ROM, static and dynamic balance, gait, and functional outcomes in the acute phase post TKA and that combined balance exercise can be proposed as a rapid rehabilitation intervention with general physical therapy following TKA.

Does backward gait require more proprioception and balance in older adults after total knee arthroplasty?

Objectives

Some basic and instrumental daily living activities include backward gait. There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. This research investigated the proprioception, and balance in forward-backward gait of older individuals with total knee arthroplasty (TKA).

Methods

A prospective cross-sectional research was conducted with 105 older adults with TKA. Individuals' forward and backward gait performance was assessed with the Timed Up & Go Test (TUG) and 3 Meter Walk Back Test (3MBWT), respectively. Proprioception was measured with a mobile application-based inclinometer. Berg Balance Scale (BBS) and Activity Specific Balance Confidence Scale (ABC) were used to assess balance and balance confidence levels, respectively. A single clinician evaluated the individuals.

Results

TUG was weakly and positively correlated with the Right and Left Leg Proprioception Test (RLPT and LLPT) (r1 = 0.386, r2 = 0.391, p < 0.01). Also, the 3MBWT was weakly and positively correlated with RLPT and LLPT, respectively (r1 = 0.293, r2 = 0.251, p < 0.01). In addition, TUG was strongly and negatively correlated with BBS and ABC, respectively (r1 = -0,693, r2 = -0.722, p < 0.01). Besides, 3MBWT was strongly and negatively correlated with BBS and ABC (r1 = -0.642, r2 = -0.645, p < 0.01).

Conclusion

The study revealed that forward and backward walking were similarly associated with balance and proprioception in older adults with TKA. Clinicians should focus more on balance ability than proprioception to improve backward walking performance in older individuals with THA.

[Rehabilitative technologies in patients after total endoprosthesis of lower limbs' major joints: scientometric analysis]

Dynamically developing sphere of physical and rehabilitative medicine raises an important issue on implementation of technologies with proven effectiveness to recover neuromuscular, skeletal and movement-related functions, activity and partipation of traumatological patients into rehabilitation practice. The aim of this review is the consistent information analysis and synthesis of evidence-based researches of current effective methods in the context of medical rehabilitation after endoprosthesis of lower limbs' major joints, as well as the provision of structured information that helps to influence on decision-making for doctors of physical and rehabilitative medicine and other professionals who take part in multidisciplinary interaction.

High tibial osteotomy improves balance control in patients with knee osteoarthritis and a varus deformity

BACKGROUND

Impaired knee stability is observed in patients with medial compartment knee osteoarthritis (OA) and varus malalignment. Although high tibial osteotomy (HTO) is widely used to treat OA-related knee varus deformity, its long-term influence on balance control in OA patients is poorly reported. This study aimed to evaluate the impact of HTO on balance control and assess its biological and functional significance.

METHODS

Thirty-two patients with medial compartment knee OA as well as varus deformity who were scheduled for HTO underwent static posturographic tests one month pre- and three months as well as one year postoperatively, respectively, along with forty matched control subjects. Radiographic and clinical evaluations were synchronously carried out on patients pre- and postoperatively.

RESULTS

Decreased postural sway was observed in patients one year after HTO. When compared to the control subjects, more postural sway was found in patients one month pre- and three months postoperatively. No difference was observed between the patients and control subjects one year postoperatively. The alignment and joint function of the affected knees significantly improved after HTO.

CONCLUSIONS

This study revealed that HTO improves balance control in patients with knee OA and varus deformity. Correct alignment and improved joint function enhance the likelihood of normal postural stability. Hence, this intervention allows the knee joint to recover its corrective compensatory role in postural regulation and should be taken into account for managing knee OA patients.

