Assessment of the Effectiveness of Rehabilitation after Total Knee Replacement Surgery Using Sample Entropy and Classical Measures of Body Balance

Anna Hadamus, Dariusz Białoszewski, Michalina Błażkiewicz, Aleksandra J Kowalska, Edyta Urbaniak, Kamil T Wydra, Karolina Wiaderna, Rafał Boratyński, Agnieszka Kobza, Wojciech Marczyński, Anna Hadamus, Dariusz Białoszewski, Michalina Błażkiewicz, Aleksandra J Kowalska, Edyta Urbaniak, Kamil T Wydra, Karolina Wiaderna, Rafał Boratyński, Agnieszka Kobza, Wojciech Marczyński

Abstract

Exercises in virtual reality (VR) have recently become a popular form of rehabilitation and are reported to be more effective than a standard rehabilitation protocol alone. The aim of this study was to assess the efficacy of adjunct VR training in improving postural control in patients after total knee replacement surgery (TKR). Forty-two patients within 7-14 days of TKR were enrolled and divided into a VR group and a control group (C). The C group underwent standard postoperative rehabilitation. The VR group additionally attended twelve 30-min exercise sessions using the Virtual Balance Clinic prototype system. Balance was assessed on the AMTI plate in bipedal standing with and without visual feedback before and after the four-week rehabilitation. Linear measures and sample entropy of CoP data were analyzed. After four weeks of rehabilitation, a significant reduction in parameters in the sagittal plane and ellipse area was noted while the eyes remained open. Regression analysis showed that sample entropy depended on sex, body weight, visual feedback and age. Based on the sample entropy results, it was concluded that the complexity of the body reaction had not improved. The standing-with-eyes-closed test activates automatic balance mechanisms and offers better possibilities as a diagnostic tool.

Keywords: body balance; knee arthroplasty; osteoarthritis; sample entropy; total knee replacement surgery; virtual reality.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Regression analysis results: (a) Empirical (from experiment) and aligned (from model) values of sample entropy versus age, (b) Empirical (from experiment) and aligned (from model) values of sample entropy versus body mass.

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