Roig-Casasús Sergio, Blasco José María, López-Bueno Laura, Blasco-Igual María Clara
Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain.
Hospital Clínic Universitari de València, Valencia, Spain.
J Geriatr Phys Ther. 2018 Oct/Dec;41(4):204-209. doi: 10.1519/JPT.0000000000000121.
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.
This was a randomized controlled clinical trial conducted at a university hospital rehabilitation unit. Patients meeting the inclusion criteria were randomly 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%.
Forty-three participants meeting the inclusion criteria and having signed the informed consent were randomly 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 resulted in a value of d = 0.97, suggesting a high practical significance of the trial.
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.
感觉运动训练已被证明是全膝关节置换术（TKR）后恢复平衡控制的有效方法。本试验的目的是评估使用测力平台进行特定的平衡靶向训练对接受TKR的老年人整体平衡状态的影响。
这是一项在大学医院康复科进行的随机对照临床试验。符合纳入标准的患者被随机分配到对照组或试验组。两组均参与相同的为期4周的术后康复训练方案。试验组的参与者使用测力平台进行额外的平衡训练，包括与稳定性挑战、体重转移和向稳定性极限移动相关的测试。主要结局指标是根据伯格平衡量表评定的整体平衡状态。平衡方面的次要结局指标是定时起立行走测试、功能性伸展测试以及睁眼和闭眼罗姆伯格测试。数据处理包括组间协方差分析、主要结局指标的最小可检测变化评估以及效应量估计。置信区间（CI）设定为95%。
43名符合纳入标准并签署知情同意书的参与者被随机分配到2组。37人完成了训练（86.1%）。使用伯格平衡量表（P = .03）和功能性伸展测试（P = .04）测量时，发现组间平衡表现存在显著差异，CI = 95%。定时起立行走测试或睁眼和闭眼罗姆伯格测试未记录到显著差异（P > .05）。此外，科恩效应量得出d = 0.97的值，表明该试验具有较高的实际意义。
根据伯格平衡量表和功能性伸展测试，使用测力平台进行了为期4周训练计划的TKR参与者，其平衡表现的改善程度高于未使用该设备进行训练的对照组。将该仪器纳入功能训练方案可能有利于TKR后平衡的恢复。
