Do Pilates-based exercises following total knee arthroplasty improve postural control and quality of life? Functional Reach, Depression Scores, and Number of Medications Are Associated With Number of Falls in People With Chronic Stroke. Physical performance tests, self-reported outcomes, and accidental falls before and after total knee arthroplasty: An exploratory study Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial. Functional outcomes of outpatient balance training following total knee replacement in patients with knee osteoarthritis: a randomized controlled trial Balance Training With a Dynamometric Platform Following Total Knee Replacement: A Randomized Controlled Trial Fall incidence and risk factors in patients after total knee arthroplasty A Balance Exercise Program Appears to Improve Function for Patients With Total Knee Arthroplasty: A Randomized Clinical Trial Relationships between balance control and cognitive functions, gait speed, and activities of daily living Comparison of Clinic- and Home-Based Rehabilitation Programs After Total Knee Arthroplasty Effects of balance training on functional outcome after total knee replacement in patients with knee osteoarthritis: a randomized controlled trial The immediate and long-term effects of a walking-skill program compared to usual physiotherapy care in patients who have undergone total knee arthroplasty (TKA): a randomized controlled trial Use of Nintendo Wii Fit™ in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial. A randomized controlled trial of exercise to improve mobility and function after elective knee arthroplasty. Feasibility, results and methodological difficulties Japan's share of articles in orthopedics Postural control in rheumatoid arthritis patients scheduled for total knee arthroplasty. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure? Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial.
ABSTRACT Purpose : The aim of this prospect i ve , r and omized , controlled study was to investigate the effects of the addition of Pilates-based exercises to st and ard exercise programs performed after total knee arthroplasty on quality of life and balance . Method : Forty-six volunteers were divided into two groups . The control group ( n = 17 ) was assigned a st and ard exercise program after discharge ; the study group ( n = 17 ) was assigned Pilates-based exercises along with the st and ard exercise program . We carried out clinical evaluations of all patients on the day of discharge and after the completion of the 6-week exercise program . We also recorded sociodemographic data , Berg Balance test scores , and Short Form-36 ( SF-36 ) health-related quality of life measurements . Results : When we compared the differences between pre- and post-treatment balance scores of the groups , we found a significant change in favor of the Pilates-based exercise group ( 13.64 ± 1.45 ; p < 0.01 ) . The changes in the pre- and post-treatment SF-36 scores of the Pilates-based exercises group were found to be significant in terms of physical function ( p = 0.001 ) , physical role restriction ( p = 0.01 ) , and physical component score ( p = 0.001 ) . Conclusions : Pilates-based exercises performed along with st and ard exercise programs were more effective for improving balance and quality of life  than st and ard exercise programs alone BACKGROUND Falls are a common adverse event among people with stroke . Previous studies investigating risk of falls after stroke have relied primarily on retrospective fall history ranging from 6 - 12 months recall , with inconsistent findings . OBJECTIVES To identify factors and balance assessment tools that are associated with number of falls in individuals with chronic stroke . DESIGN Secondary analysis of a r and omized clinical trial . SETTING Multisite academic and clinical institutions . PARTICIPANTS Data from 181 participants with stroke ( age 60.67 ± 11.77 years , post stroke 4.51 ± 4.78 years ) were included . METHODS Study participants completed baseline testing and were prospect ively asked about falls . A multivariate negative binomial regression was used to identify baseline predictive factors predicting falls : age , endurance ( 6 minute walk test ) , number of medications , motor control ( Fugl-Meyer lower extremity score ) , depression ( Patient Health Question naire-9 ) , physical activity ( number of steps per week ) , and cognition ( Mini Mental Status Exam score ) . A second negative binomial regression analysis was used to identify baseline balance assessment scores predicting falls : gait velocity ( comfortable 10 Meter Walk ) , Berg Balance Scale ( BBS ) , Timed Up and Go ( TUG ) , and Functional Reach Test ( FRT ) . Receiver operating characteristic ( ROC ) and area under the curve ( AUC ) were used to determine the cutoff scores for significant predictors