Table 2 Balance and proprioception training

Aprile et al.

THR EXPERIMENTAL: 36 patients (26 F, 10 M; mean age: 68.4 y)

THR CONTROL: 28 patients (18 F, 10 M; mean age: 63.9 y)

Not reported.

THR EXPERIMENTAL. Group treatment sessions (3 or 4 patients) on the stabilometric platform. The technological experimental protocol consisted of a series of rehabilitative paths proposed automatically by the software and designed to improve the perceptive conditions of each movement. The difficulty of the exercise was gradually increased when the patient’s condition allowed it.

THR CONTROL: group treatment sessions (3 or 4 patients). The treatment included: techniques to improve joint range of motion, muscle force, ability to adopt different postures and proprioceptive exercises.

45 min sessions, 5 times/week, for 4 weeks, in the post-surgical rehabilitation

Instrumental assessment of postural stability was performed using bipodalic platform (Prokin, Technobody, Italy). The system provides, at 40 Hz, the coordinates of the subject’s Centre of Pressure (CoP) and a biaxial accelerometer measures trunk tilts in the antero-posterior and medio-lateral directions. All outcome measures were administered before (T0) and after treatment (T1).

For the stabilometric assessment, with the platform in a blocked position, the following parameters were considered: area and perimeter of the CoP, anteroposterior and mediolateral velocity of the CoP with the eyes open and closed. The anteroposterior, mediolateral and total root mean square (RMS) of the trunk movements (with eyes open and closed) were also calculated to measure the stability of the trunk.

The dynamic assessment consisted of an evaluation of global proprioceptive control and postural instability with the platform in an unblocked position, the level of the damper was set according to each subject’s physical characteristics. The following parameters were considered: total, anteroposterior and mediolateral dynamic stability indexes and their relative RMS.

Greater improvement in the experimental group than in the control group in the following stabilometric variables: total RMS trunk with eyes opened (p = 2460.024), mediolateral RMS trunk with eyes opened (p = 0.030) and Romberg Area opened eyes/closed eyes (p = 0.029).

Greater improvement in the experimental group than in the control group in the following dynamic variables: Total Dynamic Stability Index (p = 0.003), Anteroposterior Dynamic Stability Index (p = 0.048) and Mediolateral Dynamic Stability Index (p = 0.001).

Bitterli et al.

THR EXPERIMETAL: 41 patients (19 F, 22 M; mean age: 65.3 y)

THR CONTROL: 39 patients (12 F, 27 M; mean age: 68.4 y)

THR with lateral trans-gluteal approach

THR EXPERIMENTAL: The training programme was a so-called minimal intervention strategy, demanding minimal training effort exercises. Six exercises were performed. In supine position: 1 = Tense muscles of legs and buttocks; 2 = Move affected leg out to side and back on supporting surface; 3 = Raise knees, move foot backwards and forwards on supporting surface; 4 = Make a “bridge” (raise buttocks from supporting surface). Performed while standing: 5 = Stand upright with legs slightly apart, bend hips and knees and then straighten up again; 6 = Stand on unaffected leg and move other leg out to the side and back.

THR CONTROL: no exercises.

The training was performed before surgery.10 repetition of each exercise performed twice each day, for a duration from 2 to 6 weeks.

Balance was assessed with the Biodex Balance System (BBS; produced by Biodex Medical Systems, New York). Assessment was performed before surgery, and 4 and 12 months after surgery.

In the static mode the BBS measures the angular displacement of the centre of gravity. From the degrees of tilt about the anterior-posterior and medial-lateral axes, the anterior-posterior stability index (APSI), the medial-lateral stability index (MLSI) and the overall stability index (OSI) is calculated. The participants received support from visual feedback displayed on a screen. Each test lasted 20 s. The participants completed 3 trial repetitions prior to the actual test, to rule out short-term learning effects. The test was performed standing barefoot in the most comfortable position.

TR showed better mean balance ability than CO before the THEP, regarding both the overall stability index (M = 2.34, SD = 0.55) compared to CO (M = 2.62, SD = 0.81) and the medial-lateral stability index (M = 1.58, SD = 0.48 and M = 1.90, SD = 0.72 respectively). No significant differences between the two groups were found at the 4-month and the one-year follow-up point.

Nelson et al.

THR EXPERIMENTAL:35 patients (23 F, 12 M; mean age: 62 y)

THR EXPERIMENTAL:35 patients (21 F, 14 M; mean age: 67 y)

93% of patients received a posterior approach.

THR EXPERIMENTAL: received a standard Home Exercise Program delivered through a telerehabilitation system for the first six weeks after discharge.

THR CONTROL received a standard Home Exercise Program for the first six weeks after discharge.

