Acceptability and feasibility of a community-based strength, balance, and Tai Chi rehabilitation program in improving physical function and balance of patients after total knee arthroplasty: study protocol for a pilot randomized controlled trial

Abstract

Background The rate of falls in patients after total knee arthroplasty (TKA) is high and related to lower limb muscle weakness and poor balance control. However, since routine post-TKA rehabilitation is uncommon, it is paramount to explore alternative strategies to enhance balance and physical functioning in post-TKA patients. As Tai Chi is a proven strategy for improving balance in older people, the proposed study aims to determine the feasibility and acceptability of a 12-week community-based post-TKA multimodal Tai Chi program and to collect preliminary data with respect to the efficacy of such a program in improving balance and physical functioning in post-TKA patients as compared to usual postoperative care. Methods A single-blinded 2-arm pilot randomized controlled trial will recruit 52 community-dwelling post-TKA patients (aged > 60 years) in Hong Kong. In addition, 26 untreated asymptomatic controls will be recruited for comparison purposes. The TKA patients will be randomized into either a 12-week multimodal Tai Chi rehabilitation group or a postoperative usual care group (26 each). Participants will perform the outcome assessments at baseline, 6, 12, 24, and 52 weeks after TKA, while asymptomatic controls will have the same assessments at baseline, 12, and 52 weeks after baseline. The rate of recruitment, retention, and attrition, as well as adherence to the intervention, will be measured and used to determine the feasibility of the study and whether a full-scale effectiveness trial is warranted. Further, qualitative interviews will be conducted to explore the acceptability and possible barriers to the implementation of the intervention. Primary and secondary outcomes including both patient-reported surveys and performance-based tests will be compared within and between groups. Discussion The study will determine the feasibility and acceptability/potential efficacy of community-based rehabilitation for post-TKA patients and assess whether the intervention has the potential to be assessed in a future fully powered effectiveness trial. The findings will also be used to refine the study design and guide the conduction of a future definitive randomized controlled trial. Trial registration ClinicalTrials.gov NCT03615638. Registered on 30 May 2018. https://clinicaltrials.gov/ct2/show/NCT03565380

Incidence of Fear of Fall and Stairs Climbing Status in Older Adults After Total Knee Arthroplasty

“…This aligns with findings by Laura Frattura and colleagues, who reported a postoperative fall prevalence ranging from 12% to 38% (45). The association between TKA and increased fall risk has been well documented (46)(47)(48). Notably, a history of preoperative falls and poor functional status were significant risk factors for postoperative falls.…”

Global mapping of institutional and hospital-based (Level II–IV) arthroplasty registries: a scoping review

“…Knee Peking Union Medical College HS [ 370 ] 2. Chinese People’s Liberation Army [ 539 ] Hong Kong Hong Kong Institutional Queen Mary HS [ 282 , 367 , 471 , 554 , 617 , 622 ] Japan Takatsuki (Hip) Takatsuki General HS [ 359 ] Korea Korea Korean Hip (KHR) [ 489 ] Republic of China Taiwan Chang Gung Memorial HS [ 83 , 422 , 475 , 557 ] Singapore Singapore Singapore General HS [ 108 , 124 , 168 , 192 , 227 , 229 , 245 , 253 , 273 , 277 , 284 , 434 , 436 , 440 , 443 , 466 , 467 , 513 , 538 , 546 , 579 , 591 , 595 , 602 , 608 , 612 , 616 , 621 , ...…”

Pain, balance, and mobility in people 1 year after total knee arthroplasty: a non-randomized cross-sectional pilot study contrasting posterior-stabilized and medial-pivot designs

“…However, this case–control study evaluated the feasibility of using wearable sensors to compare the static and dynamic balance of patients with different TKA protheses at 1 year after surgery. It helped refine the objective balance assessment procedures for future studies (e.g., balance assessments in patients with different TKA prosthesis designs, or post-TKA rehabilitation) [ 48 ].…”