Comparison of physical function, proprioception, muscle strength, postural balance, and walking in older women with and without total knee arthroplasty

The benefit of total knee arthroplasty (TKA) is that it alleviates pain caused by osteoarthritis; however, other postoperative effects on physical function are unclear. This study aimed to investigate the differences in physical function, proprioception, muscle strength, postural balance, and walking in older women with and without TKA. A total of 36 participants were included in this study; the TKA group comprised older women who underwent TKA (n = 18) and the non TKA group comprised older women who did not undergo TKA (n = 18). All the participants were evaluated for physical function, proprioception, muscle strength, postural balance, and walking. The outcome measures were compared between the 2 groups using an independent t test. Correlations were assessed using Pearson correlation coefficients. Participants in the TKA group had significantly reduced physical function, postural balance, and walking ability compared with those in the non TKA group (P < .05). In the TKA group, physical function was statistically correlated with proprioception, postural balance, and walking (P < .05); in particular, it had a strong correlation with proprioception (R > .60). In the non TKA group, postural balance was significantly associated with muscle strength and walking (P < .05). In particular, it was strongly correlated with walking (R > .90). This study demonstrated that older women undergoing TKA need to actively perform interventions to improve physical function, postural balance, and walking compared with older women with osteoarthritis.

Knee Loading With Blood Flow Restriction Can Enhance Recovery After Total Knee Arthroplasty

Total knee arthroplasty (TKA) is one of the most performed operations in the world, especially in the elderly. Aging has a significant effect on joint cartilage, muscle strength, and muscle mass. Following a TKA, despite the significant reduction of symptoms and the improvement in mobility, muscle strength and muscle mass recovery remains a significant challenge. Restrictions that arise from the surgical procedure include joint loading, functional activities, and range of motion, along with limitations related to the age of the individual and their previous loading history, these are the significant restrictions, at least in the early stages of rehabilitation. Evidence indicates that blood flow restriction (BFR) training has significant potential to enhance recovery via implementation of low-load or low-intensity exercise. While respecting the indications and contraindications related to BFR application, the optimization of metabolic stress seems to offer a bridging therapy to heavy load while reducing pain and inflammation. Thus, the combination of BFR and low loads may improve muscular recovery (strength and mass), and aerobic training protocols appear to show significant enhancement of multiple cardiopulmonary parameters. Mounting evidence, direct and indirect, indicate that BFR training may have the potential to benefit the pre-operative and post-operative TKA rehabilitation phases and enhance functional recovery and physical abilities in the elderly.

Reliability, validity, and minimal detectable change of the Step Test in patients with total knee arthroplasty

BACKGROUND

Step Test (ST) is frequently used to assess dynamic balance and locomotor function in clinical practice.

AIMS

This study aimed to determine the concurrent validity, reliability, and minimal detectable change (MDC) of the ST in patients with total knee arthroplasty (TKA).

METHODS

The study included 56 patients with TKA. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability of the ST. The correlations of the ST with timed up and go (TUG) and 10-m walk test (10MWT) were assessed for concurrent validity.

RESULTS

Test-retest (ICC 0.90) reliability of the ST was determined to be excellent. The SEM and MDC₉₅ values of test-retest reliability were 0.76 and 2.11, respectively. A significantly moderate correlation was found between the ST and TUG (p < 0.05, r: - 0.69), and 10MWT (p < 0.05, r: - 0.67).

CONCLUSION

The ST is a valid and reliable method in the assessment of dynamic balance ability and locomotor function in patients with TKA. The ST can be used to quantify changes in dynamic balance level and locomotor function in patients with TKA.

Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review

Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.

In vivo kinematic comparison between an ultra-congruent and a posterior-stabilized total knee arthroplasty design by RSA

PURPOSE

The aim of the present study was to compare the in vivo under weight-bearing kinematic behavior of a posterior-stabilized (PS) and an ultra-congruent (UC) total knee arthroplasty (TKA) model during a sit-to-stand motor task, a common activity of daily life.

METHODS

A cohort of 16 randomly selected patients (8 PS Persona Zimmer, 8 UC Persona Zimmer) was evaluated through dynamic radiostereometric analysis (RSA) at a minimum of 9 months after TKA, during the execution of a sit-to-stand. The anteroposterior (AP) translation of the femoral component and the AP translation of the low point of medial and lateral femoral compartments were compared through Student's t test (p < 0.05).

