Objective: To assess the effects of preoperative balance training on the early postoperative balance and functional outcomes after total knee replacement surgery and to test whether an outpatient intervention may be as effective as a domiciliary intervention. Design: This is a three-arm randomized controlled trial. Setting: University hospital. Subjects: Eighty-six individuals were recruited. Seventy-seven were analysed, aged 72.1 (SD 7.6) years, of which 68% were women. Outcome measures: Overall state of balance, as measured with the Berg Balance Scale, and patient-perceived functionality, as measured with the Knee Injury and Osteoarthritis Outcome Score Function in Activities in Daily Living (KOOS-ADL) questionnaire, were the primary outcomes. Secondary assessments targeted knee function, balance and mobility, quality of life, and self-reported outcomes. The primary end-point was six weeks after surgery. Intervention: The hospital group implemented a four-week preoperative outpatient balance-oriented intervention. The home group implemented similar training, but this was domiciliary. The control group was instructed to keep performing their normal activities. Results: Home and hospital groups presented a moderate effect against the control group ( dhospital-control = 0.54; dhome-control = 0.63), both being similarly effective in improving the overall state of balance at six weeks after surgery ( P = 0.013). KOOS-ADL scores showed no between-group differences and a small effect size ( d < 0.5; P = 0.937). Secondary assessments suggested non-significant between-group differences. Conclusion: Preoperative balance training, conducted either as domiciliary or as an outpatient, is an effective approach to enhance early postoperative balance outcome but not the perceived functionality of individuals undergoing total knee replacement.

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ObjectiveTo determine the most frequently used outcome measures in total knee replacement rehabilitation trials.Literature SurveySystematic review of randomized trials searched in five databases: Web of Science, MEDical Literature Analysis and Retrieval System, Physiotherapy Evidence Database, Scopus, and Cochrane Library.MethodologyTrials were included if participants underwent total knee replacement rehabilitation and outcome measures were used to assess rehabilitation outcomes. A descriptive synthesis determined the frequency of using outcome measures and preferred assessment time points. Outcomes were classified into eight categories: patient‐ and clinician‐reported function, performance‐based function, balance, anxiety and depressive symptoms, quality of life, and others.SynthesisEighty‐one trials were included and 102 different outcome measures were classified. The most frequently reported outcome was knee range of motion, used in 54% of trials, followed by a visual analog scale of pain (43%) and Western Ontario and McMaster Universities Arthritis Index (WOMAC; 40%). Patient‐ and clinician‐reported function were the categories most frequently assessed (74%), whereas performance‐based measures were implemented by 56% of trials. The most frequent assessment time points were 1 week presurgery (52%) and 3 months postsurgery (39%).ConclusionsThere is consensus regarding the need to evaluate functional outcomes in total knee replacement rehabilitation trials but none regarding the outcome measure that should be used. These findings suggest that most trials include patient‐ and clinician‐reported functional measures, along with pain and performance‐based measures in trial designs.