The aim of this study is to assess the efficacy of virtual rehabilitation through the Virtual Reality Rehabilitation System (VRRS) versus traditional rehabilitation improving the functional outcomes after primary Total Knee Arthroplasty (TKA).
Following ethics approval by the Ospedale San Raffaele, 84 adults aged between 45 and 80 years old will be recruited for the study, excluding people with unstable serious disease (e.g., heart or lung disease), previous orthopedics pathologies on the same side (e.g., hip arthroprosthesis), pregnancy and intake of psychotropic drugs. Patients who consent to participate in this study will be randomized into two rehabilitation groups after TKA: experimental (virtual rehabilitation) and control (traditional rehabilitation). In the experimental arm, subjects will undergo a virtual rehabilitation training during the post-surgical rehabilitation period, in addition to passive knee range of motion device (kinetec) and functional activity (stairs). In the control arm, subjects with similar demographic characteristics to those of the experimental arm, will undergo the usual physiotherapy rehabilitation, in addition to passive knee range of motion device (kinetec) and functional activity (stairs). Both control and study interventions will be provided 60 minute daily session. General status of patients will be undertaken for the following outcomes at the baseline and 10 days after surgery (at discharge). The primary outcome will be the visual analogue scale (VAS); the secondary outcomes will be: the disability knee assessed by the Western Ontario and McMaster Universities (WOMAC), the health related quality of life assessed by the EuroQol (EQ-5D), the global perceived effect assessed by the GPE score, the functional Independent measure assessed by the FIM questionnaire, the drugs assumption, the isometric strength of quadriceps and hamstrings assessed by dynamometer, the range of motion (R.O.M.) and proprioception assessed by VRRS.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
85
CPM of the knee
Stairs, walking
exercise therapy through a virtual reality rehabilitation system (VRRS)
IRCCS Galeazzi Orthopedic Hospital
Milan, Italy
Pain: Visual Analogue Scale (VAS)
The VAS scale was measured in a range of 0-100 cm (0 no pain and 100 the worst pain)
Time frame: baseline and 10 days (value at day 10 minus value at baseline)
Knee Disability: Western Ontario and McMaster Universities Arthritis Index (WOMAC) Questionnaire
The WOMAC measures five items for pain (score range 0-500), two for stiffness (score range 0-200), and 17 for functional limitation (score range 0-1700) for a total score of 2400 (0= no disability, 2400= highest disability): * Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing * Stiffness (2 items): after first waking and later in the day * Physical Function (17 items): stair use, rising from sitting, standing, bending, walking, getting in / out of a car, shopping, putting on / taking off socks, rising from bed, lying in bed, getting in / out of bath, sitting, getting on / off toilet, heavy household duties, light household duties
Time frame: baseline and 10 days (value at day 10 minus value at baseline)
Knee Active Range of Motion
assessed by Virtual Reality Rehabilitation System (degree of movement)
Time frame: assesed and reported at 10 days
Health Related Quality of Life: Euro Quality of Life Five Dimensions Questionnaire (EQ-5D)
The EQ-5D comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.The EQ-5D descriptive system is divided into five levels of perceived problems: LEVEL 1: indicating no problem; LEVEL 2:indicating some problems;LEVEL 3: indicating extreme problems. EQ-5D health states can be summarised using the 5-digit code (e.g., 11111, 12311).The answers given to ED-5D permit to find 243 5-digit codes defining the health states.The 5-digit code are linked to an unique index derived by applying a formula that attaches values (weights) to each of the levels in each dimension.Weights depend on the country (Italian Population-Based Values of EQ-5D HealthStates,Scalone 2013).The index has been calculated by deducting the appropriate weights from 1 which is the best health status as highest score (i.e. the corresponding 5-digit code is 11111) and -0.38 for the worst health status as minimum score (i.e., the corresponding 5-digit code is 33333).
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exercise therapy through a traditional rehabilitation training made by physiotherapists
Time frame: assessed and reported at 10 days
Global Perceived Effect (GPE)
The GPE scale asks the patient to rate, on a numerical scale, how much their condition has improved or deteriorated since some predefined time point. The GPE was administered at the end of the physiotherapy treatment to measure the effect of the intervention on patients' health status perception. This Likert scale had five response options (5 = Very much improved; 4 = Much improved, 3 = No change, 2 = Much worse, 1 = Very much worse).
Time frame: assessed and reported at 10 days
The Functional Independence Measure (FIM) Scale
The FIM scale assesses physical and cognitive disability focusing on the level of disability indicating the burden of caring for them. The total score is 126 (18=highest disability, 126=no disability).
Time frame: baseline and 10 days (value at day 10 minus value at baseline)
Proprioception
assessed by Virtual Reality Rehabilitation System (percentage value of similarity between ideal and patient knee movement trajector)
Time frame: assessed and reported at 10 day
Isometric Strength of Quadriceps and Hamstrings
Isometric strength of quadriceps and hamstrings is assessed by dynamometer (newton unit)
Time frame: baseline and 10 days (value at day 10 minus value at baseline)
Drugs Assumption
number of drugs assumpted for each group during rehabilitation recovery
Time frame: value at day 10