The priority goals of medical rehabilitation in the early postoperative period after total knee arthroplasty (TKR) are to eliminate abnormal movement patterns and improve patients’ quality of life. This is directly related to effective early patient activation, which is only possible with low pain severity. Modern technologies that enable graduated patient activation with training of complex, coordinated dynamic patterns in a biofeedback (BFB) system in a virtual space simulation enable ergonomic control of motor intensity, preventing increased pain in patients in the early postoperative period. Combining motor rehabilitation with physiotherapy methods promotes more effective pain relief, which complicates patient activation.
OBJECTIVE
Evaluation of the effectiveness of comprehensive early postoperative rehabilitation programs using a rehabilitation complex with biofeedback and 3D modeling of motor video analysis on the D-Wall rehabilitation system (DIH S.r.l., Florence, Italy), including in combination with local cryotherapy or electro-magnetic therapy in patients in the early recovery period of rehabilitation after total knee arthroplasty (TKR).
MATERIAL AND METHODS
The study involved 105 patients, aged 58 to 75 years, receiving early comprehensive postoperative rehabilitation programs after TKR surgery. All patients were divided into three equal groups: patients of group 1 (n=35) underwent a comprehensive rehabilitation program, including therapeutic exercises in the form of individual sessions, massage of the area of the operated limb in an electrostatic field, local magnetic therapy on the knee joint area. Patients of group 2 (n=35), in addition to the specified program, received procedures of complex-coordinated training in the D-Wall system and local cryotherapy on the knee joint. Patients of group 3 (n=35), in combination with the standard rehabilitation program and training on the
D-Wall, received procedures of high-intensity electro-magnetic stimulation on the EMW MED device (Russia). Evaluation of the effectiveness of the rehabilitation programs was carried out before the course and after its completion (on the 14th day) using the VAS (visual analogue scale of pain), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), goniometry, 6-minute walk test, flexion and extension angles in the knee joint, analysis of complaints. All methods are interpreted from the standpoint of the International Classification of Functioning, Disability and Health (ICF).
RESULTS
Statistically significant improvement in indicators was noted in all groups (p<0.05). The largest improvements were recorded in Groups 2 and 3: pain reduction according to the VAS was 58 and 62%, respectively (versus 44% in Group 1), function improvement according to the WOMAC was 52 and 56% (versus 41%), range of motion increased to 108° and 110° in flexion (versus 102°), and 6-minute walk distance improved by 38 and 41% (versus 30%).
CONCLUSION
Incorporating training on the D-Wall rehabilitation system into comprehensive early postoperative rehabilitation programs for patients undergoing TKA promotes faster recovery of motor function. The addition of local cryotherapy or high-intensity magnetic stimulation enhances the effect, particularly in terms of pain relief and swelling reduction.
