title: Patient outcomes using Wii-enhanced rehabilitation after total knee replacement - the TKR-POWER study.
abstract: BACKGROUND
  Home-based rehabilitation following total knee replacement surgery can be as effective as clinic-based or in-patient rehabilitation. The use of the Nintendo Wii has been postulated as a novel rehabilitation tool that adds an additional focus on balance and proprioception into the recovery protocol. The aim of the proposed clinical trial is to investigate the effectiveness of this novel rehabilitation tool, used at home for three months after total knee replacement surgery and to assess any lasting improvements in functional outcome at one year.
  
  
  METHODS
  This will be a randomised controlled trial of 128 patients undergoing primary total knee replacement. The participants will be recruited preoperatively from three surgeons at a single centre. There will be no change to the usual care provided until 6 weeks after the operation. Then participants will be randomised to either the Wii-Fit group or usual rehabilitative care group. Outcomes will be assessed preoperatively, a 6-week post surgery baseline and then at 18 weeks, 6 months and 1 year. The primary outcome is the change in self-reported WOMAC total score from week 6 to 18 weeks. Secondary outcomes include objective measures of strength, function and satisfaction scores.
  
  
  CONCLUSIONS
  The results of this clinical trial will be directly relevant for implementation into clinical practice. If beneficial, this affordable technology could be used by many patients to rehabilitate at home. Not only could it optimize the outcomes from their total knee replacement surgery but decrease the need for clinic-based or outpatient therapy for the majority.
  
  
  BACKGROUND
  (ACTRN12611000291987).
authors.affiliation: Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood NSW 2067, Australia. Electronic address: jonathan.negus@cantab.net.
authors.forename: J J
authors.initials: JJ
authors.lastname: Negus
authors.affiliation: Orthopaedic Department, Royal North Shore Hospital, St Leonard's, NSW, Australia. Electronic address: donald.cawthorne@gmail.com.
authors.forename: D P
authors.initials: DP
authors.lastname: Cawthorne
authors.affiliation: University of Sydney Institute of Bone and Joint Research and Department of Rheumatology, Royal North Shore Hospital, St Leonard's, NSW, Australia. Electronic address: jschen@med.usyd.edu.au.
authors.forename: J S
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood NSW 2067, Australia. Electronic address: cscholes@sori.com.au.
authors.forename: C J
authors.initials: CJ
authors.lastname: Scholes
authors.affiliation: Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood NSW 2067, Australia. Electronic address: dparker@sydneyortho.com.au.
authors.forename: D A
authors.initials: DA
authors.lastname: Parker
authors.affiliation: University of Sydney Institute of Bone and Joint Research and Department of Rheumatology, Royal North Shore Hospital, St Leonard's, NSW, Australia. Electronic address: lyn.march@sydney.edu.au.
authors.forename: L M
authors.initials: LM
authors.lastname: March
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D004856:Postural Balance; D011434:Proprioception; D020127:Recovery of Function; D012107:Research Design; D018910:Video Games
keywords: Balance; Nintendo Wii; Randomised clinical trial; Rehabilitation; Total knee replacement; WOMAC