Effects of Specific Balance Training Prior TKR Surgery in the Early Postoperative Outcomes
Condition: Knee Osteoarthritis; Aging
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Knee osteoarthritis is one of the most common pathologies in old people, and the leading
      cause of pain and disability. Symptoms include joint pain, stiffness, limited mobility,
      functional impairment and proprioceptive deficit. When conservative treatments fail to
      control these symptoms, a total knee replacement (TKR) is the chosen treatment, mainly
      because of its efficacy on pain relief. In recent decades, this surgical procedure has been
      soared, and it has also aroused the interest of researches about the patients' outcomes after
      surgery.

      Despite the TKR results in good reported outcomes, after surgery patients may manifest
      persistent pain and problems affecting to their functionality, stability, walking speed,
      proprioception, motor control, risk of falling and therefore to their quality of life. In
      more than a third of the cases, those deficiencies may be extended after surgery from six
      months to one year, when subjects use to achieve the plateau functional values.

      Traditional rehabilitation programs have been usually focused on improving muscle strength of
      the lower limbs as well as the functionality with specific exercises to achieve this purpose,
      and to a lesser extent on balance and proprioception exercises. Evidence supports this
      approach. Yet, task-oriented rehabilitation focusing on balance enhancement may be one of the
      most important factors for a complete rehabilitation, since benefits of proprioceptive and
      balance trainings may range from better stability and motor control, improvements in both
      static and dynamic balance and enhanced functionality. Indeed, recent studies have shown that
      the combination of traditional functional rehabilitation together with balance training may
      help to restore functional deficits to a larger extent than usual therapy, and based on a
      systematic review published (Moutzori, 2015) and in our previous works (Roig, 2016),
      sensori-motor training is an acceptable adjust to usual physiotherapy care .

      Looking into the effect of preoperative trainings or education before TKR surgery, it is
      aimed at improving the physical function, but also managing the expectations of the surgery
      for a better recovery. There is from low to moderate evidence about the effects of TKR
      pre-interventional training programs, and some authors have argued that the effects are too
      small to be consider clinically relevant.

      In general, the preoperative program is usually focused on functional and strengthening
      exercises. Despite of proprioception is used in the clinical practice for the prevention and
      recovery of many orthopedics injuries, the amount of evidence about the effects of
      proprioceptive training programs for knee and hip replacement is not large, few works
      compares pre-habilitation and post-rehabilitation programs, and there is not systematically
      reviewed evidence reporting the efficacy of balance and proprioceptive pre-interventional
      training programs.

      In this framework, this aimed at evaluating the effects of specific-task oriented
      proprioceptive and balance training programs when conducted by patients undergoing TKR before
      and after surgery, and will compare these effects to the outcomes achieved with traditional
      strength-functional programs, as well as to no specific prehabilitation training.
    


Intervention name(s): Strength-Function; Balance-Proprioception
Intervention type(s): Other; Other
Intervention description(s): Preoperative functional and strength capabilities training.; Preoperative proprioceptive and balance capabilities training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment