Influences of Balance Training With a Dynamometric Platform in Total Knee Arthroplasty

Study Overview
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Brief Summary
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Knee osteoarthritis produces degeneration and joint wear that greatly affects the patient's proprioceptive system increasing instability. After total knee arthroplasty intervention, it is recommended that the patient performs a rehabilitation procedure to minimize deficits caused by surgery. In this job it is essential to insist on the importance of recovering balance after total knee arthroplasty intervention, and assess a specifically designed protocol to restore its function. An intervention which includes a dynamometric platform as a training method was proposed. The randomized clinical trial compared a control group that performed balance exercises on parallel bars, unstable plates, ramps and stairs against an experimental group that included dynamometric platforms training as a differentiator.

Official Title
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Valoración de la Puesta en Marcha en Artroplastias Totales de Rodilla Mediante un Trabajo Postural en Plataforma Dinamometrica

Conditions
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Knee Osteoarthritis

Intervention / Treatment
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* Other: Functional Recovery
* Other: Balance Training
* Other: Dynamometric Platform Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 65 and 85. Subjects with knee osteoarthritis that have not been operated before. Patients operated with the same total replacement prosthesis. Patients operated with the same surgical procedure. Time before intervention over 4 weeks. Time to start rehabilitation after surgery must be less than 4 weeks. The Result in Berg scale must be greater than 21, indicating a medium-low risk of falling. the Result of the Mini-Mental State Examination must be equal or greater than 20, which means they do not have moderate or severe cognitive impairment. Once the informed consent is read and explained, patients must accept and agree to participate in the study. Exclusion Criteria: Patient does no accept sign the informed consent. Patient with morphological alterations hip or ankle (also knee). Patient that presents knee flexion out of the range between 70 ° and -20 ° because of the risk posed to suffer a fall. Patient with suspected deep vein thrombosis. Patient with post-surgical infection of the operated knee. Patient with psychiatric disorders: depression, anxious syndrome, etc. Patient with pathology of central origin (i.e. cerebellar) that could interfere with the results of the test of balance or strength Patient with vestibular pathology that could interfere with the results of the test of balance

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EXPERIMENTAL<br>Functional recovery Balance training | Other: Functional Recovery<br>* Rehabilitation protocol based on muscle strengthening with isometric, isotonic and counter-resistance with progressive load exercises. Intervention consisted of warm-up phase with passive, active-assisted and active movements, and a work-out phase<br>Other: Balance Training<br>* Balance and proprioception training using parallel bars, unstable plates, ramps and stairs<br>Other: Dynamometric Platform Training<br>* Stability tests, weight changes and stability limits, performing both anterior-posterior and medial-lateral movements simultaneously in some cases<br>|
| Active Comparator: CONTROL<br>Functional recovery Balance training Dynamometric Platform training | Other: Functional Recovery<br>* Rehabilitation protocol based on muscle strengthening with isometric, isotonic and counter-resistance with progressive load exercises. Intervention consisted of warm-up phase with passive, active-assisted and active movements, and a work-out phase<br>Other: Balance Training<br>* Balance and proprioception training using parallel bars, unstable plates, ramps and stairs<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Berg Balance Scale | Balance among older people with impairment in balance function by assessing the performance of functional tasks from the total score achieved in the 14 items test | Change from baseline (two weeks after intervention) to after four weeks of training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional Reach (cm) | Assesses a patient's stability by measuring the maximum distance an individual can reach forward while standing in a fixed position | Change from baseline (two weeks after intervention) to after four weeks of training | 
| Timed Up and Go Test (s) | Dynamic balance assessment. Also points at the risk of falling. Time of getting up from a chair, walk three meters, come back and sit again, measured in seconds | Change from baseline (two weeks after intervention) to after four weeks of training | 
| Romberg Tests | Total score achieved with open and closed eyes and on firm surface | Change from baseline (two weeks after intervention) to after four weeks of training | 
| Knee Range of Mobility (º) | Knee Range of Mobility (Flexion, Extension) in degrees | Change from baseline (two weeks after intervention) to after four weeks of training | 
| Kendall and Lovet scale | Muscle Balance estimated with with Kendall and Lovet scale (score from 0 to 5) | Change from baseline (two weeks after intervention) to after four weeks of training | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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total knee replacement, total knee arthroplasty, rehabilitation, physical therapy, balance