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Jiao S, Feng Z, Dai T, Huang J, Liu R, Meng Q. High-Intensity Progressive Rehabilitation Versus Routine Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2024; 39:665-671.e2. [PMID: 37634879 DOI: 10.1016/j.arth.2023.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND This study aimed to compare the effectiveness of high-intensity progressive rehabilitation training with routine training in the early treatment of patients undergoing total knee arthroplasty. METHODS There were 78 patients who underwent total knee arthroplasty and were randomized into high-intensity progressive training and routine rehabilitation training groups (RRT). The primary outcome measures were the American Hospital for Special Surgery Knee Score (HSS), with secondary outcomes including patient satisfaction, visual analog pain score, first time of standing after surgery, 6-minute walk test, 36-Item Short Form Survey (SF-36), and length of hospital stay. The incidence of postoperative complications were recorded. RESULTS The HSS scores were higher in the intervention group at 2 weeks, 3 months, and 12 months postoperatively (P < .001). The RRT group had higher visual analog pain scores than the intervention group at 24 hours, 3 days, and 2 weeks after surgery (P < .001). The intervention group had an earlier the first time of standing after surgery and a longer 6-minute walk test distance (P < .001, P = .028, P < .001, P < .001). Patient satisfaction was higher in the intervention group, with a higher quality of life rating at 3 months postoperatively (P < .001). However, 1 year after surgery, the 2 groups had no significant differences in mental component summaries. The length of hospital stay was shorter in the intervention group than in the RRT group. CONCLUSION Compared to routine training, high-intensity progressive rehabilitation training is more effective. It reduces postoperative patient pain, accelerates recovery of joint function, increases patient satisfaction, improves quality of life, shortens hospital stays, and promotes rapid recovery.
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Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Tianming Dai
- Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Hubei, China
| | - Ruijia Liu
- Department of Orthopedics, Foshan Fosun Chancheng Hospital, Foshan, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
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Jiao S, Feng Z, Huang J, Dai T, Liu R, Meng Q. Enhanced recovery after surgery combined with quantitative rehabilitation training in early rehabilitation after total knee replacement: a randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:74-83. [PMID: 37934189 PMCID: PMC10938034 DOI: 10.23736/s1973-9087.23.07899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/22/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The number of patients undergoing total knee replacement (TKR) is increasing yearly; however, there is still a relative lack of specific, individualized, and standardized protocols for functional exercise after TKR. Quantitative rehabilitation training was developed to improve the recovery of postoperative joint function, increase patient satisfaction, shorten the length of the hospital stay, improve the quality of life, and promote rapid patient recovery. AIM We aimed to compare the effectiveness of quantitative rehabilitation training based on the enhanced recovery after surgery (ERAS) concept with conventional rehabilitation training in the early rehabilitation of patients with TKR. DESIGN This was a single-centre, prospective, randomized controlled trial. SETTING Inpatient department. POPULATION Participants were patients who underwent unilateral total knee replacement. METHODS Based on the ERAS concept, a quantitative rehabilitation training program was developed for the quantitative group, and the control group underwent conventional rehabilitation training. Seventy-eight patients undergoing TKR were randomly divided into two blinded groups: the quantitative rehabilitation group and the conventional rehabilitation group. The analysis was performed according to per-protocol practice. The primary outcome metric was the Hospital for Special Surgery Knee Score (HSS Score), and secondary outcomes included patient satisfaction, Visual Analog Pain Score (VAS), time to get out of bed for the first time after surgery, 6-minute-walk test (6MWT), quality-of-life score (SF-36), and number of days in the hospital. The incidence of postoperative complications was also recorded. RESULTS There was no significant difference in HSS scores between the two groups before surgery (P=0.967), but the quantitative rehabilitation training group had significantly higher scores at two weeks (P=0.031), 3 months (P<0.01), and 12 months (P<0.01) after surgery than did the conventional rehabilitation training group, and both groups had higher HSS scores than before surgery. The quantitative training group had significantly higher VAS scores at 24 hours and three days postoperatively than the conventional training group (P<0.01), while there was no statistical significance at any other time points. The quantitative rehabilitation group had an earlier time to get out of bed for the first time after surgery (P<0.01), a longer 6MWT distance (P=0.028), and higher patient satisfaction and quality of life scores (SF-36) (P<0.01) that did the control group. The number of days in the hospital was lower in the quantitative training group than in the control group (P<0.001). There was no significant difference in the incidence of postoperative complications between the two groups. CONCLUSIONS Compared with conventional rehabilitation training, quantitative rehabilitation training based on the ERAS concept was found to be safe and effective and can accelerate the recovery of joint function after surgery, shorten hospitalization time, improve patient satisfaction, and promote rapid recovery. CLINICAL REHABILITATION IMPACT The quantitative rehabilitation training based on the ERAS concept provides a new program for rehabilitation exercises after total knee arthroplasty, which is safe and reliable, accelerates the recovery of joint function, and should be considered for clinical promotion.
