Effects of Balance Training on Balance and Fall Confidence After Hip Replacement Surgery

Effects of Perturbation-Based Balance Training on Balance Ability and Fall Efficacy in Patients After Total Hip Arthroplasty: A Randomized Controlled Trial

This randomized controlled study aims to investigate the effects of perturbation-based balance training using pressure biofeedback on balance ability, hip function, and falls efficacy in patients after total hip arthroplasty (THA). Thirty participants who underwent THA will be randomly assigned to either a perturbation-based balance training group or a conventional balance training group. Both groups will receive intervention five times per week for 6 weeks in addition to conventional physical therapy. Outcome measures include Berg Balance Scale, Functional Reach Test, Falls Efficacy Scale, Harris Hip Score, Lower Extremity Functional Scale, and center of pressure (COP) parameters. The study is expected to provide clinical evidence for improving balance control and reducing fall risk in patients after THA.

Study Overview

• Status: Completed
• Conditions: Total Hip Replacement
• Intervention / Treatment: Behavioral: pertubation based on balance training; Behavioral: Traditional Balance Training

Detailed Description

Total hip arthroplasty (THA) is commonly performed to reduce pain and improve functional mobility in patients with hip joint disorders. However, many patients continue to experience impaired balance control, decreased proprioception, muscle weakness, and fear of falling after surgery. These impairments may negatively affect gait stability, activities of daily living, and quality of life.

Traditional balance training programs mainly focus on static posture control and predictable weight-shifting tasks. However, such approaches may not adequately improve reactive postural control required for unexpected balance disturbances encountered during daily activities. Perturbation-based balance training (PBT) has recently gained attention as an intervention designed to improve reactive balance control by exposing individuals to unexpected external disturbances and encouraging adaptive postural responses.

This study aims to investigate the effects of perturbation-based balance training using pressure biofeedback in patients following total hip arthroplasty. The pressure biofeedback system provides controlled instability and real-time sensory feedback during balance tasks, allowing participants to improve postural control strategies and weight-shifting ability.

Thirty patients who underwent THA will be recruited and randomly assigned to either an experimental group or a control group. The experimental group will receive perturbation-based balance training using pressure biofeedback in addition to conventional physical therapy, while the control group will perform conventional balance training with conventional physical therapy. Interventions will be performed 5 times per week for 6 weeks.

Outcome measures will include balance performance assessed by the Berg Balance Scale (BBS), Functional Reach Test (FRT), and center of pressure (COP) parameters measured using a Wii Balance Board. Falls efficacy will be evaluated using the Falls Efficacy Scale (FES). Hip function and lower extremity function will be assessed using the Harris Hip Score (HHS) and Lower Extremity Functional Scale (LEFS).

The findings of this study may provide evidence supporting the clinical applicability of perturbation-based balance training using pressure biofeedback as an effective rehabilitation strategy for improving postural stability and reducing fall risk after THA.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• South Korea
  • Gyeongsangbuk-do
    • Gyeongsan-si, Gyeongsangbuk-do, South Korea, 38453
      • Daegu University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Patients who underwent total hip arthroplasty (THA)
• Postoperative period between 2 weeks and 6 months
• Ability to understand and follow therapist instructions
• Able to stand independently with or without an assistive device
• Berg Balance Scale (BBS) score between 21 and 45
• Receiving inpatient rehabilitation and physical therapy

Exclusion Criteria:

• Severe cognitive impairment (K-MMSE < 18)
• Severe visual impairment or vestibular dysfunction
• Any neurological or musculoskeletal disorder affecting balance other than THA
• Unstable cardiovascular or medical conditions that could interfere with participation
• Inability to safely participate in balance training

