Effect of proprioceptive and balance training on rehabilitation of knee joint after total knee arthroplasty: a meta-analysis

doi:10.3969/j.issn.2095-4344.1217

Abstract

Abstract:

BACKGROUND: The effects of proprioceptive and balance training in the rehabilitation of patients after total knee arthroplasty have been studied much, which have been shown to improve the postoperative balance and posture controlling abilities and reduce risk for falls. However, there is a lack of evidence-based medicine due to differences in research level and quality.

OBJECTIVE: To systematically evaluate the effects of proprioceptive and balance training on early rehabilitation after total knee arthroplasty.

METHODS: Databases of CNKI, CBM, VIP, WanFang, PubMed, web of science, Cochrane Library and Embase were searched for randomized controlled trials concerning the effects of proprioceptive and balance training on knee joint after arthroplasty. Meta-analysis was completed with Review Manager 5.3 software.

RESULTS AND CONCLUSION: (1) Twelve articles involving 688 patients were included. (2) The results of meta-analysis showed that the proprioceptive and balance training group had a significant improvement in timed up and go (WMD=-1.94, 95%CI: -3.47 to -0.41, P=0.01), Berg balance scale (WMD=6.48, 95%CI: 4.49-8.48, P < 0.000 01), single-leg stand balance (WMD=2.47, 95%CI: 2.07-2.87, P < 0.000 01), Biodex stability system (WMD=-0.42, 95%CI: -0.68 to -0.15, P=0.002), Hospital for Special Surgery function score (WMD=3.65, 95%CI: 1.72-5.58, P=0.000 2), Hospital for Special Surgery stability score (WMD=1.35, 95%CI: 0.71-2.00, P < 0.000 1), and EQ-5D-VAS (WMD=7.83, 95%CI: 1.11-14.54, P=0.02), compared with the conventional control group. (3) There was no significant difference between two groups in the angel reduction error (WMD=-3.23, 95%CI: -7.55-1.10, P=0.14), Hospital for Special Surgery pain score (WMD=2.22, 95%CI: -0.43-4.86, P=0.10), flexion deformity score (WMD=0.40, 95%CI: -0.69-1.49, P=0.47), range of motion (WMD=1.06, 95%CI: -0.86-2.98, P=0.28), or muscle strength (WMD=1.27, 95%CI: -0.03-2.57, P=0.05). (4) According to the results of this analysis, proprioceptive and balance training can effectively improve balance capacity, knee joint function and the quality of life for patients after total knee arthroplasty. While the results of pain, flexion deformity, range of motion of joint and muscle strength need to be interpreted carefully, which need to be confirmed through large sample size and high quality long-term follow-up studies.

Key words: proprioceptive training, balance training, total knee arthroplasty, knee joint, meta-analysis

CLC Number:

R459.9

Lu Yanyan, Xu Xuemeng, Liu Wengang, Du Jianping, Chen Guocai, Chen Guoqian, Qiu Bofan, Zheng Yi, Wu Zugui. Effect of proprioceptive and balance training on rehabilitation of knee joint after total knee arthroplasty: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(16): 2601-2607.

Figures/Tables 5

References

[1] Wang J, Yang L, Li Q, et al. Construction of an adherence rating scale for exercise therapy for patients with knee osteoarthritis. Bmc Musculoskeletal Disorders. 2018;19(1): 263.

[2] Komang-Agung IS, Sindrawati O, William PS. Do age and co-morbidy, among other factors, affect length of hospital stay following total knee arthroplasty. Malays Orthop J. 2018; 12(2): 25-30.

[3] Chan A, Jehu DA, Pang M. Falls after total knee arthroplasty: frequency, circumstances, and associated factors-a prospective cohort study. Phys Ther. 2018;98(9): 767-778.

[4] Zemková E, Hamar D. Sport-Specific Assessment of the effectiveness of neuromuscular training in young athletes. Front Phys. 2018; 9:264.

[5] Blasco J, Igualcamacho C, Roigcasasús S. In-home versus hospital preoperative balance and proprioceptive training in patients undergoing TKR; rationale, design, and method of a randomized controlled trial. Bmc Musculoskeletal Disorders. 2017;18(1):518.

[6] Bennell K, Dobson F, Hinman R. Measures of physical performance assessments: self-paced walk test (spwt), stair climb test (sct), six-minute walk test (6mwt), chair stand test (cst), timed up & go (tug), sock test, lift and carry test (lct), and car task. Arthritis Care Res. 2011;63(S11):S350-S370.