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Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopedics, The Central Hospital of Xiaogan, Hubei, China
| | - Tianming Dai
- Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Ruijia Liu
- Department of Orthopedics, Fosun Chancheng Hospital of Foshan, Foshan, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China -
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Özden F, Uysal İ, Tümtürk İ, Özyer F. Investigation of Reaction Time, Proprioception, and Shaped Pathway Walking Performance in Older Patients with Total Knee Arthroplasty. J Am Med Dir Assoc 2024; 25:112-117. [PMID: 37926428 DOI: 10.1016/j.jamda.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The existing literature on total knee arthroplasty (TKA) does not provide clear data on step reaction time and proprioception and gait in shaped pathways. This study investigated the relationship between proprioception and reaction time with walking performance in shaped pathways in older patients undergoing TKA. DESIGN A cross-sectional observational study. SETTING AND PARTICIPANTS An orthopedic outpatient clinic with 103 older patients with TKA after a minimum of 6 months after surgery. METHODS Participants were evaluated with Figure-of-8 Walk Test (F8WT), L Test, Tinnetti Gait Test (TGT), proprioception measurement with an app-based inclinometer, and step reaction time (SRT) test. The same assessor carried out all evaluations. RESULTS F8WT showed a strong correlation with SRT-right, SRT-left, and Tinetti Gait Test (TGT), respectively (r1 = 0.628, r2 = 0.619, r3 = -0.615, P < .01). In addition, F8WT was moderately correlated with Right Leg Proprioception Test (RLPT) and Left Leg Proprioception Test (LLPT), respectively (r1 = 0.487, r2 = 0.439, P < .01). There was a moderate correlation between L Test with RLRT, LLRT, and TGT, respectively (r1 = 0.597, r2 = 0.584, r3 = -0.542, P < .01). Besides, there was a weak positive correlation between L Test with RLPT and LLPT, respectively (r1 = 0.394, r2 = 0.335, P < .01). A regression model showed that the L test was related to RLRT, LLRT, and TGT (R2 = 0.432, P < .001). The higher ability of the L test was weakly associated with higher levels of TGT (standardized β = -0.28, P = .0012). Besides, regression analysis also proved that F8WT was related to RLRT, LLRT, and TGT (R2 = 0.522, P < .001). The most highly associated parameter was LLRT (standardized β = 0.958, P = .003). CONCLUSIONS AND IMPLICATIONS Gait in shaped pathways is associated with proprioception, reaction time, and balance ability in older patients with TKA. Therefore, proprioception, reaction time, and balance should be considered to improve the shaped pathway walking performance of patients after bilateral, right, or left TKA surgery.
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Affiliation(s)
- Fatih Özden
- Department of Health Care Services, Köyceğiz Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - İsmail Uysal
- Department of Health Care Services, Fethiye Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - İsmet Tümtürk
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Süleyman Demirel University, Isparta, Turkey
| | - Fatih Özyer
- Department of Orthopaedics and Traumatology, Fethiye State Hospital, Muğla, Turkey
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Eymir M, Yuksel E, Unver B, Karatosun V. Reliability, validity, and minimal detectable change of the Step Test in patients with total knee arthroplasty. Ir J Med Sci 2022; 191:2651-2656. [PMID: 35022951 DOI: 10.1007/s11845-021-02888-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/07/2021] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Musa Eymir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Erzurum Technical University, TR-25050, Yakutiye, Erzurum, Turkey.
| | - Ertugrul Yuksel
- Graduate School of Health Sciences, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
| | - Bayram Unver
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Erzurum Technical University, TR-25050, Yakutiye, Erzurum, Turkey
| | - Vasfi Karatosun
- Department of Orthopedics and Traumatology, School of Medicine, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
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Sarac DC, Unver B, Karatosun V. Validity and reliability of performance tests as balance measures in patients with total knee arthroplasty. Knee Surg Relat Res 2022; 34:11. [PMID: 35272697 PMCID: PMC8908580 DOI: 10.1186/s43019-022-00136-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/08/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE This study aimed to investigate validity and reliability of the Timed Up and Go Test (TUG), 10 Meter Walk Test (10MWT), Single Leg Stance Test (SLST), 2 Minute Walk Test (2MWT), and Five Times Sit-to-Stand Test (5xSST) for evaluating balance in patients with total knee arthroplasty (TKA). MATERIALS AND METHODS This cross-sectional study included 41 participants who had undergone TKA 6 months before the study due to osteoarthritis. Participants performed the TUG, 10MWT, SLST, 5xSST, and 2MWT. Each of the tests was performed twice, with a 1-day interval between tests. Intraclass correlation coefficient (ICC) models were used to determine the test-retest reliability. The level of correlations between performance tests and Berg Balance Scale and Fall Efficacy Scale-International were used to establish concurrent and convergent validity of the performance tests, respectively. RESULTS The mean age of the subjects was 64.07 ± 10.57 years. All tests showed excellent reliability (ICC > 0.94), excluding SLST that demonstrated good test-retest reliability (ICC = 0.72). All of the tests (SLST, 10MWT, 5xSST, 2MWT, TUG) were found to have good validity (rho > 0.704). CONCLUSIONS According to these results, TUG, 10MWT, SLST, 5xSST, and 2MWT are reliable and valid outcome measures in patients with TKA, and could be used to assess balance after TKA surgery.
