The Effects of Dual-Task Exercises on Parameters After Total Knee Arthroplasty

The Effects of Dual-Task Exercises on Pain, Balance, Function, and Reaction Time After Total Knee Arthroplasty

Introduction: Total knee arthroplasty (TKA) is a widely used surgical treatment method worldwide for advanced pain and functional loss resulting from osteoarthritis and other degenerative knee pathologies. The aim of TKA is to reduce pain, restore joint function, and improve quality of life. Although many patients experience a significant reduction in pain after surgery, balance problems, risk of falls, and functional limitations may persist in the postoperative period.In addition, loss of performance may occur in daily tasks requiring motor-cognitive interaction (e.g., talking while walking, changing direction while carrying objects).The dual-task paradigm describes exercises and assessments that require the simultaneous execution of both motor and cognitive tasks; in rehabilitation, it aims to improve daily living functions by targeting the simultaneous functioning of motor and cognitive systems.In the literature, studies on dual-task assessment and training in individuals with knee osteoarthritis and TKA are limited, and the findings are heterogeneous. Studies in elderly and osteoarthritic populations have reported that both single-task and dual-task training improve balance performance, but dual-task training does not always show a clear superiority compared to single-task training. These studies have generally focused on balance and gait parameters; evidence on how other clinically important variables such as pain, reaction time, and fear of movement (kinesiophobia) change with dual-task interventions is insufficient and inconsistent.

Method: The effect size of the WOMAC Osteoarthritis Index assessment parameter in the reference article is 1.02. It was calculated that a minimum of 20 individuals in total, 10 in each group, were required for a study with 80% power, using a type I error of α=0.05 and a type II error of β=0.20.After obtaining informed consent from all participants, their sociodemographic information will be recorded. Subsequently, their cognitive status will be assessed using the Mini Mental State Test (MMSE).Pain will be assessed using the Numerical Pain Rating Scale (NPRS). Functional mobility will be assessed using the Timed Up and Go (TUG). Dynamic balance will be assessed using the Functional Reach Test. Static balance will be assessed using the Berg Balance Scale (BBS). Functionality will be assessed using the WOMAC Osteoarthritis Index. Kinesiophobia will be assessed using the Tampa Kinesiophobia Scale (TKS). Lower extremity reaction time will be assessed using the Fitlight Trainer (FITLIGHT Sports Corp., Ontario, Canada), a wireless system consisting of 8 sensors.Interventions: After participants were randomly divided into two groups, those in the control group would perform a physiotherapy program consisting of strengthening and balance exercises at home, provided by us, and would not participate in any other exercise program during the study period. Exercises would be taught to the control group in person by a physiotherapist at the time of the initial assessment, and follow-up sessions would be video-recorded. The intervention group's program would be a dual-task exercise program, in addition to the exercises provided in the home exercise program. Interventions would last for 8 weeks, 2 days a week, and the program would be updated weekly.

Study Overview

• Status: Not yet recruiting
• Conditions: Total Knee Arthroplasty; Dual Task Exercises
• Intervention / Treatment: Other: Home Exercises; Other: Dual Task Exercises

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Necati Muhammed Tat, Asst.Prof; Phone Number: +905075083347; Email: necatimuhammedtat@yyu.edu.tr
• Study Contact Backup: Name: Anıl Sensever, Physiotherapist; Phone Number: +905308926718; Email: anilsensever82@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Mini Mental State Test score ≥24; ability to provide signed informed consent and voluntary agreement to participate in the study.
• Underwent primary unilateral total knee replacement surgery.
• Being between 50 and 65 years old

Exclusion Criteria:

• Having undergone revision or bilateral knee replacement surgery,
• Having experienced postoperative complications,
• Having undergone lower extremity surgery,
• Having a neurological disease.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Home Exercise Group: Control Group	Other: Home Exercises; Home exercises consisting of strengthening and balance exercises at home and will not engage in any other exercise programs during the study period.The interventions will last for 8 weeks, 2 days a week, and the program will be updated each week.
Experimental: Dual Task Exercises: Physiotherapy Group; Dual Task Exercises	Other: Home Exercises; Home exercises consisting of strengthening and balance exercises at home and will not engage in any other exercise programs during the study period.The interventions will last for 8 weeks, 2 days a week, and the program will be updated each week.; Other: Dual Task Exercises; In addition to the home exercise program, a dual-task exercise program will be implemented.The interventions will last for 8 weeks, 2 days a week, and the program will be updated each week.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reaction time	The total time and average time until the light turns off were recorded.	8 weeks
WOMAC Osteoarthritis Index	This is a 24-item self-report scale used to assess functional status after osteoarthritis and TKA (Total Knee Arthroplasty). It has three sub-dimensions: pain (5 items), stiffness (2 items), and physical function (17 items). Each item is scored between 0 and 4. A higher score indicates a worse functional level.	8 weeks
Kinesiophobia	The Tampa Kinesiophobia Scale (TKS) will be used for assessment. The TKS is a 17-item scale that measures fear of movement and re-injury. Each item is scored from 1 to 4; the total score ranges from 17 to 68. A higher score indicates a greater fear of movement.	8 weeks
Functional Mobility	The TUG test measures the time, in seconds, for an individual to stand up from a chair, walk 3 meters, turn around, and sit back down. It comprehensively evaluates functional mobility, balance, walking speed, and lower extremity strength.	8 weeks
Static Balance	The Berg Balance Scale (BDS) will be used for assessment. The BDS is a 14-item scale that evaluates an individual's static and dynamic balance skills. Each item is scored between 0 and 4; the total score ranges from 0 to 56.	8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	Pain will be assessed using the Numerical Pain Rating Scale (NPRS). Pain intensity is evaluated on a numerical scale of 0-10; 0 = no pain, 10 = unbearable pain.	8 weeks
Dynamic balance	The functional reach test will be used in the dynamic balance assessment.	8 weeks

Collaborators and Investigators

• Sponsor: Yuzuncu Yil University
• Investigators: Study Chair: Necati Muhammed Tat, Asst.Prof., Van Yuzuncu Yil University, Faculty of Health Science; Principal Investigator: Anıl Şensever; Study Chair: Mehmet Ata Gökalp, Prof.Dr., Van Yuzuncu Yil University, Faculty of Medicine; Principal Investigator: Şilan Kaplan

Study record dates

Study Major Dates

• Study Start (Estimated): February 15, 2026
• Primary Completion (Estimated): July 15, 2026
• Study Completion (Estimated): September 15, 2026

Study Registration Dates

• First Submitted: February 11, 2026
• First Submitted That Met QC Criteria: February 11, 2026
• First Posted (Actual): February 18, 2026

Study Record Updates

• Last Update Posted (Actual): February 18, 2026
• Last Update Submitted That Met QC Criteria: February 11, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: exercise; functionality; Total knee arthroplasty; kinesiophobia; reaction time; dual task exercises
• Additional Relevant MeSH Terms: Mental Disorders; Phobic Disorders; Anxiety Disorders; Behavior; Kinesiophobia; Motor Activity
• Other Study ID Numbers: Van YYUYL1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Study Protocol and Statistical Analysis Plan

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No