of recurrent falls . MAIN OUTCOME MEASUREMENT The number of falls during the 42-week follow-up period . RESULTS Baseline measures that significantly predicted the number of falls included increased number of medications , higher depression scores , and decreased FRT . Cutoff scores for the number of medications were 8.5 with an AUC of 0.68 . Depression scores differentiated recurrent fallers at a threshold of 2.5 scores with an AUC of 0.62 . FRT differentiated recurrent fallers at a threshold of 18.15 cm with an AUC of 0.66 . CONCLUSIONS Number of medications , depression scores , and decreased FRT distance at baseline were associated with increased number of falls . Increased medications might indicate multiple comorbidities or polypharmacy effect ; increased depression scores may indicate psychological status ; and decreased functional reach distance could indicate dynamic balance impairments . LEVEL OF EVIDENCE II This longitudinal , observational study explored the relationship between physical performance tests , self-reported outcomes , and accidental falling , before and after total knee arthroplasty ( TKA ) . Thirty-seven patients were r and omly selected from a larger study of falling before and after surgery conducted at a UK National Health Service Orthopaedic Unit . Physical performance tests were the  Berg Balance Score ( BBS ) , Timed Up and Go ( TUG ) , and H and Grip Strength ( HGS ) . Self-reported outcomes incorporated the Western Ontario and McMaster 's Osteoarthritis Index ( WOMAC ) , Activities Balance Confidence Scale ( ABC-UK ) , Geriatric Depression Scale ( GDS ) , and accidental falls . Paired pre- and postoperative data were available on 22 patients . A total of 22.7 % patients fell before and after TKA . Postoperative improvement in BBS and TUG was found in 41 % and 50 % of patients , respectively , HGS did not change . BBS showed a consistent moderate-to-strong association with other physical tests both before and after surgery ; TUG ( rs −0.76 ; rs −0.90 ) , maximal HGS ( r 0.49 ; r 0.48 ) , and self-report measures ; ABC-UK ( r 0.52 ; r 0.74 ) , WOMAC stiffness ( r −0.53 ; r −0.48 ) , and WOMAC function ( r −0.56 ; r −0.45 ) . Although self-report question naires are an efficient , cost-effective approach to outcome assessment in TKA , there is a growing case for inclusion of physical performance tests . The Berg Balance Score may be a useful addition to outcome assessment in patients with TKA OBJECTIVE To compare the improvement in disability , kinesiophobia , pain , and quality of life obtained by means of home-based functional exercises aim ed at managing kinesiophobia with that obtained by giving subjects undergoing total knee arthroplasty ( TKA ) advice to stay active after discharge from a rehabilitation unit . DESIGN R and omized controlled trial with 6-months ' follow-up . SETTING Patients ' homes . PARTICIPANTS Patients ( N=110 ; 40 men ; mean age , 67y ) at the end of a 15-day period of in-hospital rehabilitation after undergoing primary TKA . INTERVENTIONS In the experimental group , before returning home , the patients were asked to continue the functional exercises learned during hospitalization in twice-weekly 60-minute sessions for 6 months , and were given a book containing theoretical information about the management of kinesiophobia . In the control group , the patients were advised to stay active and gradually recover their usual activities . MAIN OUTCOME MEASURES Repeated- measures analysis of covariance with baseline values as the covariates ( P<.05 ) was used to assess the effect of treatment on disability , fear-avoidance beliefs , pain intensity , and quality of life . RESULTS The analysis revealed a significant time by group interaction in all the variables in favor of the experimental group . Post hoc analysis showed that the effect of the group was statistically significant at the end of home training and follow-up . The treatment effect was clinical ly tangible in terms of disability and quality of life , and persisted for 6 months after the intervention ended . CONCLUSIONS A home-based program based on functional exercises and the management of kinesiophobia was useful in changing the course of disability , fear-avoidance beliefs , pain , and the quality of life in patients with TKA Objective : To evaluate whether balance training after total knee replacement surgery improves functional outcomes and to determine whether postoperative balance is associated with mobility . Design : A prospect i ve intervention study and r and omized controlled trial with an intention-to-treat analysis . Setting : The rehabilitation center of a university-based teaching hospital . Participants : A total of 130 patients with knee osteoarthritis who had undergone total knee replacement surgery were recruited to attend an outpatient rehabilitation program . They were r and omly allocated to additional balance rehabilitation and functional rehabilitation groups . Interventions : During the eight-week outpatient rehabilitation program , both groups received general functional training . Patients in the balance rehabilitation group received an additional balance-based rehabilitation program . Primary outcome measures : The functional reach test , single-leg stance test , 10-m walk test , Timed Up and Go Test , timed chair-st and test , stair-climb test , and Western Ontario and McMaster Universities Osteoarthritis Index were measured at baseline , eight weeks ( T1 ) , and 32 weeks ( T2 ) . Results : The balance rehabilitation group patients demonstrated significant improvement in the results of the functional reach test at T1 ( 37.6 ±7.8 cm ) and T2 ( 39.3 ±9.7 cm ) compared with the baseline assessment ( 11.5 ±2.9 cm ) and Timed Up and Go Test at T1 ( 8.9 ±1.2 seconds ) and T2 ( 8.0 ±1.9 seconds ) compared with the baseline assessment ( 12.5 ±1.8 seconds ) . Moreover , the balance rehabilitation group patients exhibited significantly greater improvements in balance and mobility than did the functional rehabilitation group patients ( all P < 0.001 ) . Furthermore , improved balance was significantly associated with improved mobility at T2 . Conclusion : Postoperative outpatient rehabilitation with balance training improves the balance , mobility , and functional outcomes in patients with knee osteoarthritis after total knee replacement Background and Purpose : Sensorimotor training has proven to be an efficient approach for recovering balance control following total knee replacement ( TKR ) . The purpose of this trial was to evaluate the influence of specific balance-targeted training using a dynamometric platform on the overall state of balance in older adults undergoing TKR . Methods : This was a r and omized controlled clinical trial conducted at a university hospital rehabilitation unit . Patients meeting the inclusion criteria were r and omly assigned to a control group or an experimental group . Both groups participated in the same 4-week postoperative rehabilitation training protocol . Participants in the experimental group performed additional balance training with a dynamometric platform consisting of tests related to stability challenges , weight-shifting , and moving to the limits of stability . The primary outcome measure was the overall state of balance rated according to the Berg Balance Scale . Secondary outcomes in terms of balance were the Timed Up and Go Test , Functional Reach Test , and Romberg open and closed-eyes tests . Data processing included between-group analysis of covariance , minimal detectable change assessment for the primary outcome measure , and effect size estimation . Confidence intervals ( CIs ) were set at 95 % . Results : Forty-three participants meeting the inclusion criteria and having signed the informed consent were r and omly assigned to 2 groups . Thirty-seven completed the training ( 86.1 % ) . Significant between-group differences in balance performance were found as measured with the Berg Balance Scale ( P = .03 ) and Functional Reach Test ( P = .04 ) with a CI = 95 % . Significant differences were not recorded for the Timed Up and Go Test or Romberg open and closed-eyes tests ( P > .05 ) . Furthermore , Cohen 's effect size result ed in a value of d = 0.97 , suggesting a high practical significance of the trial . Discussion and Conclusions : According to the Berg Balance Scale and Functional Reach Test , participants with TKR who have followed a 4-week training program using a dynamometric platform improved balance performance to a higher extent than a control group training without such a device . The inclusion of this instrument in the functional training protocol may be beneficial for recovering balance following TKR Purpose To prospect ively investigate the relationship between physical function and falls among elderly patients who underwent total knee arthroplasty ( TKA )  and to determine the incidence of falls as well as their risk factors . Methods A total of 108 patients ( 17 male , 91 female ) over 60 years of age who underwent TKA were enrolled and who were living independently in community . 75 patients fulfilled our inclusion criteria and 74 ( 8 male , 66 female ) of them agreed to participate . Baseline assessment ( physical examination , physical performance tests , and self-administered question naire )  were conducted between 6 and 12 months after the last arthroplasty and the follow-up assessment was performed 6 months after the baseline assessment . Monthly pre-stamped postcards were sent to assess the incidence of falls . Results Of the 74 patients enrolled , 70 ( 94.6 % ) completed a 6-month prospect i ve observation . 