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Affiliation(s)
- Devrim Can Sarac
- grid.411795.f0000 0004 0454 9420Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Bayram Unver
- grid.21200.310000 0001 2183 9022School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Floor: 3, Balcova, Izmir, Turkey
| | - Vasfi Karatosun
- grid.21200.310000 0001 2183 9022Department of Orthopedics and Traumatology, School of Medicine, Dokuz Eylul University, Balcova, Izmir, Turkey
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Arumugam A, Björklund M, Mikko S, Häger CK. Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis. BMJ Open 2021; 11:e049226. [PMID: 34006560 PMCID: PMC8130739 DOI: 10.1136/bmjopen-2021-049226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training/sham) on knee proprioception following anterior cruciate ligament (ACL) injury. DESIGN Systematic Review. DATA SOURCES PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index were searched from inception to February 2020. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and controlled clinical trials investigating the effects of neuromuscular training on knee-specific proprioception tests following a unilateral ACL injury were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened and extracted data and assessed risk of bias of the eligible studies using the Cochrane risk of bias 2 tool. Overall certainty in evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. RESULTS Of 2706 articles retrieved, only 9 RCTs, comprising 327 individuals with an ACL reconstruction (ACLR), met the inclusion criteria. Neuromuscular training interventions varied across studies: whole body vibration therapy, Nintendo-Wii-Fit training, balance training, sport-specific exercises, backward walking, etc. Outcome measures included joint position sense (JPS; n=7), thresholds to detect passive motion (TTDPM; n=3) or quadriceps force control (QFC; n=1). Overall, between-group mean differences indicated inconsistent findings with an increase or decrease of errors associated with JPS by ≤2°, TTDPM by ≤1.5° and QFC by ≤6 Nm in the ACLR knee following neuromuscular training. Owing to serious concerns with three or more GRADE domains (risk of bias, inconsistency, indirectness or imprecision associated with the findings) for each outcome of interest across studies, the certainty of evidence was very low. CONCLUSIONS The heterogeneity of interventions, methodological limitations, inconsistency of effects (on JPS/TTDPM/QFC) preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice. There is a need for methodologically robust RCTs with homogenous populations with ACL injury (managed conservatively or with reconstruction), novel/well-designed neuromuscular training and valid proprioception assessments, which also seem to be lacking. PROSPERO REGISTRATION NUMBER CRD42018107349.
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Affiliation(s)
- Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Martin Björklund
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå University, Umeå, Sweden
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Sanna Mikko
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation - Physiotherapy Section, Umeå University, Umeå, Sweden
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Blasco JM, Hernández-Guillen D, Domínguez-Navarro F, Acosta-Ballester Y, Alakhdar-Mohmara Y, Roig-Casasús S. Sensorimotor training prior total knee arthroplasty and effects on functional outcome: A systematic review and meta-analysis. Gait Posture 2021; 86:83-93. [PMID: 33711615 DOI: 10.1016/j.gaitpost.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/28/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- José-María Blasco
- Group in Physiotherapy of the Ageing Processes: Social and Healthcare Strategies, Department of Physiotherapy, Universitat de València, Spain; IRIMED Joint Research Unit (La Fe - Universitat de València), Spain
| | - David Hernández-Guillen
- Group in Physiotherapy of the Ageing Processes: Social and Healthcare Strategies, Department of Physiotherapy, Universitat de València, Spain.
