A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial
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Published on: July 22, 2019
Sara R Piva1, Alexandra B Gil, Gustavo J M Almeida
1Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA. spiva@pitt.edu
Background:
Patients with total knee arthroplasty (TKA) have impaired balance and movement control. Exercise interventions have not targeted these impairments in this population.
Objectives:
The purposes of this study were: (1) to determine the feasibility of applying a balance exercise program in patients with TKA, (2) to investigate whether a functional training (FT) program supplemented with a balance exercise program (FT+B program) could improve physical function compared with an FT program alone in a small group of individuals with TKA, and (3) to test the methods and calculate sample size for a future randomized trial with a larger study sample.
Design:
This study was a double-blind, pilot randomized clinical trial.
Setting:
The study was conducted in the clinical laboratory of an academic center.
Participants:
The participants were 43 individuals (30 female, 13 male; mean age=68 years, SD=8) who underwent TKA 2 to 6 months prior to the study.
Interventions:
The interventions were 6 weeks (12 sessions) of a supervised FT or FT+B program, followed by a 4-month home exercise program.
Measurements:
Feasibility measures included pain, stiffness, adherence, and attrition. The primary outcome measure was a battery of physical performance tests: self-selected gait speed, chair rise test, and single-leg stance time. Secondary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index and the Lower Extremity Functional Scale.
Results:
Feasibility of the balance training in people with TKA was supported by high exercise adherence, a relatively low dropout rate, and no adverse events. Both groups demonstrated clinically important improvements in lower-extremity functional status. The degree of improvement seemed higher for gait speed, single-leg stance time, and stiffness in the FT+B group compared with the FT group.
Limitations:
Due to the pilot nature of the study, differences between groups did not have adequate power to show statistical significance.
Conclusions:
There is a need for conducting a larger randomized controlled trial to test the effectiveness of an FT+B program after TKA.