23 of 70 patients ( 32.9 % ) fell during the observational period . Postoperative range of knee flexion , ranges of knee flexion and extension and ankle plantar flexion were significantly lower in fallers than in non-fallers ( P = 0.016 , P = 0.037 , P = 0.014 , respectively ) . In the multivariate analysis , postoperative range of knee flexion ( OR 0.277 , 95%CI 0.088–0.869 , P = 0.028 ) and ankle plantar flexion ( OR 0.594 , 95%CI 0.374–0.945 , P = 0.028 ) were determined to be significant risk factors . Conclusion Elderly people who underwent TKA are considered more likely to fall compared with healthy elderly people . For patients with limited knee flexion and ankle plantar flexion , improvement of ROM by exercise therapy and patient education regarding the prevention of falls and fractures are considered necessary 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 purpose s 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 r and omized trial with a larger study sample . Design This study was a double-blind , pilot r and omized 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 clinical ly 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 r and omized controlled trial to test the effectiveness of an FT+B program after TKA Purpose The purpose of this study was to examine the relationship between balance control and cognitive functions , gait speed , and activities of daily living . Sample In all , 80 elderly participants with mild cognitive impairment ( mean age 67.07 ± 4.3 years ) were r and omly allocated into the experimental group ( n = 40 ) or the control group ( n = 40 ) . Methods Balance control was evaluated by the  Balance Evaluation Systems Test ( BESTest ) . Cognitive functions were evaluated by the  Trail Making Test  and the  Nine Hole Peg Test . Gait speed was assessed by the  Up and Go test with and without dual task . For evaluation of activities of daily living ( ADL ) , the BADLS test was used . The experimental group underwent CogniPlus 20 training sessions twice a week . Both groups had 30 min of physical training daily for 10 weeks . Results After training , there were five significant correlations found in the experimental group ( balance control and visuomotor coordination , psychomotor speed , gait speed with and without cognitive tasks , and activities of daily living ) . In the control group , one significant correlation was found between balance control and gait speed . Conclusion The cognitive-motor training performed for 10 weeks confirmed more significant relationships between balance control , cognitive functions , gait speed , and activities of daily living , when compared with motor intervention alone . ZusammenfassungZielsetzungZiel dieser Studie war es , die Beziehung zwischen der Kontrolle des Körpergleichgewichts und den kognitiven Funktionen , der Gehgeschwindigkeit sowie den Aktivitäten des täglichen Lebens zu untersuchen . StichprobeInsgesamt 80 ältere Menschen mit leichter kognitiver Beeinträchtigung ( Durchschnittsalter 67,07 ± 4,3 Jahre ) wurden r and omisiert und der Versuchsgruppe ( n = 40 ) oder Kontrollgruppe ( n = 40 ) zugeteilt . Method enDie Kontrolle des Körpergleichgewichts wurde mit dem Balance Evaluation Systems Test ( BESTest ) bewertet . Kognitive Funktionen wurden mit dem Trail Making Test und dem Nine Hole Peg Test eingeschätzt . Die Gehgeschwindigkeit wurde i m Timed-Up- and -Go-Test mit oder ohne doppelte Aufgabenstellung ermittelt . Für die Bewertung der Aktivitäten des täglichen Lebens wurde der BADLS-Test angewendet . Die Versuchsgruppe durchlief 2-mal wöchentlich  CogniPlus-20-Trainingseinheiten  . Beide Gruppen absolvierten über 10 Wochen täglich ein 30-minütiges körperliches Training . ErgebnisseNach Beendigung des Trainings wurden 5 signifikante Korrelationen in der Versuchsgruppe festgestellt ( Kontrolle des Körpergleichgewichts und visuomotorische Koordination , psychomotorische Geschwindigkeit , Gehgeschwindigkeit mit und ohne kognitive Aufgaben sowie Aktivitäten des täglichen Lebens ) . In der Kontrollgruppe f and sich nur eine signifikante Korrelation zwischen der Kontrolle des Körpergleichgewichts und der Gehgeschwindigkeit . SchlussfolgerungDas kognitiv-motorische Training über 10 Wochen bestätigte i m Vergleich zur alleinigen motorischen Intervention mehr signifikante Beziehungen zwischen der Kontrolle des Körpergleichgewichts und den kognitiven Funktionen , der Gehgeschwindigkeit und den Aktivitäten des täglichen Lebens One hundred sixty patients ( mean age , 68 ± 8 years ) having primary total knee arthroplasty were assigned r and omly to two rehabilitation programs : ( 1 ) clinic-based rehabilitation provided by outpatient physical therapists ; or ( 2 ) home-based rehabilitation monitored by periodic telephone calls from a physical therapist . Both rehabilitation programs emphasized a common home exercise program . Before surgery , and at 12 and 