| | - Fernando Domínguez-Navarro
- Group in Physiotherapy of the Ageing Processes: Social and Healthcare Strategies, Department of Physiotherapy, Universitat de València, Spain
| | | | - Yasser Alakhdar-Mohmara
- Group in Physiotherapy, Technology and Research, Department of Physiotherapy, Universitat de València, Spain
| | - Sergio Roig-Casasús
- Group in Physiotherapy of the Ageing Processes: Social and Healthcare Strategies, Department of Physiotherapy, Universitat de València, Spain; Hospital Universitari I Politècnic La Fe, Valencia, Spain
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Fortier LM, Rockov ZA, Chen AF, Rajaee SS. Activity Recommendations After Total Hip and Total Knee Arthroplasty. J Bone Joint Surg Am 2021; 103:446-455. [PMID: 33337819 DOI: 10.2106/jbjs.20.00983] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
» A formal unsupervised activity program should be recommended to all patients recovering from total knee arthroplasty (TKA) and total hip arthroplasty (THA). » In a subset of all patients undergoing TKA or THA, studies have found that an unsupervised activity program may be as efficacious as supervised physical therapy (PT) after surgery. Certain patients with inadequate independent function may continue to benefit from supervised PT. » For TKA, supervised telerehabilitation has also been proven to be an effective modality, with studies suggesting equivalent efficacy compared with supervised in-person PT. » Following TKA, there is no benefit to the use of continuous passive motion or cryotherapy devices, but there are promising benefits from the use of pedaling exercises, weight training, and balance and/or sensorimotor training as adjuncts to a multidisciplinary program after TKA. » No standardized postoperative limitations exist following TKA, and the return to preoperative activities should be dictated by an individual's competency and should consist of methods to minimize high impact stress on the joint. » Despite traditional postoperative protocols recommending range-of-motion restrictions after THA, it is reasonable to recommend that hip precautions may not be needed routinely following elective primary THA.
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Affiliation(s)
- Luc M Fortier
- Georgetown University School of Medicine, Washington, DC
| | - Zachary A Rockov
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sean S Rajaee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Gränicher P, Stöggl T, Fucentese SF, Adelsberger R, Swanenburg J. Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial. Arch Physiother 2020; 10:13. [PMID: 32774889 PMCID: PMC7405420 DOI: 10.1186/s40945-020-00085-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/15/2020] [Indexed: 01/20/2023] Open
Abstract
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
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Affiliation(s)
- Pascale Gränicher
- The University Center for Prevention and Sports Medicine (UCePS), Balgrist University Hospital, Forchstrasse 319, 8008 Zurich, Switzerland.,Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands
| | - Thomas Stöggl
- Department of Sport and Exercise Science, University of Salzburg, Schlossallee 49, 5400 Hallein/Rif, Austria
| | - Sandro F Fucentese
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Rolf Adelsberger
- Wearable Computing Lab Zurich, ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Jaap Swanenburg
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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Blasco JM, Acosta-Ballester Y, Martínez-Garrido I, García-Molina P, Igual-Camacho C, Roig-Casasús S. The effects of preoperative balance training on balance and functional outcome after total knee replacement: a randomized controlled trial. Clin Rehabil 2019; 34:182-193. [DOI: 10.1177/0269215519880936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To assess the effects of preoperative balance training on the early postoperative balance and functional outcomes after total knee replacement surgery and to test whether an outpatient intervention may be as effective as a domiciliary intervention. Design: This is a three-arm randomized controlled trial. Setting: University hospital. Subjects: Eighty-six individuals were recruited. Seventy-seven were analysed, aged 72.1 (SD 7.6) years, of which 68% were women. Outcome measures: Overall state of balance, as measured with the Berg Balance Scale, and patient-perceived functionality, as measured with the Knee Injury and Osteoarthritis Outcome Score Function in Activities in Daily Living (KOOS-ADL) questionnaire, were the primary outcomes. Secondary assessments targeted knee function, balance and mobility, quality of life, and self-reported outcomes. The primary end-point was six weeks after surgery. Intervention: The hospital group implemented a four-week preoperative outpatient balance-oriented intervention. The home group implemented similar training, but this was domiciliary. The control group was instructed to keep performing their normal activities. Results: Home and hospital groups presented a moderate effect against the control group ( dhospital-control = 0.54; dhome-control = 0.63), both being similarly effective in improving the overall state of balance at six weeks after surgery ( P = 0.013). KOOS-ADL scores showed no between-group differences and a small effect size ( d < 0.5; P = 0.937). Secondary assessments suggested non-significant between-group differences. Conclusion: Preoperative balance training, conducted either as domiciliary or as an outpatient, is an effective approach to enhance early postoperative balance outcome but not the perceived functionality of individuals undergoing total knee replacement.
