Abstract
ObjectivesThe aim of this study was to evaluate the effects of an additional close-kinetic-chain exercise program (CKC-PT), in conjunction with the standard physiotherapy intervention (TKA-PT), on the general health status, functionality, balance confidence, and postoperative falls of knee osteoarthritic patients who had undergone total knee arthroplasty (TKA).Patients and methodsThirty community-dwellers, aged >65 years, were randomized into equal groups. The Greek versions of the SF-36 version1.0 (SF-36v1.0-Gr), WOMAC® (WOMAC®-Gr), Activities-specific Balance Confidence scale (ABC-Greek), Timed Up and Go (TUG) test, and Berg Balance Scale were assessed preoperatively and twice postoperatively (7th week and 12th month). Non-parametric (Mann-Whitney test) and parametric (two-way analysis of variance (ANOVA) model and student t-test) analyses were used to compare the percentage changes in all variables.ResultsThe CKC-PT group reported better (%) functional improvement (WOMAC®-Gr Physical Function subscale) and higher (%) balance confidence (ABS-Greek) at the seventh week and twelfth month as compared to TKA-PT (p<0.05). No other statistically significant differences were observed.ConclusionsThe implementation of a close-kinetic-chain exercise program, in addition to standard physiotherapy, may significantly increase both the functionality and balance confidence of patients who have undergone TKA. Further studies are needed to verify these findings.
Highlights
Over the past four decades, total knee arthroplasty (TKA) has become the most successful surgery for patients with severe knee osteoarthritis (OA) [1]
Post-TKA standard physiotherapy programs may vary across various rehabilitation settings, they typically focus on pain and edema management, regaining the knee joint’s range of motion, lower extremity strength and a normal gait pattern, and on functional activity training [2]
It was calculated that a sample size of 30 evaluable patients (15 per group) was required in order to have an 80% probability of demonstrating a between-groups difference of 10% in the percentage change from baseline to 12 months of the Activities-specific Balance Confidence Scale (ABC) score with a significance of
Summary
Over the past four decades, total knee arthroplasty (TKA) has become the most successful surgery for patients with severe knee osteoarthritis (OA) [1]. Patients who undergo TKA show marked improvements in function, and a reduction in pain compared with their preoperative limitations and symptoms [2]. Post-TKA standard physiotherapy programs may vary across various rehabilitation settings, they typically focus on pain and edema management, regaining the knee joint’s range of motion, lower extremity strength and a normal gait pattern, and on functional activity training [2]. It has been reported that the decreased knee extension strength, functional ability, and proprioception, as well as gait disorders that are observed preoperatively in knee OA patients sometimes deteriorate further postoperatively and may increase the risk of falls [3,4]. The lower limb proprioception deficiency has been reported to persist for one year following TKA, despite improvements in knee extension strength [5]. Studies have identified deficits in components of the balance system, such as decreased ability to detect joint position and motion, delayed muscle latency, altered amplitude of muscle activity, and decreased postural control, in patients
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