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Europa Medicophysica 2003 June;39(2):87-94


language: English

Preliminary study on the validity of an instrumental method of evaluating proprioception in patients undergoing total knee arthroplasty

Felicetti G. 1, Chiappano G. 2, Molino A. 2, Brignoli E. 1, Maestri R. 3, Maini M. 1

1 Division of Rehabilitation, Salvatore Maugeri Foundation IRCCS, Scientific Institute, Montescano (PV) 2 Bioengineering Service, Salvatore Maugeri Foundation IRCCS, Scientific Institute, Montescano (PV) 3 School of Physical Medicine and Rehabilitation University of Pavia, Pavia, Italy


Aim. The aim of ­this ­study was to use a com­pu­ter­ized pro­pri­o­cep­tive foot­board (Pro-Kin com­pany) to ­verify: 1) ­whether ­patients who ­have under­gone a ­total ­knee arthro­plasty (TKA), ­admitted to our ­Centre ­during the post­acute ­period to ­carry out ­post-oper­a­tive ­rehabili-­tation, ­have a pro­pri­o­cep­tive def­icit; 2) the reli­ability of the ­above men­tioned equip­ment in ­recording the pro­pri­o­cep­tive def­i­cits.
­Methods. Two ­groups of sub­jects ­were con­sid­ered in ­this ­study: the 1st ­group was ­formed of 34 ­patients (­mean age 60.5 ­years) who had under­gone a TKA and the 2nd com­prised 20 ­healthy sub­jects ­used as con­trols. All the indi­vid­uals under­went a ­careful eval­u­a­tion of pro­pri­o­cep­tion in the oper­ated ­limb, or in the dom­i­nant ­limb in the ­case of con­trols, ­using a com­pu­ter­ised, elec­tronic, stab­i­lom­eter ­made of a ­mobile foot­board ­with ­fluid oil ­dynamic ­piston ­rods. The param­e­ters con­sid­ered in ­order to eval­uate the per­for­mances of our sub­jects ­were, for ­each of the 3 ­traces, the ­time nec­es­sary to ­carry out the ­test and the per­centage of the ­route cov­ered. In accor­dance ­with the ­advice of the equip­ment ­device’s man­u­fac­turer, 100% was con­sid­ered ­optimal. The ­patients under­went 2 eval­u­a­tion ses­sions on dif­ferent ­days; the 1st ses­sion was per­formed ­about 10 ­days ­post-oper­a­tively and the 2nd 2 ­days ­after the ­first eval­u­a­tion. ­This ­test-­retest pro­ce­dure was ­used in ­order to ­assess the repro­du­cibility of the ­test. The param­e­ters (­TIME and %­ROUTE) for ­each ­test in the 1st eval­u­a­tion ses­sion ­were com­pared ­with the cor­re­sponding ­values of the ­same sub­ject in the ses­sion on the 2nd ­day’s ­test. Sub­se­quently, in ­order to ­verify the pres­ence of any pro­pri­o­cep­tive def­icit in the ­group of ­patients, the ­mean of the ­data (­TIME and %­ROUTE) ­relating to ­each of the 3 ­tests car­ried out by ­this ­group of sub­jects was com­pared ­with ­that of the cor­re­sponding ­values of the con­trol ­group.
­Results. We ­found a reduc­tion in the ­TIME param­eter ­betweeen the 1st and the ­second day of meas­ure­ment in ­both pop­u­la­tions, but ­only in the con­trol ­group it was sta­tis­ti­cally sig­nif­i­cant (p=0.013). ­Also the %­ROUTE ­improved ­between the 1st and the 2nd day, but the dif­fer­ence was ­very ­little and not sta­tis­ti­cally sig­nif­i­cant. Com­paring the 2 pop­u­la­tions, ­both ­TIME and %­ROUTE param­e­ters ­were sig­nif­i­cantly ­better in con­trols ­than in ­patients (p<0.001 and p<0.007 respec­tively).
Con­clu­sion. ­This ­type of eval­u­a­tion is too ­strongly influ­enced by the ­subject’s gen­eral char­ac­ter­is­tics (age, ­mental ­lucidity, con­cen­tra­tion, eye­sight, ­speed of ­reflex reac­tions, ­overall ­motor per­for­mances, etc.) to pro­vide a ­very reli­able indi­cator of his or her pro­pri­o­cep­tion. ­Despite the ­above men­tioned sta­tis­tical ­caveats, the ­data ­from ­this ­study ­were suf­fi­ciently ­valid and ­clear to be ­able to ­state ­with cer­tainty ­that TKA has an ­effect on pro­pri­o­cep­tion. ­This is dem­on­strated ­from ­both the ­greater ­time nec­es­sary for ­patients to com­plete the ­test, and the ­greater sur­face cov­ered in ­order to ­trace the ­route.

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