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Affiliation(s)
- José-María Blasco
- Group of Physiotherapy in the Ageing Process, Departamento de Fisioterapia, Universitat de València (UV), Valencia, Spain
- IRIMED Joint Research Unit (IIS La Fe – UV), Valencia, Spain
| | - Yolanda Acosta-Ballester
- Group of Physiotherapy in the Ageing Process, Departamento de Fisioterapia, Universitat de València (UV), Valencia, Spain
| | | | | | - Celedonia Igual-Camacho
- Group of Physiotherapy in the Ageing Process, Departamento de Fisioterapia, Universitat de València (UV), Valencia, Spain
- Hospital Clínico y Universitario de Valencia, Valencia, Spain
| | - Sergio Roig-Casasús
- Group of Physiotherapy in the Ageing Process, Departamento de Fisioterapia, Universitat de València (UV), Valencia, Spain
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Roig-Casasús S, Blasco JM, López-Bueno L, Blasco-Igual MC. Balance Training With a Dynamometric Platform Following Total Knee Replacement: A Randomized Controlled Trial. J Geriatr Phys Ther 2019; 41:204-209. [PMID: 28252471 DOI: 10.1519/jpt.0000000000000121] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Sensorimotor training has proven to be an efficient approach for recovering balance control following total knee replacement (TKR). The purpose of this trial was to evaluate the influence of specific balance-targeted training using a dynamometric platform on the overall state of balance in older adults undergoing TKR. METHODS This was a randomized controlled clinical trial conducted at a university hospital rehabilitation unit. Patients meeting the inclusion criteria were randomly assigned to a control group or an experimental group. Both groups participated in the same 4-week postoperative rehabilitation training protocol. Participants in the experimental group performed additional balance training with a dynamometric platform consisting of tests related to stability challenges, weight-shifting, and moving to the limits of stability. The primary outcome measure was the overall state of balance rated according to the Berg Balance Scale. Secondary outcomes in terms of balance were the Timed Up and Go Test, Functional Reach Test, and Romberg open and closed-eyes tests. Data processing included between-group analysis of covariance, minimal detectable change assessment for the primary outcome measure, and effect size estimation. Confidence intervals (CIs) were set at 95%. RESULTS Forty-three participants meeting the inclusion criteria and having signed the informed consent were randomly assigned to 2 groups. Thirty-seven completed the training (86.1%). Significant between-group differences in balance performance were found as measured with the Berg Balance Scale (P = .03) and Functional Reach Test (P = .04) with a CI = 95%. Significant differences were not recorded for the Timed Up and Go Test or Romberg open and closed-eyes tests (P > .05). Furthermore, Cohen's effect size resulted in a value of d = 0.97, suggesting a high practical significance of the trial. DISCUSSION AND CONCLUSIONS According to the Berg Balance Scale and Functional Reach Test, participants with TKR who have followed a 4-week training program using a dynamometric platform improved balance performance to a higher extent than a control group training without such a device. The inclusion of this instrument in the functional training protocol may be beneficial for recovering balance following TKR.
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Affiliation(s)
- Sergio Roig-Casasús
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain.,Hospital Clínic Universitari de València, Valencia, Spain
| | - José María Blasco
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Laura López-Bueno
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain.,Hospital Clínic Universitari de València, Valencia, Spain
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12
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Doma K, Grant A, Morris J. The Effects of Balance Training on Balance Performance and Functional Outcome Measures Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Sports Med 2019; 48:2367-2385. [PMID: 30117054 DOI: 10.1007/s40279-018-0964-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several studies have examined the effects of balance training in elderly individuals following total knee arthroplasty (TKA), although findings appear to be equivocal. OBJECTIVES This systematic review and meta-analysis examined the effects of balance training on walking capacity, balance-specific performance and other functional outcome measures in elderly individuals following TKA. METHODS Data sources: Pubmed, PEDro, Cinahl, SportDiscus, Scopus. Eligibility criteria: Data were aggregated following the population-intervention-comparison-outcome (PICO) principles. Eligibility criteria included: (1) randomised controlled trials; (2) studies with comparative groups; (3) training interventions were incorporated post-TKA; and (4) outcome measures included walking capacity, balance-specific performance measures, subjective measures of physical function and pain and knee range-of-motion. PARTICIPANTS Elderly individuals (65 + years) who underwent total knee arthroplasty. INTERVENTIONS Balance interventions that consisted of balance exercises, which were compared to control interventions that did not involve balance exercises, or to a lesser extent. Participants also undertook usual physiotherapy care in conjunction with either the balance and/or control intervention. The intervention duration ranged from 4 to 32 weeks with outcome measures reported immediately following the intervention. Of these, four studies also reported follow-up measures ranging from 6 to 12 months post-interventions. Study appraisal: PEDro scale. SYNTHESIS METHODS Quantitative analysis was conducted by generating forest plots to report on standardised mean differences (SMD; i.e. effect size), test statistics for statistical significance (i.e. Z values) and inter-trial heterogeneity by inspecting I2. A meta-regression was also conducted to determine whether training duration predicted the magnitude of SMD. RESULTS Balance training exhibited significantly greater improvement in walking capacity (SMD = 0.57; Z = 