RESULTS

A significantly greater anterior translation of the femoral component was found for the PS group compared to the UC group. The flexion interval where statistical significance was found was between 30° and 0° (p = 0.017). Both groups showed a significantly greater anterior translation of the low point of the lateral compartment with respect to the medial one (PS: p = 0.012, UC: p = 0.018). This was consistent with a medial-pivot pattern. Furthermore, a significantly greater anterior translation of the medial compartment was found in the PS group compared to the UC group (p = 0.001). The same pattern was observed for the lateral compartment (p = 0.006).

CONCLUSIONS

The TKA designs evaluated in the present study showed comparable in-vivo kinematics with regards to medial pivot pattern but differences in absolute AP translation. Specifically, the UC design showed greater AP stability than the PS design. This finding could be positive in terms of implant stability, but negative in terms of premature polyethylene wear and thus implant failure. This remains to be verified in studies with a larger sample size and longer follow-up.

LEVEL OF EVIDENCE

IV.

Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis

Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.

Sensorimotor training prior total knee arthroplasty and effects on functional outcome: A systematic review and meta-analysis

BACKGROUND

Altered muscle activation patterns and proprioception, loss of strength, and weight bearing asymmetries are common limitations after total knee arthroplasty, which can also affect balance. Therefore, preoperative sensorimotor training has been proposed to enhance surgical outcome.

RESEARCH QUESTION

Is preoperative sensorimotor training effective in improving functional outcome in patients undergoing total knee arthroplasty? Does preoperative sensorimotor training affect secondary outcomes such as balance, pain, and quality of life?

METHODS

A systematic review and meta-analysis were conducted by searching PEDro, MEDLINE, Embase, Cochrane Library, and Scopus databases from inception to May 2020. Studies were eligible if participants underwent total knee arthroplasty after two or more weeks of preoperative sensorimotor training. A meta-analysis compared the effects of such interventions with standard care before and after surgery using standardized mean differences (SMD) with 95 % confidence interval (CI). Functional outcome was the primary measure. Balance, pain, and quality of life were also outcomes of interest.

RESULTS

Of the 384 items identified, 7 met the inclusion criteria, and 332 participants were assessed. There was limited evidence suggesting that preoperative sensorimotor training enhanced self-reported function (SMD, 0.89; 95 % CI, 0.16-1.62), functional performance (SMD, 0.56; 95 % CI, 0.19 to 0.93), or knee function (SMD = 0.22-1.05) compared with conventional care. Moderate quality evidence suggested that benefits were only maintained in terms of functional performance up to 3 months after surgery (SMD = 0.37; 95 % CI, 0.13 to 0.62). The outcome was similar after one year.

SIGNIFICANCE

Compared with conventional care, preoperative sensorimotor training may enhance early postoperative functional recovery, with no additional benefits on balance, knee function, or pain. The outcome is the same one year after surgery, regardless of whether such training is implemented. Further investigation is needed to determine whether sensorimotor training may be a feasible conservative treatment for severe knee osteoarthritis.

Quadriceps muscle group function and after total knee arthroplasty-asystematic narrative update

BACKGROUND

This article systematically summarizes the present evidences, published in the last 20 years, regarding the pre- and post-operative factors, which may influence recovery of the function of the quadriceps muscle group following total knee arthroplasty (TKA). We following the PRISMA methodology, including meta-analyses and high-level evidence studies (prospective trials, and, when unavailable, retrospective studies).

SOURCES OF DATA

Pubmed and Cochrane databases: 582 articles were identified and 54 of them were selected.

AREAS OF AGREEMENT

Tourniquets inflated at high pressure exert a detrimental effect on the quadriceps muscle group. Faster quadriceps recovery takes place using mini-invasive approaches, an eight-week rehabilitation period including balance training and the use of nutraceuticals.

AREAS OF DISAGREEMENT

Pre-habilitation and pre-operative factors, analgesic methods and different TKA implants.

GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH

Telerehabilitation seems a cost-effective tool for rehabilitation after TKA. Patients' optimization protocols before TKA should include standardized nutraceuticals intake.

