Improving Function After Knee Arthroplasty With Weight-Bearing Biofeedback
Condition: Arthropathy of Knee Joint
MeSH terms: Joint Diseases
Study type: Interventional

Summary: 
      The purpose of this study is to determine if rehabilitation using weight-bearing biofeedback
      training following total knee arthroplasty (TKA) is more effective than standard
      rehabilitation methods in promoting weight-bearing symmetry through the lower limbs during
      functional activities such as sit-to-stand transfers and walking. Secondary outcomes of
      interest include functional measures and internal moment at the hip, knee, and ankle joints
      during sit-to-stand and walking.
    

Detailed description: 
      People who have had knee replacement surgery typically have worse physical function compared
      to healthy people of similar age. This problem occurs despite completion of standard
      rehabilitation programs. One reason for less-than-optimal restoration of physical function is
      that standard rehabilitation does not effectively address habitual movement patterns that
      persist after surgery. These movement patterns are characterized by patients placing less
      weight on their surgical leg compared to their non-surgical leg after surgery. This
      asymmetrical movement pattern has been identified by researchers and shown to not completely
      resolve after knee replacement surgery, even though the surgery reliably reduces knee pain.
      The persistence of asymmetrical weight-bearing during every day activity may limit the
      stimulus needed for full recovery by the muscles and joints of the surgical leg. By promoting
      increased loading of the surgical leg, a greater stimulus can be provided to promote better
      functional recovery, compared with standard rehabilitation. As a result, people may
      subsequently move more symmetrically with improved recovery of physical function. Improved
      function would in turn promote the person's ability to participate in life events, limiting
      disability. Considering that over 500,000 knee replacement surgeries occur in the United
      States each year, maximizing functional recovery and limiting disability following surgery
      are important goals.

      The investigators propose a new method of exercising following knee replacement surgery. This
      method involves using a commercially available game system to promote "re-loading" of the
      surgical limb. The game system has games designed to allow the person playing to move objects
      or characters on a screen by shifting his/her weight from one leg to another while standing
      on an instrumented "balance board". The investigators have developed an exercise program to
      promote shifting weight to the surgical limb, by choosing appropriate games and manipulating
      the goals of those games. It is the investigators' hypothesis that early application of this
      surgical leg "re-loading" intervention after knee replacement will result in meaningful
      improvement in physical function by improving movement symmetry.
    

Intervention name(s): Weight-bearing biofeedback exercise; Standard of care exercise
Intervention type(s): Other; Other
Intervention description(s): Patients in the experimental group completed the same standard of care rehabilitation program as the control group. Thus, the experimental intervention was in addition to the standard intervention.
Upon discharge to home, patients in the RELOAD group began the weight bearing (WB) biofeedback phase of the study. Patients participated in two 30-minute training sessions/week with a physical therapist for a total of 6 weeks, focusing on promoting WB symmetry using a progressive series of activities adapted to video games.; Standard inpatient rehabilitation began on post-operative day 1 and lasted for an average of 3.2 days. After hospital discharge, two weeks of home rehabilitation (6 visits) were provided by physical therapists. Patients progressed to outpatient rehabilitation, consisting of 4 weeks of treatment. As such, 6 weeks of rehabilitation following hospital discharge was implemented for both groups.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: total knee arthroplasty; osteoarthritis; biomechanics; gait