Background: Standing HAT (Head-Arm-Trunk) Strategy in postural strategy of frontal plane (PSFP) is often observed in OA patients and the elderly. Patients with total knee arthroplasty (TKA) suffer from impaired balance and postural control. Purpose: The purpose of this randomized controlled trials was to compare the effect of physical therapy intervention with emphasis on postural control as a multi joint kineticschain exercise (MJKC) to conventional physical therapy (CPT). Methods: 33 individuals (28 female, 5 male; age, 72.2+/-7.4 years) who underwent TKA for knee osteoarthritis (OA) were enrolled. The participants were randomly divided into MJKC or CPT groups. Both groups received 3 months of physical therapy intervention. PSFP (Calculated by the angle connecting the center points of both acromion, both greater trochanter and both lateral malleolus; using ToMoCo-Lite), index of postural stability (IPS) to examine dynamic balance, knee extension strength (KES)(%BW) were assessed at preoperative, postoperative 2 months (2POM) and postoperative 3 months (3POM). Statistical analysis: Chi square test and Mann-Whitney test were used to compare the baseline scores. 2-wayANOVA was used to compare the effects of group and timing (p < .05). Results: There were no significant differences in the baseline clinical and functional scores at preoperative between the two groups. IPS measurements of the MJKC Group at preoperative, 2POM, and3 POM were 1.24, 1.61, 1.62, respectively. IPS measurements of the CPT Group at preoperative, 2POM, and 3 POM were 1.21, 1.18, 1.26, respectively. IPS measurements were significantly better in the MJKC group than the CPT group at postoperative, 2POM, and 3POM (p < .01). In the MJKC group, significant improvement was observed in the IPS scores at 2POM and 3POM compared to preoperative (p < .01). The PSFP measurements of the MJKC group at preoperative, 2POM, and 3POM were 173.6+/-0.40, 181.9+/-2.2, 183.3+/-2.6, respectively. There was a significant difference in the PSFP measurements between preoperative and 2POM, and between preoperative and 3POM (p < .01). The PSFP measurements of the CPT Group at preoperative, 2POM, and 3POM were 172.9+/-5.9, 174.0+/-5.4, 173.9+/-4.8, respectively, and there was no significant difference between the three time periods. No significant difference between the two groups was observed regarding KES. Conclusion(s): MJKC is a novel rehabilitation program which was designed to improve dynamic balance and postural strategy in the early postoperative period of TKA. The improvement in PSFP in the MJKC group postoperatively, suggests that patients are standing with the HAT strategy at preoperatively and with the pelvic at 2POM. The PSFP measurements in the CPT group suggest that patients are standing with the HAT strategy postoperatively. This study shows that patients receiving MJKC changed their standing PSFP from HAT to pelvic by 2POM. This suggests the need for and effectiveness of intervention by MJKC in early postoperative TKA. Implications: The results of this study may be useful in selecting of physical therapy program.
Muto, T., Kanemura, N., Takayanagi, K., Ogawa, R., Tanikawa, H., & Okuma, K. (2015). Effects of multi-joint kinetics-chain exercise versus conventional exercise for patients with TKA: a randomized controlled trial. A 3-months research. Physiotherapy, 101, e1061. https://doi.org/10.1016/j.physio.2015.03.1943