Pre-Planned and Non-Planned Agility in Patients Ongoing Rehabilitation after Knee Surgery: Design, Reliability and Validity of the Newly Developed Testing Protocols

Background: Due to its association with the risk of falling and consequent injury, the importance of agility is widely recognized, but no study so far has examined the different facets of agility in an untrained/clinical population. The aim of this study was to evaluate the reliability, validity, and correlates of newly developed tests of non-planned agility (NPA) and pre-planned agility (PPA) in an untrained/clinical sample. Methods: The sample comprised 38 participants older than 40 years (22 females, age: 56.1 ± 17.3 years, height: 170.4 ± 10.8 cm, mass: 82.54 ± 14.79 kg) who were involved in a rehabilitation program following total knee arthroplasty and knee arthroscopy. Variables included age, gender, type of surgery, history of fall, anthropometrics/body composition, and newly developed tests of NPA and PPA. Results: The results showed the high inter-testing- (ICC > 0.95, CV < 9%), and intra-testing-reliability (ICC > 0.96, CV < 9) of the newly developed tests. PPA and NPA were found to be valid in differentiation between age groups (>50 yrs. vs. <50 yrs.), and genders, with better performance in younger participants and males. Only NPA differentiated participants according to type of surgery, with better performance in those who had arthroscopic surgery, than those who had total knee arthroplasty. No differences in NPA and PPA were established between groups based on fall-history. In females, the body mass (Pearson’s r = 0.58 and 0.59, p < 0.001) and body fatness (Pearson’s r = 0.64 and 0.66, p < 0.001) were negatively correlated, while the lean body mass (Pearson’s r = 0.70 and 0.68, p < 0.001) was positively correlated with PPA and NPA. The NPA and PPA were highly correlated (Pearson’s r = 0.98, p < 0.001). Conclusions: We found that the proposed tests are reliable when evaluating agility characteristics in an untrained/clinical population after knee arthroplasty/arthroscopy. Further evaluation of the specific validity of the proposed tests in other specific subsamples is warranted.

Selected root plant supplementation reduces indices of exercise-induced muscle damage: A systematic review and meta-analysis

This systematic review and meta-analysis examined the effects of selected root plants (curcumin, ginseng, ginger and garlic) on markers of muscle damage and muscular performance measures following muscle-damaging protocols. We included 25 studies (parallel and crossover design) with 353 participants and used the PEDro scale to appraise each study. Forest plots were generated to report on standardised mean differences (SMD) and p-values at 24 and 48 hours following the muscle-damaging protocols. The meta-analysis showed that the supplemental (SUPP) condition showed significantly lower levels of indirect muscle damage markers (creatine kinase, lactate dehydrogenase and myoglobin) and muscle soreness at 24 hours and 48 hours (p < 0.01) than the placebo (PLA) condition. The inflammatory markers were significantly lower for the SUPP condition than the PLA condition at 24 hours (p = 0.02), although no differences were identified at 48 hours (p = 0.40). There were no significant differences in muscular performance measures between the SUPP and PLA conditions at 24 hours and 48 hours (p > 0.05) post-exercise. According to our qualitative data, a number of studies reported a reduction in oxidative stress (e.g., malondialdehyde, superoxide dismutase) with a concomitant upregulation of anti-oxidant status, although other studies showed no effects. Accordingly, selected root plants minimised the level of several biomarkers of muscle damage, inflammation and muscle soreness during periods of exercise-induced muscle damage. However, the benefits of these supplements in ameliorating oxidative stress, increasing anti-oxidant status and accelerating recovery of muscular performance appears equivocal, warranting further research in these outcome measures.

Instrumented platforms for balance and proprioceptive assessment in patients with total knee replacement: A systematic review and meta-analysis

BACKGROUND

The functional outcome of total knee replacement (TKR) is usually satisfying. However, patients may show functional limitations for years after surgery, which have been ascribed to impairments in balance and proprioception, mainly during standing tasks. A number of instrumentations and parameters have been used, rising confusion for clinical decisions on the assessment of patients.

RESEARCH QUESTION

Which are the most widespread and consistent procedures to assess balance and proprioception following TKR?

