Effects of Balance Training on Balance and Fall Confidence After Hip Replacement Surgery

Daegu University30 enrolled

Overview

This randomized controlled study aims to investigate the effects of perturbation-based balance training using pressure biofeedback on balance ability, hip function, and falls efficacy in patients after total hip arthroplasty (THA). Thirty participants who underwent THA will be randomly assigned to either a perturbation-based balance training group or a conventional balance training group. Both groups will receive intervention five times per week for 6 weeks in addition to conventional physical therapy. Outcome measures include Berg Balance Scale, Functional Reach Test, Falls Efficacy Scale, Harris Hip Score, Lower Extremity Functional Scale, and center of pressure (COP) parameters. The study is expected to provide clinical evidence for improving balance control and reducing fall risk in patients after THA.

Total hip arthroplasty (THA) is commonly performed to reduce pain and improve functional mobility in patients with hip joint disorders. However, many patients continue to experience impaired balance control, decreased proprioception, muscle weakness, and fear of falling after surgery. These impairments may negatively affect gait stability, activities of daily living, and quality of life. Traditional balance training programs mainly focus on static posture control and predictable weight-shifting tasks. However, such approaches may not adequately improve reactive postural control required for unexpected balance disturbances encountered during daily activities. Perturbation-based balance training (PBT) has recently gained attention as an intervention designed to improve reactive balance control by exposing individuals to unexpected external disturbances and encouraging adaptive postural responses. This study aims to investigate the effects of perturbation-based balance training using pressure biofeedback in patients following total hip arthroplasty. The pressure biofeedback system provides controlled instability and real-time sensory feedback during balance tasks, allowing participants to improve postural control strategies and weight-shifting ability. Thirty patients who underwent THA will be recruited and randomly assigned to either an experimental group or a control group. The experimental group will receive perturbation-based balance training using pressure biofeedback in addition to conventional physical therapy, while the control group will perform conventional balance training with conventional physical therapy. Interventions will be performed 5 times per week for 6 weeks. Outcome measures will include balance performance assessed by the Berg Balance Scale (BBS), Functional Reach Test (FRT), and center of pressure (COP) parameters measured using a Wii Balance Board. Falls efficacy will be evaluated using the Falls Efficacy Scale (FES). Hip function and lower extremity function will be assessed using the Harris Hip Score (HHS) and Lower Extremity Functional Scale (LEFS). The findings of this study may provide evidence supporting the clinical applicability of perturbation-based balance training using pressure biofeedback as an effective rehabilitation strategy for improving postural stability and reducing fall risk after THA.

Interventions

pertubation based on balance trainingBEHAVIORAL

Participants performed perturbation-based balance training using pressure biofeedback devices in addition to conventional physical therapy. During standing tasks, pressure biofeedback units were placed under both feet, and temporary instability was induced by adjusting air pressure to alter support surface stability. Participants performed progressive balance tasks including static standing, weight shifting, multidirectional reaching, and PNF-based reaching patterns. Training intensity and task difficulty were progressively increased according to participant performance. The intervention was conducted for 15 minutes per session, 5 sessions per week, for 6 weeks under therapist supervision.

Traditional Balance TrainingBEHAVIORAL

Participants in the control group received traditional balance training without pressure biofeedback. The intervention included static and dynamic balance exercises, postural control training, weight-shifting tasks, and posture transition activities. The training tasks were performed in the same sequence and progression as the experimental group, but without perturbation induced by pressure biofeedback devices. Participants received training for 30 minutes per session, 5 times per week, for 6 weeks in addition to conventional physical therapy.

Eligibility

Sex: ALLMin age: 40 YearsMax age: 100 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients who underwent total hip arthroplasty (THA) * Postoperative period between 2 weeks and 6 months * Ability to understand and follow therapist instructions * Able to stand independently with or without an assistive device * Berg Balance Scale (BBS) score between 21 and 45 * Receiving inpatient rehabilitation and physical therapy Exclusion Criteria: * Severe cognitive impairment (K-MMSE \< 18) * Severe visual impairment or vestibular dysfunction * Any neurological or musculoskeletal disorder affecting balance other than THA * Unstable cardiovascular or medical conditions that could interfere with participation * Inability to safely participate in balance training

Outcomes

Primary Outcomes

Berg Balance Scale (BBS)

Functional balance assessed with the Berg Balance Scale, a 14-item performance-based scale scored from 0 to 56, with higher scores indicating better balance.