[7] Muir SW, Berg K, Chesworth B, et al. Use of the berg balance scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Phys Ther. 2008;88(4): 449-459.

[8] Vellas BJ, Wayne SJ, Romero L, et al. One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc. 1997;45(6):735-738.

[9] Higgins JPT, Green S(editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.

[10] Huber EO, Roos EM, Meichtry A, et al. Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement: an assessor-blinded randomized controlled trial. BMC Musculoskelet Disord. 2013; 16(1):101.

[11] Moutzouri M, Gleeson N, Coutts F, et al. Early self-managed focal sensorimotor rehabilitative training enhances functional mobility and sensorimotor function in patients following total knee replacement: a controlled clinical trial. Clin Rehabil. 2018;32(7):888-898.

[12] Liao CD, Liou TH, Huang YY, et al. Effects of balance training on functional outcome after total knee replacement in patients with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2013;27(8):697-709.

[13] Jogi P, Overend TJ, Spaulding SJ, et al. Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial. SAGE Open Med. 2015;3: 2102642769.

[14] Piva SR, Gil AB, Almeida GJ, et al. A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial. Phys Ther. 2010;90(6): 880-894.

[15] Gstoettner M, Raschner C, Dirnberger E, et al. Preoperative proprioceptive training in patients with total knee arthroplasty. Knee.2011; 18(4):265-270.

[16] Villadsen A, Overgaard S, Holsgaard-Larsen A, et al. Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty: a randomised controlled trial. Ann Rheum Dis. 2014;73(6):1130-1137.

[17] 李美,马磊,宋鑫,等. 本体感觉强化训练对全膝关节置换术后膝关节功能的影响[J]. 中国运动医学杂志,2015,34(3):275-278.

[18] 冯彦,唐建华,陈亚丽. 平衡训练对初次全膝关节置换术后患者平衡功能的影响[J]. 中国康复医学杂志, 2013, 28(11): 1060-1062.

[19] 张哲,马辉,康一凡,等. 本体感觉训练在全膝关节置换术后康复中的应用价值[J]. 中华关节外科杂志(电子版), 2016, 10(4): 17-20.

[20] 皮衍玲,王雪强,杨树芬,等. 全膝关节置换术前本体感觉训练对术后的影响[J]. 中国康复,2011,26(5):350-352.

[21] 吴婉霞,徐武华,刘文权,等. 早期本体感觉训练对全膝关节置换术后患者步行能力的影响[J]. 中国矫形外科杂志, 2013, 21(15): 1508-1512.

[22] Lanting BA, Lieberman JR, Callaghan JJ, et al. Ensuring a winner: the abcs of primary total knee arthroplasty. Instr Course Lect. 2015;64:369-379.

[23] Westby MD, Brittain A, Backman CL. Expert consensus on best practices for post-acute rehabilitation after total hip and knee arthroplasty: a canada and united states delphi study. Arthritis Care Res. 2014;66(3):411-423.

[24] Rakel BA, Zimmerman MB, Geasland K, et al. Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized, blinded, placebo-controlled trial. Pain. 2014; 155(12): 2599-2611.

[25] Saleh KJ, Lee LW, Gandhi R, et al. Quadriceps strength in relation to total knee arthroplasty outcomes. Instr Course Lect. 2010;59:119.

[26] Xu J, Zhang J, Wang XQ, et al. Effect of joint mobilization techniques for primary total knee arthroplasty: Study protocol for a randomized controlled trial. Medicine. 2017;96(49): e8827.

[27] Soison A, Riratanapong S, Chouwajaroen N, et al. Prevalence of fall in patients with total knee arthroplasty living in the community. J Med Assoc Thai. 2014;97(12):1338-1343.

[28] Wodowski AJ, Swigler CW, Liu H, et al. Proprioception and knee arthroplasty: a literature review. Orthop Clin North Am. 2016; 47(2):301-309.

[29] Pohl T, Brauner T, Wearing S, et al. Effects of sensorimotor training volume on recovery of sensorimotor function in patients following lower limb arthroplasty. BMC Musculoskelet Disord. 2015;16(1):1-9.

[30] Nam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement: a growing concern? Bone Joint J. 2014;96-B(11-Supple-A):96-100.