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

Validation of proprioception measures of the lumbar spine

BACKGROUND

To better personalize treatment and monitor recovery of individuals with low back pain, objective tests of sensorimotor functions, such as lumbar proprioception, must be selected based on their reliability and validity. The primary objective of this study was to test the concurrent validity of three measures of lumbar proprioception.

METHODS

Thirty-one participants performed three lumbar proprioception tests (motion perception threshold, active and passive joint positioning sense), a whole-body mobility and balance (time up-and-go) and two trunk-specific postural control (threshold of stability and sensor-based sway measures) tests.

RESULTS

Only the motion perception threshold proprioception test showed some validity, correlating with the trunk-specific postural control tests [r range (positive values): 0.37 to 0.60]. The three lumbar proprioception measures were not correlated to each other. The threshold of stability measure was correlated with the time up-and-go (r = 0.37) and trunk-specific (sensor-based sway measures) postural control [r range (positive values): 0.48 to 0.77] tests.

CONCLUSION

The present study generated three original findings. Only the motion perception threshold proprioception test demonstrated its concurrent validity. In fact, the three lumbar proprioception tests performed in the present study were not correlated to each other, thus assessing different constructs. Finally, the threshold of stability protocol was validated against other tests. These findings will help in selecting the most appropriate lumbar proprioception measures to study the effects of exercise treatments in patients with back pain.

Efficiency assessment of follow-up methodology of patients with knee replacement to predict post-surgical functionality: a protocol for randomised control PROKnee trial

INTRODUCTION

Even when total knee arthroplasty (TKA) is an extended treatment, most patients experience a suboptimal evolution after TKA. The objectives of this study are the following: (1) to determine the effectiveness of two different prosthesis stabilisation systems on the functionality in activities of daily life, and (2) to determine prognostic biomarkers of knee prosthesis function based on radiological information, quantification of cytokines, intra-articular markers and biomechanical functional evaluation to predict successful evolution.

METHODS AND ANALYSIS

The PROKnee trial was designed as a randomised controlled patient-blinded trial with two parallel groups that are currently ongoing. The initial recruitment will be 99 patients scheduled for their first TKA, without previous prosthesis interventions in lower limbs, who will be randomly divided into two groups that differed in the stabilisation methodology incorporated in the knee prosthesis: the MEDIAL-pivot group and the CENTRAL-pivot group. The maximum walking speed will be reported as the primary outcome, and the secondary results will be patient-reported questionnaires related to physical status, cognitive and mental state, radiological test, laboratory analysis and biomechanical instrumented functional performance, such as the 6-minute walking test, timed up-and-go test, gait, sit-to-stand, step-over, and ability to step up and down stairs. All the results will be measured 1 week before TKA and at 1.5, 3, 6 and 12 months after surgery.

ETHICS AND DISSEMINATION

All procedures were approved by the Ethical Committee for Research with Medicines of the University Clinical Hospital of Valencia on 8 October 2020 (order no. 2020/181). Participants are required to provide informed consent for the study and for the surgical procedure. All the data collected will be treated confidentially since they will be blinded and encrypted. The results from the trial will be published in international peer-reviewed scientific journals, regardless of whether these results are negative or inconclusive.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04850300).

Effect of dynamic neuromuscular stabilization training using the inertial load of water on functional movement and postural sway in middle-aged women: a randomized controlled trial

BACKGROUND

Chronic stress and diseases occur more frequently in middle-aged compared to younger women and this is often the result of physical, psychological and socio-economic changes. These health consequences reduce lower body muscle mass and flexibility, leading to generalized impairments in functional movement and balance. Dynamic Neuromuscular Stabilization (DNS) training using the inertial load of water is known for its positive impact on functional strength improvement and muscle stabilization.

OBJECTIVE

This study aimed to determine the effect of DNS training using inertial water loads on functional movement and postural sway in middle-aged women.