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
Experimental: Pressure Biofeedback-Based Perturbation Balance Training Group; Participants will receive perturbation-based balance training using pressure biofeedback in addition to conventional physical therapy. The intervention will be conducted for 15 minutes per session, five times per week, for six weeks.	Behavioral: pertubation based on balance training; Participants performed perturbation-based balance training using pressure biofeedback devices in addition to conventional physical therapy. During standing tasks, pressure biofeedback units were placed under both feet, and temporary instability was induced by adjusting air pressure to alter support surface stability. Participants performed progressive balance tasks including static standing, weight shifting, multidirectional reaching, and PNF-based reaching patterns. Training intensity and task difficulty were progressively increased according to participant performance. The intervention was conducted for 15 minutes per session, 5 sessions per week, for 6 weeks under therapist supervision.
Active Comparator: Conventional Balance Training; Participants performed traditional balance training combined with conventional physical therapy. Training included static and dynamic balance exercises, weight shifting, postural control tasks, and functional reaching activities without pressure biofeedback. The intervention was conducted for 30 minutes per session, 5 sessions per week, for 6 weeks.	Behavioral: Traditional Balance Training; Participants in the control group received traditional balance training without pressure biofeedback. The intervention included static and dynamic balance exercises, postural control training, weight-shifting tasks, and posture transition activities. The training tasks were performed in the same sequence and progression as the experimental group, but without perturbation induced by pressure biofeedback devices. Participants received training for 30 minutes per session, 5 times per week, for 6 weeks in addition to conventional physical therapy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Berg Balance Scale (BBS)	Functional balance assessed with the Berg Balance Scale, a 14-item performance-based scale scored from 0 to 56, with higher scores indicating better balance.	Baseline and after 6 weeks of intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional Reach Test (FRT)	Maximum forward reach distance in centimetres while standing, measured with the Functional Reach Test; greater distance indicates better dynamic balance.	Baseline and after 6 weeks of intervention
Falls Efficacy Scale (FES)	Fall-related self-efficacy assessed with the Falls Efficacy Scale; higher scores indicate greater confidence in performing activities without falling.	Baseline and after 6 weeks of intervention
Harris Hip Score (HHS)	Hip function assessed with the Harris Hip Score, covering pain, function, deformity and range of motion, scored from 0 to 100, with higher scores indicating better hip function.	Baseline and after 6 weeks of intervention
Lower Extremity Functional Scale (LEFS)	Lower-limb function assessed with the Lower Extremity Functional Scale, a 20-item self-report questionnaire scored from 0 to 80, with higher scores indicating better function.	Baseline and after 6 weeks of intervention

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean COP velocity, eyes open (cm/s)	Mean velocity of centre-of-pressure displacement during quiet standing with eyes open, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
COP root mean square distance, eyes closed (cm)	Root-mean-square distance of the centre-of-pressure from its mean position during quiet standing with eyes closed, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
COP 95% confidence ellipse area, eyes closed (cm^2)	Area of the 95% confidence ellipse fitted to the centre-of-pressure distribution during quiet standing with eyes closed, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
COP sway path length, eyes closed (cm)	Total length of the centre-of-pressure trajectory during quiet standing with eyes closed, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
COP mediolateral range, eyes closed (cm)	Range of centre-of-pressure excursion in the mediolateral direction during quiet standing with eyes closed, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
Mean COP velocity, eyes closed (cm/s)	Mean velocity of centre-of-pressure displacement during quiet standing with eyes closed, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
COP mediolateral range, eyes open (cm)	Range of centre-of-pressure excursion in the mediolateral direction during quiet standing with eyes open, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
COP sway path length, eyes open (cm)	Total length of the centre-of-pressure trajectory during quiet standing with eyes open, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
COP 95% confidence ellipse area, eyes open (cm^2)	Area of the 95% confidence ellipse fitted to the centre-of-pressure distribution during quiet standing with eyes open, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention
COP root mean square distance, eyes open (cm)	Root-mean-square distance of the centre-of-pressure from its mean position during quiet standing with eyes open, measured with a Nintendo Wii Balance Board and Balancia software; mean of three 30-second trials.	Baseline and after 6 weeks of intervention

Collaborators and Investigators

• Sponsor: Daegu University
• Investigators: Principal Investigator: Deok Hoon Jun, Daegu University

Study record dates

Study Major Dates

• Study Start (Actual): October 28, 2025
• Primary Completion (Actual): March 1, 2026
• Study Completion (Actual): March 1, 2026

Study Registration Dates

• First Submitted: August 24, 2026
• First Submitted That Met QC Criteria: August 26, 2026
• First Posted (Actual): August 28, 2026

Study Record Updates

• Last Update Posted (Actual): August 28, 2026
• Last Update Submitted That Met QC Criteria: August 26, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: pertubation balance training
• Other Study ID Numbers: 1040621-202509-HR-074

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The plan for sharing individual participant data has not yet been determined.

Drug and device information, study documents

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