METHODS

A literature review was conducted in Pubmed, PEDro, and Cochrane database. From a total sample of 112 articles, 23 original studies published between 2008 and 2019 met inclusion criteria. The primary outcomes selected were variables related to balance and proprioception assessment in static and dynamic tasks performed with instrumented platforms. Data from papers using the same instrumentation, on patients with unilateral TKA and at least 12 months postoperatively were synthesized quantitatively in a random effect meta-analysis.

RESULTS

Fourteen articles were appropriate for the review. A large variability was found both in the instrumentation and the parameters used. The Neurocom Balance Master System™ was the most used instrument (four articles). On a total population of 186 patients with unilateral TKR 12 months postoperatively, a low degree of heterogeneity was found adopting the random effect in the four tasks explored (Firm and Foam Surface both with Eyes Open and Eyes Closed).

SIGNIFICANCE

This review found a large variability in the instrumentation used to assess balance and proprioception in patients operated on TKR. The meta-analysis demonstrated that the Neurocom Balance Master System™ for static assessment of balance showed an acceptable consistency and can be considered as a reference for further studies. However, balance and proprioception impairments following TKR have not been widely quantified by means of instrumented platforms. Further research is needed to address this issue, and improve clinical practice.

Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial

Background

The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA).

Methods

20 patients (mean ± SD: age 67 ± 7 years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptive neuromuscular facilitation (PNF) techniques, endurance training and individually indicated interventions. Measurements were executed at baseline, preoperative and 3 months after TKA. The primary outcome measure was the Stair Climbing Test (SCT), secondary outcome measures were the knee range of motion (ROM) and the level of physical activity using Lysholm Score (LS) and Tegner Activity Scale (TAS). The subjective and socio-economic parameters were the Patients’ Global Impression of Change (PGIC) scale, inpatient rehabilitation time, preoperative pain levels and metabolic equivalent (MET), postoperative intake of analgesics and overall costs.

Results

No difference between IG and CG was found for SCT (F (2/36) = 0.016, p = 0.984, η2 = 0.004). An interaction between group and time was shown for TAS (F (18/1) = 13.890) with an increase in the IG (p = 0.002, η2 = 0.536). The sub-item “pain” within the LS presented a higher pain-level in CG (F (18/1) = 4.490, p = 0.048, η2 = 0.974), while IG showed a higher preoperative MET compared to CG (p = 0.035). There were no other significant changes. The CG produced 21.4% higher overall costs, took more analgesics and showed higher preoperative pain levels than the IG.

Conclusions

Findings show that preoperative therapy improved the level of physical activity before and after TKA and resulted in a clinically relevant gain in TAS.

Trial registration

ClinicalTrials.gov Identifier; NCT03160534. Registered 19 May 2017

Fruit supplementation reduces indices of exercise-induced muscle damage: a systematic review and meta-analysis

This systematic review and meta-analysis examined the effects of fruit supplements on indices of muscle damage and physical performance measures following muscle-damaging exercise protocols. The PEDro scale and Cochrane's risk of bias tool was used to critically appraise each study, whilst forest plots were generated to report on standardised mean differences (SMD) and p-values. The studies employed a crossover-randomised design, or a randomised controlled placebo design, with measures compared between the supplement (SUPP) and placebo (PLA) conditions at 24 and 48 h following the muscle-damaging exercise protocols. Compared to the PLA condition, the SUPP condition exhibited significantly lower levels of indirect muscle damage markers (p = 0.02; I² = 44%), inflammatory markers (p = 0.03; I² = 45%) and oxidative stress (p < 0.001; I² = 58%), whilst antioxidant capacity was significantly increased (p = 0.04; I² = 82%) at 24 h post-exercise. The maximal isometric voluntary contraction was significantly greater for the SUPP condition than the PLA at 24 h (p < 0.001; I² = 81%) and 48 h (p < 0.001; 84%) post-exercise. Only a few studies reported on functional outcome measures (i.e. countermovement jump, cycling, sprint and running maximal oxygen uptake), and the findings appeared conflicting according to qualitative analyses. Fruit supplementation minimised the level of several biomarkers of muscle damage, inflammation and oxidative stress, whilst improved muscular contractility during periods of EIMD. These findings demonstrate that fruit supplements could be used as recovery strategies from strenuous exercise sessions.