METHOD

A sample of 24 middle-aged women participated in the study and were randomly divided into two groups: the experimental group, n = 12 (age: 58.33 ± 1.48 yrs, height: 162.16 ± 1.27 cm, weight: 61.77 ± 2.21 kg) and control group, n = 12 (age: 59.58 ± 1.13 yrs, height: 160.1 ± 1.13 cm, weight: 57.51 ± 1.12 kg). Center of Pressure (COP), moving distance, Root Mean Square (RMS), movement area and Functional Movement Screen (FMS) were conducted and analyzed pre- and post-examination. Participants engaged in the DNS training regimen, which utilized the inertial load of water, for 60 min each session, conducted twice weekly for 12 weeks.

RESULTS

There were significant differences in the COP distance (p < 0.001), RMS (p < 0.05), COP area and FMS test (p < 0.001) in the pre-post comparison of each group. And significant differences were found in COP distance (p < 0.05), RMS (p < 0.05), COP area (p < 0.05) and FMS test (p < 0.05) between groups. The DNS training improved the dynamic stability of single-leg standing, torso stability and functional movement in middle-aged women.

CONCLUSION

DNS training programs using the inertial load of water have been shown to be effective in movement improvement and posture retention ability, which is beneficial for functional movement, equilibrium strategy, and dynamic stability of middle-aged women. Furthermore, the DNS training method designed in this study can be useful for trainees who require posture correction in a safe and effective way regardless of their age and gender.

Effects of exercise training programs on motor skills of individuals with intellectual disabilities: a systematic review and meta-analysis

PURPOSE

Motor skills are involved in many physical activities and are prerequisites for the performance of sport skills. The purpose of this systematic review was to examine the effects of exercise training programs (ETP) on the motor skills of individuals with intellectual disabilities (IwID).

METHODS

Primary sources were obtained from four databases including PubMed, SCOPUS, CENTRAL, and Web of Science. The search period covered years from inception to October 26th, 2023. Inclusion criteria were as follows: Population: IwID; Intervention: ETP; Comparator: motor skills vs. nontraining control; Outcomes: motor skills outcomes. Standardized mean differences, weighted mean differences, and 95% confidence intervals (CI) were calculated using both random and fixed-effect models for outcomes.

RESULTS

A total of 14 studies involving 586 participants were included in the systematic review. The results of the present meta-analysis showed that ETP improved composite motor skills (1.28 95% CI: [0.86, 1.70], p = 0.001), gross motor skills (0.91, 95% CI: [0.62,1.19], p = 0.001), fine motor skills (0.74, 95% CI: [0.21,1.27], p = 0.01) and fine-gross motor skills (0.64, 95% CI: [0.29, 1.00], p = 0.001).

CONCLUSION

The results meta-analysis demonstrated that ETP improves the motor skills of IwID. Therefore, it is recommended to apply ETP to improve the motor skills of the IwID.

The impacts of exercise training programs on balance in children with hearing loss: A systematic review and meta-analysis

INTRODUCTION AND PURPOSE

According to the prevalence of balance disorders among children with hearing loss (HL), researchers used exercise programs to improve balance in children with HL. So, the present systematic review and meta-analysis briefly summarize findings regarding the impacts of exercise training programs on balance in children with HL.

METHODS

Science Direct, MEDLINE/PubMed, SCOPUS, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, and Google Scholar were searched from inception until November 11th, 2023. Two independent researchers analyzed and extracted the data from potential papers whose eligibility was confirmed. Then, the PEDro scale was used to obtain quality assessment scores. The total PEDro score is 11 and incorporates the presentation of statistical analysis and evaluation criteria of internal validity. Studies that scored 7-11 were considered methodologically "high", 5 to 6 were "fair", and ≤4 were considered "poor".

RESULTS

10 studies involving a total of 304 participations were included in the systematic review. Our results demonstrate that exercise training programs positively impact static balance (p = 0.001) with level 1a evidence, the postural sway (p = 0.001) with level 1a evidence, and dynamic balance (p = 0.001) with level 1a evidence in children with HL.