52 weeks after surgery , no statistically significant differences were observed between the clinic- and the home-based groups on any of the following measures : ( 1 ) total score on the Knee Society clinical rating scale ; ( 2 ) total score on the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 3 ) total score on the Medical Outcomes Study Short Form ; ( 4 ) pain scale of the Knee Society clinical rating scale ; ( 5 ) pain scale of the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 6 ) functional scale of the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 7 ) distance walked in 6 minutes ; ( 8) number of stairs ascended and descended in 30 seconds ; and ( 9 ) knee flexion range of motion , on either the per protocol or the intent-to-treat or the analyses . After primary total knee arthroplasty , patients who completed a home exercise program ( home-based rehabilitation ) performed similarly to patients who completed regular outpatient clinic sessions in addition to the home exercises ( clinic-based rehabilitation ) . Additional studies need to determine which patients are likely to benefit most from clinic-based rehabilitation programs Objective : To evaluate the effectiveness of additional balance training on mobility and function outcome in patients with knee osteoarthritis after total knee replacement . Design : A prospect i ve intervention study and r and omized controlled trial . Setting : A university-based teaching hospital . Participants : Patients who received total knee replacement surgery were recruited sequentially from the orthopedic department . They were r and omly assigned to either the experimental group or control group . Interventions : The control group received conventional function training for eight weeks . The experimental group not only received the same conventional training as the control group , but also received additional balance exercises in each admission . Main outcome measures : Before and after training we took the following measurements : distance of functional forward reach ; duration of single leg stance ; timed sit-to-st and test ; timed up- and -down stair test ; timed 10-m walk ; timed up- and -go test ; and the Western Ontario and McMaster Universities Osteoarthritis Index score . Results : 58 patients in the experimental group with a mean ( SD ) age of 71.4 ( 6.6 ) years and 55 in the control group with mean ( SD ) age of 72.9 ( 7.3 ) years , completed the study . After eight-weeks intervention with additional balance exercises , the experimental group demonstrated significant changes in 10-m walk ( P < 0.001 , 95 % confidence interval ( CI ) : 3.6 to 4.4 seconds ) and in timed up- and -go ( P < 0.001 , 95 % confidence interval : 2.6 to 3.4 seconds ) tests . Significant changes of all other measures and Western Ontario and McMaster Universities Osteoarthritis Index score were also observed in the experimental group ( all P < 0.001 ) . Conclusion : Additional balance training exerted a significant beneficial effect on the function recovery and mobility outcome in patients with knee osteoarthritis after total knee replacement Abstract Purpose : To examine the immediate and long-term effects of a walking-skill program compared with usual physiotherapy on physical function , pain and perceived self-efficacy in patients after total knee arthroplasty ( TKA ) . Method : A single blind r and omized controlled trial design was applied . Fifty-seven patients with primary TKA , mean age of 69 years ( SD ± 9 ) , were r and omly assigned to a walking-skill program emphasizing weight-bearing exercises or usual physiotherapy . Outcomes were assessed before the interventions started at 6 weeks postoperatively ( T1 ) , directly after the interventions at 12–14 weeks ( T2 ) and 9 months after the interventions ( T3 ) . Walking was the primary outcome , assessed by the 6 min walk test ( 6MWT ) . The secondary outcomes were timed stair climbing , timed st and s , Figure-of-eight test , Index of muscle function , active knee range of motion , Knee Injury and Osteoarthritis Outcome Score and self-efficacy score . Results : From T1 to T2 , a better 6MWT score was found in favor of the walking-skill program of 39 m ( 2–76 ) , p = 0.04 . The difference between the groups in 6MWT persisted at T3 , 44 m ( 8–80 ) , p = 0.02 . No differences in other outcome measures were found . Conclusion : The walking-skill program had better effect on walking than usual physiotherapy . Weight bearing was tolerated . Implication s for Rehabilitation Weight-bearing exercises are tolerated by the patients in the early stage after TKA . Physiotherapy that focuses on learning different ways of walking through practice may be a plausible way to train patients after TKA OBJECTIVES To determine whether Nintendo Wii Fit ™ is an acceptable adjunct to physiotherapy treatment in the