Epidemiology of painful knee after total knee arthroplasty in a tertiary care center: Assessment by decision tree

BACKGROUND

Painful knee after arthroplasty concerns up to 21% of patients at six months. We aimed to evaluate: the application of a decision tree to explain painful knee after total knee arthroplasty (TKA), the rate of unexplained pain after complete algorithmic screening. The aim of the study was to evaluate the causes of painful TKA. Our hypothesis was that it is possible to find the cause of the pain in more than 90% of cases.

METHODS

A single-center retrospective study analyzed all 1130 consultations between 1 April 2017 and 31 July 2018. We included all patients consulting for unexplained chronic painful knee arthroplasty.

RESULTS

We included 112 knees in 105 patients as unexplained painful knee arthroplasty. Final diagnostic status was no diagnosis in seven (6.3%) cases; infection in five (4.5%); instability without real dislocation in three (2.7%); placement error in two (1.8%), due to rotational problems; loosening in 25 (22.3%): 24 (21.4%) tibial and two (1.8%) femoral; polyethylene wear in nine (8.0%); periarticular pain in 37 (33.9%): 20 with quadriceps deficiency, four with iliotibial tendinitis, four with pes bursitis, six with stiffness, and three with prepatellar bursitis); zero material problems; projected pain in 21 (18.8%); and complex regional pain syndrome in three (2.7%) cases, improved by gentle physiotherapy.

CONCLUSIONS

The present study was original and presents the problem in the context of everyday practice, from the clinician's point of view, with an easy-to-use decision tree that can be implemented to assess painful knee in consultation.

Balance training can enhance hip fracture patients' independence in activities of daily living: A meta-analysis of randomized controlled trials

BACKGROUND

We conducted this meta-analysis to analyze the effectiveness of balance training in improving postoperative rehabilitation outcomes in hip fracture surgery patients.

METHODS

The Cochrane Library, Web of Science, Embase, and PubMed electronic databases were searched from their inception to December 2018. We selected prospective clinical control analyses and high-quality randomized controlled trials (RCTs) following the inclusion standards. We used Stata 12.0 to perform the meta-analysis. Where possible, the standard mean difference (SMD) with the 95% confidence interval (CI) was determined using a random effects model.

RESULTS

Ten RCTs involving 955 hips (balance training = 487, control = 468) published between 2002 and 2019 were assessed for eligibility of inclusion in the meta-analysis. Balance training was shown to remarkably improve the aspects of quality of life associated with physical health (standard mean difference [SMD], 2.20; 95% CI, 1.63-2.78, P = .000), a fast gait speed (SMD, 1.01; 95% CI, 0.25-1.77, P = .009), and balance (SMD = 0.26, 95% CI: [0.12, 0.41], P = .000). Moreover, the balance training group showed increases in independence in activities of daily living (ADLs), performance task scores, and health-related quality of life (HRQoL) scores compared with the control group (P < .05).

CONCLUSION

According to the present meta-analysis, balance training improves one's independence in activities of daily living, performance tasks, lower limb strength, gait, and total physical function compared with no balance training. More high-quality RCTs with large sample sizes are required for the identification of the best balance training program after hip fracture.

Rehabilitation protocols following total knee arthroplasty: a review of study designs and outcome measures