CONCLUSION

The findings of this systematic review and meta-analysis related to studies with excellent methodological quality revealed that the intended training programs significantly impact postural sway along with static and dynamic balance in children with HL. It is recommended that future exercise training programs be paired with rehabilitation programs for children with HL.

Balance Control in Individuals with Hearing Impairment: A Systematic Review and Meta-Analysis

Comprehensive insights into balance control of individuals with hearing impairment are compared with individuals with hearing. Primary sources were obtained from 7 databases including PubMed, LILACS, SCOPUS, CINAHL, PEDro, CENTRAL, and Web of Science. The search period extended from inception until January 5, 2022. The systematic review included 24 studies and 27 trials, with a total of 2,148 participants. The meta-analysis showed a significant difference in the average balance control between individuals with hearing impairment and individuals with hearing, with individuals with hearing having a favorable advantage (p = 0.001). Additionally, average balance control was found to be in favor of individuals with hearing (p = 0.001) when comparing individuals with hearing impairment who participated in sports. Finally, individuals with hearing impairment who participated in sports demonstrated a significantly higher average difference in balance control (p = 0.001) when compared to sedentary people with hearing impairment. Our meta-analysis results indicate a balance defect in individuals with hearing impairment compared to individuals with hearing. In addition, with increasing age, the balance in individuals with hearing impairment improved. Additionally, the dependence of individuals with hearing impairment on the visual and proprioception systems to maintain balance increased. Finally, there was more dependence on the proprioception than the visual system, while individuals with hearing had stronger average balance control than individuals with hearing impairment who participated in sports, when compared to sedentary people with hearing impairment.

Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial

BACKGROUND

Virtual reality (VR) and serious games (SGs) are widespread in rehabilitation for many orthopedic and neurological diseases. However, few studies have addressed the effects of rehabilitation with VR-based SGs on clinical, gait, and postural outcomes in individuals with total knee replacement (TKR).

OBJECTIVE

The primary objective was the efficacy of balance training using non-immersive VR-based SGs compared to conventional therapy in TKR patients on the Time Up and Go test. Secondary objectives included the efficacy on clinical, gait, and postural outcomes.

METHODS

We randomly allocated 56 individuals with unilateral TKR to the experimental group (EG) or control group (CG) for 15 sessions (45 min; 5 times per week) of non-immersive VR-based SGs or conventional balance training, respectively. The primary outcome was functional mobility measured by the Timed Up and Go test; secondary outcomes were walking speed, pain intensity, lower-limb muscular strength, independence in activities of daily living as well as gait and postural parameters.

RESULTS

We found significant within-group differences in all clinical outcomes and in a subset of gait (p<0.0001) and postural (p ≤ 0.05) parameters. Analysis of the stance time of the affected limb revealed significant between-group differences (p = 0.022): post-hoc analysis revealed within-group differences in the EG (p = 0.002) but not CG (p = 0.834). We found no significant between-group differences in other outcomes.

CONCLUSIONS

Balance training with non-immersive VR-based SGs can improve clinical, gait, and postural outcomes in TKR patients. It was not superior to the CG findings but could be considered an alternative to the conventional approach and can be added to a regular rehabilitation program in TKR patients. The EG had a more physiological duration of the gait stance phase at the end of the treatment than the CG.

CLINICALTRIALS

GOV: NCT03454256.

Age and attentional focus instructions effects on postural and supra-postural tasks among older adults with mild cognitive impairments

OBJECTIVE

The purpose of this study was to investigate the age and attentional focus instruction effects on the postural and supra-postural tasks among older adults with mild cognitive impairments.

METHOD

Forty healthy adults (mean age of 48.01 ± 5.45 years) and 40 older adults with mild cognitive impairments (mean age of 69.87 ± 4.28 years) were selected as participants. They were randomly divided into eight groups receiving internal and external attentional focus instructions for postural and supra-postural tasks. The postural status was evaluated by measuring the COP sway velocity with the Master Balance System.

