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Training with biofeedback devices improves clinical outcome compared to usual care in patients with unilateral TKA: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Biofeedback following total knee arthroplasty (TKA) seems to be a feasible approach to improve rehabilitation, outcomes, mobility and reduce pain. This systematic review gives the practicing orthopedic surgeon a summary of what is available and how biofeedback affects clinical outcomes.

Methods

We reviewed the current literature regarding methods, devices and effects of biofeedback in patients who underwent total knee arthroplasty. Embase, Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to May 2018 for the following keywords: Biofeedback OR Feedback AND Total Knee Arthroplasty OR TKA. Data were extracted according to a predefined setting (see Protocol for systematic review on PROSPEO). Devices used for biofeedback were recorded. Demographics, training methods and effects were also collected.

Results

The search resulted in 380 potentially eligible studies from which 11 met all inclusion criteria including 7 randomized controlled trials (RCTs), 3 cohort studies, and 1 cross-sectional study. A total of 416 patients with unilateral TKA were included, with an average of 37.8 patients per study. In patients with TKA, significant improvements in activity scores or pain were reported by 9 of 11 studies. Only two of the studies reported no significant influence of the feedback on the chosen outcome parameters. Devices for biofeedback varied between studies and included the use of a goniometer, force plate, balance board, treadmill, and/or electromyography (EMG). The most common type of feedback was visual followed by audio, with one study mentioning that the audio mode was preferred by the patients as it was easier to handle. Overall, 5 out of 6 different methods demonstrated a potential value for improving mobility and decreasing pain.

Conclusions

This review suggests that biofeedback in early postoperative rehabilitation after TKA is effective in improving gait symmetry, reducing pain and increasing activity level. It should be noted that the great variety of devices used for feedback limits comparisons between studies.

Level of evidence

IIa.

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Abbreviations

EMG:

Electromyography

FB:

Feedback

FTSST:

Five-time sit to stand test

RCT:

Randomized controlled trial

TKA:

Total knee arthroplasty

TUG:

Timed up and go test

VAS:

Visual analog scale

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

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Authors and Affiliations

  1. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Daniel Pfeufer, Jeremy Gililland, Mike Anderson, Nicola Krähenbühl & Christopher Pelt

  2. Department of Traumatology, Munich University Hospital LMU, Munich, Germany

    Daniel Pfeufer, Wolfgang Böcker & Christian Kammerlander

Authors
  1. Daniel Pfeufer
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  2. Jeremy Gililland
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  3. Wolfgang Böcker
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  4. Christian Kammerlander
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  5. Mike Anderson
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  6. Nicola Krähenbühl
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  7. Christopher Pelt
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Contributions

CK, WB, CP, JG: Interpretation of data, revising manuscript, final approval. MA, NK, DP: Conception of design, acquisition and analysis of data, drafting manuscript, final approval.

Corresponding author

Correspondence to Daniel Pfeufer.

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Conflict of interest

The authors report no significant financial interests related to this research.

Additional information

Following the guidelines, our systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on May 23, 2018 (registration number CRD42018095518).

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Pfeufer, D., Gililland, J., Böcker, W. et al. Training with biofeedback devices improves clinical outcome compared to usual care in patients with unilateral TKA: a systematic review. Knee Surg Sports Traumatol Arthrosc 27, 1611–1620 (2019). https://doi.org/10.1007/s00167-018-5217-7

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  • DOI: https://doi.org/10.1007/s00167-018-5217-7

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