Comparisons of clinically based outcome measures and laboratory-based outcome measure for balance in patients following total hip and knee arthroplasty.

BACKGROUND: Information available in the literature on clinically based and laboratory-based outcome measures of balance is limited. How much information is provided by clinically based outcome measures compared to laboratory-based measure in patients with total hip (THA) and knee arthroplasty (TKA) is not known. AIM: The purpose of this study was to determine the relationship between selected clinically based outcome measures and laboratory-based force platform measure in patients following THA and TKA. METHODS: Patients who underwent THA (n = 26) and TKA (n = 28) were evaluated at about 5-7 weeks following surgery. Participants were assessed using four clinically based outcome measures - 1) the Berg Balance Scale (BBS), 2) the Timed Up and Go test (TUG), 3) the Activities-specific Balance Confidence Scale (ABC), and 4) the Western Ontario McMaster Universities Osteoarthritis Index-function subscale (WOMAC-function) - and one laboratory-based force plate measure (95% ellipse area). RESULTS: Moderate correlations were observed between the BBS and the 95% ellipse area of force plate (r = 0.46-0.51) for the two-legged stance, the anterior lean stance, and the posterior lean stance. Fair correlations were observed between TUG and the 95% ellipse area of force plate (r = 0.31-0.37) for all the three test conditions. Low correlations were observed for the ABC and the WOMAC-function with the 95% ellipse area of force plate (r = 0.11-0.25) for all the three test conditions. CONCLUSION: The BBS demonstrated the greatest correlations with the 95% ellipse area of the force plate measure and should be preferred by physical therapists over the TUG, the ABC, and the WOMAC-function to assess balance in patients with THA and TKA.

Force-plate analyses of balance following a balance exercise program during acute post-operative phase in individuals with total hip and knee arthroplasty: A randomized clinical trial.

OBJECTIVES: Typical rehabilitation programs following total hip arthroplasty and total knee arthroplasty include joint range of motion and muscle-strengthening exercises. Balance and balance exercises following total hip arthroplasty and total knee arthroplasty have not received much attention. The purpose of this study was to determine whether an intervention of balance exercises added to a typical rehabilitation program positively affects patients' balance. METHODS: A total of 63 patients were provided with outpatient physical therapy at their home. Patients were randomly assigned to either typical (n = 33) or balance (n = 30) exercise group. The typical group completed seven typical surgery-specific joint range of motion and muscle-strengthening exercises, while the balance group completed the typical exercises plus three balance exercises. After 5 weeks of administering the rehabilitation program, patients' balance was assessed on a force plate using 95% ellipse area of the center of pressure amplitude. RESULTS: Patients in the balance group demonstrated significant reduction in the 95% ellipse area for the anterior and posterior lean standing conditions (p < 0.01). CONCLUSION: Balance exercises added to the typical outpatient physical therapy program resulted in significantly greater improvements in balance for participants with total hip arthroplasty or total knee arthroplasty, compared to the typical exercise program alone. Physical therapists might consider the use of balance exercises to improve balance in individuals in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty.

Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial.

OBJECTIVES: To determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty. METHODS: Patients who had total hip arthroplasty (n = 30) or total knee arthroplasty (n = 33) were seen in their residence 1-2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33) or typical plus balance (TE + B, n = 30) exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1) the Berg Balance Scale, (2) the Timed Up and Go test, (3) the Western Ontario McMaster Universities Osteoarthritis Index, and (4) the Activities-specific Balance Confidence Scale. RESULTS: Post-intervention scores for all four outcome measures were significantly improved (p < 0.01) over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01). CONCLUSION: Balance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone.

Comparison of the original and reduced versions of the Berg Balance Scale and the Western Ontario and McMaster Universities Osteoarthritis Index in patients following hip or knee arthroplasty.

PURPOSE: To compare the original and reduced versions of the Berg Balance Scale (BBS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as completed by patients following total hip arthroplasty (THA) or total knee arthroplasty (TKA), with respect to their potential utility in clinical and research settings. METHOD: Patients with THA (n=26) or TKA (n=28) were evaluated before and after 5 to 7 weeks' participation in a home-based exercise programme. They were assessed using the original versions of the BBS and the WOMAC; scores for the reduced versions of the BBS and the WOMAC were extracted from the original versions. RESULTS: Good to excellent correlations (r≥0.80) were observed between the original and the reduced versions of the BBS and the WOMAC. The index of responsiveness, evaluated using standardized response means (SRM), was similar for the original and the reduced versions of the BBS and the WOMAC function sub-scale. CONCLUSIONS: The reduced versions of the BBS and the WOMAC provided similar information to the original versions and were equally responsive. These reduced versions comprise fewer questions and may be completed in considerably less time, which suggests that they may be advantageous for clinical and research use.