6.30; P < 0.001; I2 = 35%), balance-specific performance measures (SMD = 1.19; Z = 7.33; P < 0.001; I2 = 0%) and subjective measures of physical function (SMD = 0.46; Z = 4.19; P < 0.001; I2 = 0%) compared to conventional training immediately post-intervention. However, there were no differences in subjective measures of pain (SMD = 0.77; Z = 1.63; P > 0.05; I2 = 95%) and knee range-of-motion (SMD = 0.05; Z = 0.39; P > 0.05; I2 = 1%) between interventions. At the 6- to 12-month follow-up period, improvement in combined measures of walking capacity and balance performance (SMD = 041; Z = 3.55; P < 0.001; I2 = 0%) were significantly greater for balance training compared to conventional training, although no differences were observed for subjective measures of physical function and pain (SMD = 0.26; Z = 2.09; P > 0.05; I2 = 0%). Finally, the training duration significantly predicted subjective measures of pain and physical function (r2 = 0.85; standardised β = 0.92; P < 0.001), although this was not observed for walking capacity and balance-specific performance measures (r2 = 0.02; standardised β = 0.13; P = 0.48). LIMITATIONS A number of outcome measures indicated high inter-trial heterogeneity and only articles published in English were included. CONCLUSION Balance training improved walking capacity, balance-specific performance and functional outcome measures for elderly individuals following TKA. These findings may improve clinical decision-making for appropriate post-TKA exercise prescription to minimise falls risks and optimise physical function.
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Affiliation(s)
- Kenji Doma
- College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia.
- Orthopaedic Research Institute of Queensland, Townsville, QLD, 4814, Australia.
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, QLD, 4814, Australia
| | - Jodie Morris
- Orthopaedic Research Institute of Queensland, Townsville, QLD, 4814, Australia
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13
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Risk of falls in patients with knee osteoarthritis undergoing total knee arthroplasty: A systematic review and best evidence synthesis. J Orthop 2018; 15:903-908. [PMID: 30174378 DOI: 10.1016/j.jor.2018.08.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives Falls occur frequently in patients with impaired ambulation and may dramatically affect the elderly population. Aim was to document the incidence of falls in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA), and to identify factors and treatments that may influence the risk of falls. Methods A systematic literature search was conducted on three medical electronic databases, PubMed, PeDRO, and Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used. Risk of bias analysis and best evidence synthesis were performed. The main aspects related to falls were analyzed: prevalence, risk factors, correlation with clinical outcome, effect of treatments. Results The systematic review identified 11 papers on 1237 patients. Pre-operative fall prevalence ranged from 23% to 63%, while post-operative values ranged from 12% to 38%. Moderate evidence was found on no influence of clinical scales, no BMI differences between "faller" and "non-faller", and on influence of limited pre-operative range of motion. Conflicting evidence was found for sex, history of previous falls, age, kyphosis, muscle weakness, fear of falling, depression, balance, gait impairment. No evidence was found for the effectiveness of surgical or rehabilitative strategies on falls reduction. Conclusions OA patients undergoing TKA are at high risk of falls, which is reduced but still present after surgery. Although some risk factors were identified, there are no studies demonstrating the possibility of reducing the incidence of this deleterious event, which warrants further research efforts to better manage this fragile population of elderly patients.
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Domínguez-Navarro F, Igual-Camacho C, Silvestre-Muñoz A, Roig-Casasús S, Blasco JM. Effects of balance and proprioceptive training on total hip and knee replacement rehabilitation: A systematic review and meta-analysis. Gait Posture 2018. [PMID: 29525292 DOI: 10.1016/j.gaitpost.2018.03.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGOUND Balance and proprioceptive deficits are frequently persistent after total joint replacement, limiting functionality and involving altered movement patterns and difficulties in walking and maintaining postural control among patients. RESEARCH QUESTION The goal of this systematic review was to evaluate the short- and mid-term effects of proprioceptive and balance training for patients undergoing total knee and hip replacement. METHODS This is a systematic review of literature. MEDLINE, Embase, Cochrane Library, PEDro, and Scopus were the databases searched. The review included randomized clinical trials in which the experimental groups underwent a training aimed at improving balance and proprioception, in addition to conventional care. The studies had to assess at least one of the following outcomes: self-reported functionality or balance (primary outcomes), knee function, pain, falls, or quality of life. RESULTS Eight trials were included, involving 567 participants. The quantitative synthesis found a moderate to high significant effect of balance and proprioceptive trainings on self-reported functionality and balance after total knee replacement. The effects were maintained at mid-term in terms of balance alone. Conversely, preoperative training did not enhance outcomes after total hip arthroplasty. SIGNIFICANCE The synthesis showed that, in clinical terms, balance trainings are a convenient complement to conventional physiotherapy care to produce an impact on balance and functionality after knee replacement. If outcomes such as improvement in pain, knee range of movement, or patient quality of life are to be promoted, it would be advisable to explore alternative proposals specifically targeting these goals. Further research is needed to confirm or discard the current evidence ultimately, predominantly in terms of the effects on the hips and those yielded by preoperative interventions.