RESULTS

The results showed that in both phases of acquisition and retention, the main effect of the attentional focus type was significant (P < 0.05). The group's postural control with external attentional instructions was better than the group's postural control with internal attentional instructions. Furthermore, the CI elderly gained benefit from the guidelines of attentional focus. Results showed that the task type was not significant in the acquisition phase. However, in the retention phase, the main effect of the attentional focus type was significant. The groups' postural function with the supra-postural task was better than the groups with the postural task. Furthermore, the older adults showed a better postural function in the supra-postural task than in the postural task.

CONCLUSIONS

Our results showed that the ability to allocate resources of attention may decrease with CI. These findings suggest that considering the effect of the supra-postural tasks' manipulation on postural control, it is possible to improve balance by designing training programs for directing supra-postural tasks. The findings of the present study can be a guide for educators and therapists. They can increase the balance of the patients by considering the dysfunction and the type of attentional guidelines to prevent them from falling and performing a dual task.

Does adding neuromuscular electrical stimulation to rehabilitation following total knee arthroplasty lead to a better quadriceps muscle strength recovery? A systematic review

Patients undergoing total knee arthroplasty (TKA) show postsurgical quadriceps weakness. Neuromuscular electrical stimulation (NMES) has been shown to be an effective treatment for muscle strength recovery in a number of orthopaedic conditions. The aim of this review is to investigate whether adding NMES to TKA rehabilitation leads to a better quadriceps strength recovery in comparison with standardized rehabilitation. A second aim is to investigate which are the most commonly used NMES pulse settings and their effectiveness. A systematic review of literature was conducted on PubMed, Cochrane, Scopus and Web-of-Science. Intervention studies evaluating the effects of a rehabilitation intervention based on quadriceps NMES in patients undergoing TKA were retrieved. Methodological quality was assessed using the risk of bias-2 Cochrane tool. Features of NMES rehabilitation and technical data on NMES settings were extracted from the studies. Four studies met the inclusion criteria. Due to the limited number and the heterogeneity of the selected studies, it was not appropriate to carry out a meta-analysis. All the studies reported higher quadriceps strength in patients undergoing quadriceps NMES, particularly early after TKA. The addition of NMES or traditional strength training shows similar long-term effects. Short duration and low-intensity NMES have limited effects on quadriceps strength. Heterogeneity was found on NMES methodologies and pulse settings. In conclusion, NMES is effective for quadriceps strength recovery following TKA. NMES intensity and duration are essential for good NMES outcomes on quadriceps strength. Further studies on NMES methodologies, pulse features and settings are required to address the gaps in knowledge on NMES following TKA.

Vibratory cue training elicits anticipatory postural responses to an external perturbation

Anticipatory postural adjustments (APAs) represent the feedforward mechanism of neuromuscular control essential for maintaining balance under predictable perturbations. The importance of vision as a distal sensory modality in the generation of APAs is well established. However, the capabilities of external cues in generating APAs are less explored. In the present study, vibratory cue was investigated for its reliability among healthy individuals in generating anticipatory response under external perturbation in the absence of vision. Ten participants, in quiet stance, were provided with external perturbation in the form of pendulum impact in anterior-posterior (AP) direction under conditions of: both vision and vibratory cue absent; vision present but vibratory cue was absent; vision and vibratory cue both were present; only vibratory cue is present with vision being absent. EMG activities of the leg muscles and displacement of center of pressure (COP) in AP direction were recorded. The data were later analyzed and quantified in the time frame of anticipatory and compensatory phases. The results showed that with training, participants were able to generate significant APAs relying on the vibratory cue alone. Improvement in APAs was accompanied by minimizing the need for larger CPA and improved stability (COP displacement) under perturbation. The study outcome indicates the possibility of using vibratory cues for APA-based interventions.