rehabilitation of balance , lower extremity movement , strength and function in out patients following total knee replacement . DESIGN Preliminary r and omised controlled trial . SETTING Outpatient department of a rehabilitation hospital . PARTICIPANTS Adult out patients following total knee replacement . INTERVENTIONS The study group received a physiotherapy session followed by 15minutes of Wii Fit gaming activities . The games encouraged lateral and multidirectional weight shifting , and provided visual feedback regarding postural balance . The control group received a physiotherapy session followed by 15minutes of lower extremity strengthening and balance training exercises . MAIN OUTCOME MEASURES Length of outpatient rehabilitation , 2-minute walk test , knee range of motion , timed st and ing , Activity-specific Balance Confidence Scale , Lower Extremity Functional Scale and Numeric Pain Rating Scale , all measured on admission and every 2 weeks until discharge . A patient satisfaction survey was completed at discharge . RESULTS Seventeen males ( 34 % ) and 33 females ( 66 % ) with a mean age of 68 ( st and ard deviation 11 ) years participated in the study . No significant differences in age , gender , days since surgery or length of outpatient rehabilitation were found between the groups . In addition , there were no significant differences in pain ( P=0.220 ) , knee flexion ( P=0.951 ) , knee extension ( P=0.492 ) , walking speed ( P=0.855 ) , timed st and ing tasks ( P=0.289 ) , Lower Extremity Functional Scale ( P=0.079 ) , Activity-specific Balance Confidence Scale ( P=0.523 ) or patient satisfaction with therapy services ( P=0.201 ) between the groups . CONCLUSIONS Wii Fit is potentially acceptable as an adjunct to physiotherapy intervention for out patients following total knee replacement , provided the games chosen challenge balance and postural control , and use the lower extremities . Further research is needed to establish whether video games as a therapy adjunct increase patient motivation and compliance with rehabilitation goals . Clinical Trials.gov ID : NCT01548664 Objective : To assess the feasibility of comparing two types of exercise regime aim ing to improve mobility and function following knee arthroplasty . Design : A single-blind r and omized controlled trial . Subjects : Patients with primary , unilateral knee osteoarthritis undergoing elective knee joint replacement . Intervention : Home-based traditional exercise group ( TEG ) or home-based functional exercise group ( FEG ) following discharge from hospital . Outcome measures : These included goniometry ; a knee-specific pain score , leg extensor power and a walking test . Patients were followed up at three , six and 12 months after surgery . Results : Forty-seven patients met the study criteria , 24 were r and omized to the TEG and 23 to the FEG .  There were marked improvements in mobility , leg extensor power and pain in the year after surgery ( MANOVA p < 0.001 ) . There were no statistically significant differences between the two exercise groups . Knee flexion decreased during the follow-up period and had not recovered by 12 months . Retention of patients was a problem , with nearly 50 % lost to follow-up at 12 months . These patients were assessed as having low motivation during inpatient rehabilitation ( p < 0.05 ) . Conclusions : There were trends in favour of the FEG that were of clinical relevance . A definitive study would need a sample size of at least 100 patients in each arm . It is essential to develop strategies to combat loss to follow-up Abstract . We investigated Japan 's contribution to research in orthopedics during the last decade . Articles published during 1991–2000 in highly reputed orthopedics journals were accessed through the MEDLINE data base . Articles with an affiliation with a Japanese institution were recorded along with the publication year . The proportions of  r and omized controlled trials ( RCTs ) , cohort studies , and case reports among the articles from Japan were also generated and compared with the overall number for all articles published in these journals . The shares of the top-ranking countries are presented along with the trend over time . Of the total articles ( 10 551 ) , Japan 's share for the selected journals in orthopedics was 8.3 % ( 878 articles ) , ranking third in the world , after the United States ( 50.3 % ) and the United Kingdom ( 11.2 % ) . The recent increase in the share was not statistically significant for Japan . Proportions of the level of evidence were lower for Japan-originated articles than for the total articles . Japan 's contribution to orthopedics research is higher than that in other biomedical fields , but the number of high- quality clinical research studies conducted in Japan in this field was meager , similar to that in other