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Affiliation(s)
| | - Celedonia Igual-Camacho
- Departamento de Fisioterapia, Universidad de Valencia, Calle Gascó Oliag 5, 46010 Valencia, Spain; Hospital Clínico y Universitario de Valencia, Avd. Blasco Ibáñez 13, 46010 Valencia, Spain; Group of Physiotherapy in the Ageing Process, Spain.
| | - Antonio Silvestre-Muñoz
- Hospital Clínico y Universitario de Valencia, Avd. Blasco Ibáñez 13, 46010 Valencia, Spain; Departmento de Cirugía, Universidad de Valencia, Avd. Blasco Ibáñez 15, 46010 Valencia, Spain.
| | - Sergio Roig-Casasús
- Departamento de Fisioterapia, Universidad de Valencia, Calle Gascó Oliag 5, 46010 Valencia, Spain; Group of Physiotherapy in the Ageing Process, Spain; Hospital Universitario y Politécnico la Fe, Avd. de Fernando Abril Martorell 106, 46026 València, Spain.
| | - José María Blasco
- Departamento de Fisioterapia, Universidad de Valencia, Calle Gascó Oliag 5, 46010 Valencia, Spain; Group of Physiotherapy in the Ageing Process, Spain; IRIMED Joint Research Unit Hospital La Fe - Universidad de Valencia, Spain.
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15
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Moutzouri M, Gleeson N, Coutts F, Tsepis E, Gliatis J. Early self-managed focal sensorimotor rehabilitative training enhances functional mobility and sensorimotor function in patients following total knee replacement: a controlled clinical trial. Clin Rehabil 2018; 32:888-898. [PMID: 29473481 DOI: 10.1177/0269215518757291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. DESIGN A single-blind controlled clinical trial. SETTING University Hospital of Rion, Greece. SUBJECTS A total of 52 participants following total knee replacement. OUTCOME MEASURES The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8 weeks post surgery, and 14 weeks post surgery). INTERVENTION Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3-5 sessions/week (35-45 minutes). RESULTS Consistently greater improvements ( F2,98 = 4.3 to 24.8; P < 0.05) in group mean scores favour the experimental group compared to the control group: Timed Up and Go (7.8 ± 2.9 seconds vs. 4.6 ± 2.6 seconds); balance (2.1 ± 0.9° vs. 0.7 ± 1.2°); joint position error (13.8 ± 7.3° vs. 6.2 ± 9.1°); Knee Outcome Survey Activities of Daily Living Scale (44.2 ± 11.3 vs. 26.1 ± 11.4); and pain (5.9 ± 1.3 cm vs. 4.6 ± 1.1 cm). Patterns of improvement for the experimental group over time were represented by a relative effect size range of 1.3-6.5. CONCLUSIONS Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.
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Affiliation(s)
- Maria Moutzouri
- 1 Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece, Aigio, Greece
| | - Nigel Gleeson
- 2 Exercise and Rehabilitation Sciences, Queen Margaret University, Musselburgh, UK.,3 School of Health Sciences, Queen Margaret University, Musselburgh, UK
| | - Fiona Coutts
- 3 School of Health Sciences, Queen Margaret University, Musselburgh, UK
| | - Elias Tsepis
- 1 Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece, Aigio, Greece
| | - John Gliatis
- 4 Orthopedic Surgery Department, University Hospital of Patras, Rio, Greece
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16
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Blasco JM, Igual-Camacho C, Roig-Casasús S. In-home versus hospital preoperative balance and proprioceptive training in patients undergoing TKR; rationale, design, and method of a randomized controlled trial. BMC Musculoskelet Disord 2017; 18:518. [PMID: 29221471 PMCID: PMC5723092 DOI: 10.1186/s12891-017-1887-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/01/2017] [Indexed: 12/17/2022] Open
Abstract
Background Severe knee osteoarthritis, as well as the surgical procedure of total knee replacement that aims to reduce its symptoms, cause great deterioration on the proprioceptive system. Taking this fact into account, and considering that balance abilities positively influence the capacity to perform basic functional tasks, this trial aims to find the short and mid-term effects of a preoperative balance and proprioceptive training when conducted by patients undergoing total knee replacement. Along with the effects, it is intended to determine whether in-home based training can be as effective as hospital training. The results will help to conclude whether the possible benefits may outweigh the health costs. Methods Seventy-five participants will take part. The trial will include in-home and supervised hospital experimental training compared to a non-active control group in order to estimate the actual effect of the proposal against the benefits due exclusively to the surgical procedure. Interventions last 4 weeks prior to surgery, and the follow-up will be at 2w, 6w, and 1y following the operation. The primary outcomes are in agreement with the goals: self-reported functionality in terms of KOOS and overall balance in terms of the Berg Balance Scale. The secondary outcomes will include the measurements of static and dynamic balance abilities, pain, function, and quality of life. Discussion It is expected for the results of this trial to provide relevant information in order to decide if a specific intervention is cost-effective to be implemented in clinical practice. Trial registration Clinicaltrials.gov identifier NCT03100890. Registered in April 4, 2017.