Total knee arthroplasty (TKA) is among the most common elective procedures performed worldwide. Recent efforts have been made to significantly improve patient outcomes, specifically with postoperative rehabilitation. Despite the many rehabilitation modalities available, the optimal rehabilitation strategy has yet to be determined. Therefore, this systematic review focuses on evaluating existing postoperative rehabilitation protocols. Specifically, this review analyses the study designs, rehabilitation methods, and outcome measures of postoperative rehabilitation protocols for TKA recipients in the past five years. The PubMed, EMBASE, and Cochrane Library databases were queried for studies evaluating rehabilitation protocols following primary TKA. Of the 11,013 studies identified within the last five years, 70 met the inclusion and exclusion criteria. After assessing for relevance and removing duplicates, a final count of 20 studies remained for analysis. Level-of-evidence was determined by the American Academy of Orthopaedic Surgeons (AAOS) classification system. Our findings demonstrated that continuous passive motion and inpatient rehabilitation may not provide additional benefit to the patient or healthcare system. However, early rehabilitation, telerehabilitation, outpatient therapy, high intensity, and high velocity exercise may be successful forms of rehabilitation. Additionally, weight-bearing biofeedback, neuromuscular electrical stimulation, and balance control appear to be beneficial adjuncts to conventional rehabilitation. Postoperative rehabilitation following TKA facilitates patient recovery and improves quality of life. This systematic review analyzed the existing rehabilitation protocols from the past five years. Some studies did not accurately describe the conventional rehabilitation protocols, the duration of therapy sessions, and the timing of these sessions. As such, future studies should explicitly describe their methodology. This will allow high-quality assessments and the conception of standardized protocols.

Efficacy of balance training for hip fracture patients: a meta-analysis of randomized controlled trials

Background

To investigate whether the clinical effects of balance training were improved in hip fracture patients.

Methods

Electronic databases which included PubMed, Embase, Web of Science, and the Cochrane Library up to December 2018 were searched. High-quality randomized controlled trials (RCTs) and prospective clinical controlled studies were selected based on inclusion criteria. Stata 12.0 was used for the meta-analysis. Standard mean difference (SMD) with 95% confidence interval (CI) was used to assess the effects.

Results

Finally, 9 studies with 872 patients (balance training = 445, control = 427) were included in our meta-analysis (published between 1997 and 2018). Compared with the control group, balance training group showed a significant increase in overall function (SMD = 0.59, 95% CI [0.25, 0.93], P = 0.001), gait speed (SMD = 0.63, 95% CI [0.19, 1.07], P = 0.005), lower limb strength (SMD = 0.73, 95% CI [0.50, 0.95], P = 0.000), activities of daily living (ADLs) (SMD = 0.97, 95% CI [0.61, 1.34], P = 0.000), performance task scores (SMD = 0.41, 95% CI [0.21, 0.61], P = 0.000), and health-related quality of life (HRQoL) scores (SMD = 0.32, 95% CI [0.16, 0.47], P = 0.000).

Conclusions

Our meta-analysis revealed that the balance training group has improved overall physical functioning, gait, lower limb strength, performance task, and activity of daily living than the control group. More high-quality and large-scale RCTs are needed to identify the optimal regimen of balance training after hip fracture.

Comparison of psychometric properties between recall methods of interview-based physical activity questionnaires: a systematic review

BACKGROUND

This systematic review examined the methodological quality of studies and assessed the psychometric qualities of interview-administered Past-week and Usual-week Physical Activity Questionnaires (PAQs). Pubmed and Embase were used to retrieve data sources.

METHODS

The studies were selected using the following eligibility criteria: 1) psychometric properties of PAQs were assessed in adults; 2) the PAQs either consisted of recall periods of usual 7-days (Usual-week PAQs) within the past 12 months or during the past 7-days (Past-week PAQs); and 3) PAQs were interview-administered. The COSMIN taxonomy was utilised to critically appraise study quality and a previously established psychometric criteria employed to evaluate the overall psychometric qualities.

RESULTS

Following screening, 42 studies were examined to determine the psychometric properties of 20 PAQs, with the majority of studies demonstrating good to excellent ratings for methodological quality. For convergent validity (i.e., the relationship between PAQs and other measures), similar overall associations were found between Past-week PAQs and Usual-week PAQs. However, PAQs were more strongly associated with direct measures of physical activity (e.g., accelerometer) than indirect measures of physical activity (i.e., physical fitness), irrespective of recall methods. Very few psychometric properties were examined for each PAQ, with the majority exhibiting poor ratings in psychometric quality. Only a few interview-administered PAQs exhibited positive ratings for a single psychometric property, although the other properties were either rated as poor or questionable, demonstrating the limitations of current PAQs.

CONCLUSION

Accordingly, further research is necessary to explore a greater number of psychometric properties, or to develop new PAQs by addressing the psychometric limitations identified in the current review.