Virtual reality rehabilitation in patients with total knee replacement: Preliminary results

Introduction: Impaired proprioceptive accuracy could be a risk factor for progression of gait limitations in knee osteoarthritis patients, even after the Total Knee Replacement (TKR) [1]. Recent studies on Virtual Reality (VR) in rehabilitation show its efficacy in restoring proprioceptive capacity, postural control and gait [2]. However, literature lacks such studies in TKR patients. This preliminary study aims to evaluate the efficacy of a VR system for the enhancement of motor skills in TKR patients. Methods: 10 TKR patients were enrolled within 10 days after an unilateral TKR: 5 (66 ± 10y.o.) Control Group (CG) and 5 (64 ± 10y.o.) Virtual Realty Group (VRG). All subjects conducted 15 sessions of 45-min (5times/week) of VR (VRG) or traditional (CG) postural control and proprioceptive exercises. The VRG used the VRRS (Khymeia, Italy) standing on the balance board and receiving a real-time visual bio-feedback in serious video games. Clinical assessments and gait analysis (BTS SMART-DX Motion Capture Systems, Italy)were performed before(T1)and after(T2)rehabilitation period. Wilcoxon's test (p<0.05) was used to detect significant changes between T1 and T2 (Table 1). Results: At T1, no significant differences were found between groups. Statistically significant improvements were longitudinally found for both groups in 10mWT, MRC QF, MRC TA and VAS. Significant variation of TUG was found in VRG only. The gait analysis shows significant variation in the spatio-temporal parameters (mean velocity, cadence, cycle length, prosthetic step length)inthe VRG only. Discussion: The VR system improves motor skills (gait, postural control and direction shift) in TKR patients compared to traditional therapy.The resultsob tained withthegait analysisand the TUG test are encouraging and suggest further instrumental investigations on the sit-to-stand and balance tasks. A RCT on a larger sample is currently in progress in order to confirm these preliminary results. (table presented).