fields OBJECTIVE To investigate the use of compensatory visual and attentional control strategies for st and ing balance in patients with rheumatoid arthritis ( RA ) with severe knee joint impairment . DESIGN Experimental 2-group design . SETTING Specialized clinic for orthopedics , rheumatology , and rehabilitation in The Netherl and s. PARTICIPANTS Eighteen patients without comorbidity ( age range , 65 + /- 7.7 yr ; 16 women , 2 men ) from a consecutive sample of patients with RA scheduled for total knee arthroplasty ; 23 controls of the same age group also were tested ( 13 women , 10 men ) . MAIN OUTCOME MEASURES By means of a dual-plate force platform , the velocity of center of pressure ( COP ) fluctuations were analyzed in the anteroposterior and lateral sway directions during quiet st and ing with eyes open , eyes closed , and while performing a secondary attention-dem and ing arithmetic task . RESULTS Patients showed an average 80 % greater COP velocity in both directions of sway compared with controls . In addition , stability deteriorated substantially more in patients than controls when deprived of visual information , which was associated with the degree of knee destruction . The effect of the arithmetic task was small and similar in patients and controls . CONCLUSION RA patients with severe knee joint impairment can have a substantial basic postural instability ; their relatively high reliance on visual information suggests impaired sensory feedback from the lower limbs . Current research is aim ed at determining whether these postural deficits can be improved by total knee replacement We investigated the relationship of  knee range of motion ( ROM )  and function in a prospect i ve , observational study of primary total knee arthroplasty ( TKA ) . Preoperative and 12-month data were collected on 684 patients , including knee ROM , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain and function question naire scores , patient satisfaction , and perceived improvement in quality of life ( QOL ) . Only modest correlations were found between knee ROM and WOMAC function ( r<0.34 ) . At 12 months we found significantly worse WOMAC function scores for patients with < 95 degrees flexion compared with patients with > or = 95 degrees ( mean , 61.9 vs 75.0 ; P<.0001 ) . In linear regression models , WOMAC pain and function scores at 12 months were both correlates of patient satisfaction and perceived improvement in QOL ( st and ardized beta>3.5 ; P<.0001 ) , but knee flexion was not . For assessment of these outcomes , WOMAC function appears to be more important than knee flexion OBJECTIVE To evaluate the effectiveness of a new intensive functional rehabilitation ( IFR ) program on functional ability and quality of life ( QOL ) in persons who underwent a first total knee arthroplasty ( TKA ) . DESIGN R and omized controlled trial . SETTING Ambulatory care . PARTICIPANTS Seventy-seven people with knee osteoarthritis . INTERVENTION Two months after TKA , subjects were r and omly assigned to either a group with IFR ( n=38 ) , who received 12 supervised rehabilitation sessions combined with exercises at home between months 2 and 4 after TKA , or to a control group ( n=39 ) , who received st and ard care . All participants were evaluated by a blind evaluator at baseline ( 2mo after TKA ) , immediately after IFR ( 2mo later ; POST1 ) , and 2 and 8 months later ( POST2 and POST3 ) . Main outcome measures The primary outcome measure with respect to effectiveness was the 6-minute walk test ( 6MWT ) at POST2 . Secondary outcome measures were the 6MWT at the other evaluations and the Western Ontario and McMaster Universities Osteoarthritis Index and Medical Outcomes Study 36-Item Short-Form Health Survey . RESULTS Subjects in the IFR group walked longer distances ( range , 23 - 26 m ) in 6 minutes at the 3 POST evaluations than subjects in the control group . At POST1 and POST2 , they also had less pain , stiffness , and difficulty in performing daily activities . Positive changes in QOL in favor of the IFR were found only at POST2 . CONCLUSIONS The IFR was effective in improving the short-term and mid-term functional ability after uncomplicated primary TKA . The magnitude of the IFR effect on the primary outcome was modest but consistent . More intensive rehabilitation should be promoted in the subacute recovery period after TKA , to optimize functional outcomes in the first year after surgery
Background Several studies have examined the effects of balance training in elderly individuals following total knee arthroplasty ( TKA ) , although findings appear to be equivocal .
Objectives This systematic review and meta- analysis examined the effects of balance training on walking capacity , balance-specific performance and other functional outcome measures in elderly individuals following TKA .