title: Biofeedback to promote movement symmetry after total knee arthroplasty: a feasibility study.
abstract: METHODS
  Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point.
  
  
  OBJECTIVE
  To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA).
  
  
  BACKGROUND
  TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes.
  
  
  METHODS
  Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean ± SD age, 61.4 ± 5.8 years; body mass index, 33.1 ± 5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean ± SD age, 61.8 ± 5 years; body mass index, 34.3 ± 5.1 kg/m2), that did not receive specialized symmetry retraining.
  
  
  RESULTS
  Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol.
  
  
  CONCLUSIONS
  Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared to rehabilitation protocols that focus on range of motion, strength, and return to independence.
  
  
  METHODS
  Therapy, level 4.
authors.affiliation: Department of Physical Therapy, University of Delaware, Newark, DE.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zeni
authors.forename: Sumayah
authors.initials: S
authors.lastname: Abujaber
authors.forename: Portia
authors.initials: P
authors.lastname: Flowers
authors.forename: Federico
authors.initials: F
authors.lastname: Pozzi
authors.forename: Lynn
authors.initials: L
authors.lastname: Snyder-Mackler
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D001676:Biofeedback, Psychology; D001696:Biomechanical Phenomena; D005240:Feasibility Studies; D005260:Female; D005684:Gait; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009068:Movement; D020370:Osteoarthritis, Knee / Q000601:surgery; D016896:Treatment Outcome
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