The standard protocol consisted of strengthening exercises for quadriceps, hip abductors, extensors, and flexors. At At two, four, and six weeks post-operatively all participants attended a one-to-one physiotherapy session focussing on gait and reviewing and progressing their HEP. The experimental group attended it via telemedicine while control group attended it in outpatient setting.

After six weeks all participants were provided with a paper-based HEP to continue independently. All sessions beyond the six-week intervention period were in-person appointments, regardless of allocation to the control or intervention group.

Standardised HEP three times daily for six weeks. Six post-operatively weeks

Dynamic balance was assessed via the step test and Timed-up-and-go (TUG) tests.

Outcomes were collected at baseline (pre-operatively), discharge from inpatient physiotherapy, six weeks and six months post-operatively.

The step test was performed standing on the study leg the entire time, while the other leg was moved back and forth from the step to the floor (eg, the stepping foot was placed flat up onto the step, then back down flat onto the ground) as many times as possible in 15 s without overbalancing (moving the stance leg from the start position). During the TUG the patients were required to rise from a chair of standard height, walk 3 m, turn 180°, return to the chair, and sit down.

No between group difference were found. TUG and step test showed significant improvement over time in both groups.

Pethe-Kania et al.

THR EXPERIMENTAL: 30 patients (19 F, 11 M; mean age: 61.4 y)

THR CONTROL: 30 patients (18 F, 12 M; mean age: 65.1 y)

?

THR EXPERIMENTAL: Standardized rehabilitation + follow-up posturography with an adaptively modified biofeedback. The training was based on performance of the visually stimulated exercises on a double-plate posturographic platform. While standing on the plat-form patients were supposed to sway their body in such a way that the scaled position of the trained per-son’s Center of Pressure (COP) visualized on the computer screen coincided as closely as possible witht he moving point representing the visual stimulus. The COP constitutes a good approximation of the patient’s center of gravity projected onto the supporting plane (the platform). During the training the position of the visualized COP marker is being scaled according to the value of the biofeedback coefficient evaluated in the static posturography examination just before the training session is started. If in such an examination a given limb is diagnosed to be underloaded, a correspondingly greater loading is imposed on it during the symmetry training session.

THR CONTROL: Standardized rehabilitation

Between 3 and 6 months after the operation.

6 and 5 times a week, for a total of 21 days

Assessment of the lower limb loading symmetry was performed using a double-plate posturographic platform. The limb loading symmetry evaluation was carried out before and after 3-week hospital rehabilitation.

During the examinations patients were supposed to stand still on the platform for a pe-riod of 30 s (having left foot positioned on the left plate of the platform and the right foot on the right plate). The examinations were conducted in both open and closed eyes scenarios. The essence of the performed limb loading symmetry evaluation boils down to a precise measurement of the average weight exerted on each plate of the posturographic platform. Analysis of the COP trajectories registered individually for the left and right leg were also performed.

The eyes-open static posturography examinations indicated significantly improvement in the lower limb loading symmetry in 29 (97%) patients from the experimental group (p = 0.000003). In the control group, such an improvement was observed in 20 (67%) patients (p = 0.034796). In the eyes closed examinations correction in the limb loading symmetry was evident in 23 (77%) patients from the experimental group (p = 0.000247) and 18 (60%) patients from the control group (p = 0.043327).

Shabana et al.

THR EXPERIMENTAL: 10 patients (3 F, 7 M; mean age: 61.9 y) THR CONTROL: 10 patients (4 F, 6 M; mean age: 58.4 y)

?

THR EXPERIMENTAL: received dynamic balance training program in addition to traditional rehabilitation programme. The balance training consisted in standing over an unstable board.

THR CONTROL: received traditional rehabilitation program only in form of therapeutic exercise, transfer training and gait training.

From immediate post-surgery for 12 weeks, three times per week

Balance was assessed at the beginning and at the 6th & 12th week post operatively.

The assessment of balance was performed by means of a pre-determined protocol of the Biodex Stability System (BSS). Patients were instructed to step onto the platform of the BSS with the knee of the supported leg flexed about 10 degrees. In addition, the subject was instructed to keep his hands at his sides throughout the test. A single limb test was conducted. The test consisted of 30 s test using all eight levels of instability provided by the system.

The experimental group showed a statistical improvement in the mean Biodex overall stability index at 6 weeks and 12 weeks interval compared to the initial.

The control group did not show any improvement across time.

Trudelle-Jackson et al.

THR EXPERIMENTAL: 14 patients (6 F, 8 M; mean age: 59.4 y)

THR CONTROL: 14 patients (9 F, 5 M; mean age: 59.6 y)

THR with antero-lateral approach

THR EXPERIMENTAL: a set of 7 weight-bearing exercises: sit to stand, unilateral heel raises, partial knee bends, 1-legged standing balance, knee raises with alternating arm raises (marching), side and back leg raises in standing, and unilateral pelvic raising and lowering in standing. No resistance was added to any of the exercises, and abdominal contraction was emphasized during all weight-bearing exercises to promote trunk stability.

THR CONTROL: The exercise protocol for the control group consisted of 7 basic isometric and active ROM exercises: gluteal muscle sets, quadriceps sets, hamstring sets, ankle pumps, heel slides, hip abduction in supine, and internal and external rotation in supine.

15 to 20 repetitions of each exercise, 3 to 4 times a week for 8 weeks of training, 4 to 12 months after THA.

Postural stability was assessed using the BEP-IV force platform (Human Performance Measurement [HPM]a). Assessments were performed pre-and post- the exercise intervention.

Stability was measured as subjects attempted to stand steadily on the involved lower extremity while holding the opposite leg in full hip extension and 90°of knee flexion with eyes open. Subjects did not wear shoes during the testing. The recording lasted 10 s. The BEP-IV postural stability measurement system uses a lightweight, portable force platform to measure ML stability, AP stability, and total stability by tracking changes in the centre of pressure (COP). The ratio of average movement of the COP to the size and placement of the stance foot was calculated. The resulting normalized score represents a “percentage instability” score.

Postural stability improved 36.8% in the THR experimental group (from 66.1 to 90.4) and 0.9% in the THR control group (from 76.3 to 77.0).

Winther et al.

THR EXPERIMENTAL: 14 patients (6 F, 8 M; mean age: 59.4 y)

THR CONTROL: 14 patients (9 F, 5 M; mean age: 59.6 y)

THR with posterior approach

THR EXPERIMENTAL: The training consisted of leg press and

abduction performed by the operated leg.

THR CONTROL: The patients in the received conventional physiotherapy, consisting of different types of strength exercises with

low or no external load (10–20 repetitions).

Warm-up exercises were mainly cycling, step, and treadmill walking. Other workouts used were aquatic exercises, balance training, range-of motion exercises, massage, and sling exercises.

THR: EXPERIMENTAL:

3 days a week, 4–5 repetitions × 4 series with a load equal to 85–95% of one-repetition maximum.

THR CONTROL:

3 days a week, 10–20 repetitions.

Intervention lasted 3 months.

At 3, 6, and 12 mos postoperatively, postural sway was evaluated in two gait tests; ie, one test before and one test after conducting a battery of physical performance tests.

Postural sway in the test before (TB) and test after (TA) conducting a battery of individually validated physical performance tests that resemble daily living activities. First, an initial walking test (the TB) was conducted as each patient walked back and forth along a 5-m OptoGait walkway, a floor-based photocell system with a validated electronic walkway system for movement analysis (Microgate Bolzano, Italy), Body sway was assessed using a validated body-worn inertial measurement tool (Gyko Interial System; Microgate, Bolzano, Italy) placed in a belt at the lower back, as described by the manufacturer.

At 3 mos postoperatively, postural sway in the test after was significantly higher for the conventional rehabilitation group than the maximal strength training group; however, there was no between-group difference at the test before. Postural sway was also significantly higher in the test after compared with the test before in the conventional rehabilitation group. No difference was found between the test before and test after in the maximal strength training group. At 6 and 12 mos postoperatively, there were no statistically significant within- or between-group differences in postural sway.

Zeng et al.

TRAINING GROUP: 32 patients (F 15, M.1; mean age 65,19 y)

CONTROL GROUP: 27 patients (F 13, M: 14; mean age 64,81 y)

THR with anterolateral approach

TG: Tai Chi training, hip muscle strengthens training and ROM training. 10 simplified forms of TC exercise procedures included: Opening Form, Parting Wild Horse’s Mane, Apparent Close Up, wave hand like clouds, Step back and whirl arms on both sides, Grasp the Sparrow’s Tail, Brush Knee and Push, Golden Rooster Stands on One Leg, Heel Kick, and Cross Hands (with Closing form).

CG and TG: Both received a standardized postoperative exercise program.

45–60 min Tai Chi training, 20–30 min hip muscle strengthens training and ROM training. 5 times per week for 12 weeks before scheduled THA.

Unipedal stance test (UPST); Timed-up-and-go (TUG) tests. Tests were performed within three days after they were allocated into the study, within three days preoperatively and Week 13 and Week 26 postoperatively.

TUG: During the TUG the patients were required to rise from a chair of standard height, walk 3 m, turn 180°, return to the chair, and sit down. UPST: Patients stood on the preferred leg with the shoes off, placed their arms across chest with hands touching their shoulders and did not let legs touch each other. Look straight ahead with eyes open and focus on an object about 1 m in front of body. A stopwatch was used to record in seconds the duration of standing.

Significant improvement in both TUG and UPST were found. In TG after exercise program the improvement maintained to Week 26 post-operation.