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Affiliation(s)
- José-María Blasco
- Department of Physiotherapy, University of Valencia, Calle Gascó Oliag 5, 46010, Valencia, Spain. .,Group of Physiotherapy in the Ageing Process, València, Spain. .,Joint Research Unit La Fe-UV (IRIMED), València, Spain.
| | - Celedonia Igual-Camacho
- Department of Physiotherapy, University of Valencia, Calle Gascó Oliag 5, 46010, Valencia, Spain.,Group of Physiotherapy in the Ageing Process, València, Spain.,Hospital Clínico y Universitario de Valencia, Avenida de Blasco Ibáñez, 17, 46010, València, Spain
| | - Sergio Roig-Casasús
- Department of Physiotherapy, University of Valencia, Calle Gascó Oliag 5, 46010, Valencia, Spain.,Group of Physiotherapy in the Ageing Process, València, Spain.,Hospital Universitario y Politécnico de La Fe, Avenida de Fernando Abril Martorell, 106, 46026, València, Spain
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The Effect of Early Progressive Resistive Exercise Therapy on Balance Control of Patients With Total Knee Arthroplasty. TOPICS IN GERIATRIC REHABILITATION 2017. [DOI: 10.1097/tgr.0000000000000165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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18
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L Snell D, Hipango J, Sinnott KA, Dunn JA, Rothwell A, Hsieh CJ, DeJong G, Hooper G. Rehabilitation after total joint replacement: a scoping study. Disabil Rehabil 2017; 40:1718-1731. [PMID: 28330380 DOI: 10.1080/09638288.2017.1300947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research. MATERIALS AND METHODS We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement. We reviewed this work in the context of outcomes described from previously published research. RESULTS Thirty individual studies and seven systematic reviews were included, with most research examining the effectiveness of physiotherapy-based exercise rehabilitation after total knee replacement using randomized control trial methods. Rehabilitation after hip and knee replacement whether carried out at the clinic or monitored at home, appears beneficial but type, intensity and duration of interventions were not consistently associated with outcomes. The burden of comorbidities rather than specific rehabilitation approach may better predict rehabilitation outcome. Monitoring of recovery and therapeutic attention appear important but little is known about optimal levels and methods required to maximize outcomes. CONCLUSIONS More work exploring the role of comorbidities and key components of therapeutic attention and the therapy relationship, using a wider range of study methods may help to advance the field. Implications for Rehabilitation Physiotherapy-based exercise rehabilitation after total hip replacement and total knee replacement, whether carried out at the clinic or monitored at home, appears beneficial. Type, intensity, and duration of interventions do not appear consistently associated with outcomes. Monitoring a patient's recovery appears to be an important component. The available research provides limited guidance regarding optimal levels of monitoring needed to achieve gains following hip and knee replacement and more work is required to clarify these aspects. The burden of comorbidities appears to better predict outcomes regardless of rehabilitation approach.
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Affiliation(s)
- Deborah L Snell
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.,b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand
| | - Julia Hipango
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - K Anne Sinnott
- b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand
| | - Jennifer A Dunn
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - Alastair Rothwell
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - C Jean Hsieh
- c MedStar Health Research Institute , Washington , DC , USA.,d MedStar National Rehabilitation Hospital , Washington , DC , USA
| | - Gerben DeJong
- d MedStar National Rehabilitation Hospital , Washington , DC , USA.,e Department of Rehabilitation Medicine , Georgetown University School of Medicine , Washington , DC , USA
| | - Gary Hooper
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
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The effect of total knee arthroplasty on patients' balance and incidence of falls: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:3439-3451. [PMID: 27761627 PMCID: PMC5644701 DOI: 10.1007/s00167-016-4355-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 07/05/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Despite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature. METHODS A systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool. RESULTS Thirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III. CONCLUSIONS Findings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II-III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.
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