Effect of proprioceptive neuromuscular facilitation and focal vibration in older adults with osteoarthritis after total knee arthroplasty: A randomized clinical trial study

Abstract

BackgroundPostoperative balance disorders in older adults after total knee arthroplasty (TKA) due to osteoarthritis are commonly attributed to proprioceptive joint deficits. Both Proprioceptive Neuromuscular Facilitation (PNF) and Focal Vibration (FV) can improve balance and proprioception.AimTo examine the combination of a PNF exercise program and quadriceps tendon FV in older adults after TKA due to osteoarthritis.MethodsNinety older adults who underwent TKA were randomly assigned to three groups of 30. The PNF Group followed a 6-week PNF exercise program starting four weeks post-surgery. The PNF + FV Group followed the same PNF program combined with FV applied to the rectus femoris and vastus medialis. The control group received instructions for a home-based exercise program. Pain (Numeric Pain Rating Scale; NPRS), knee range of motion (ROM), functional ability (Knee Injury and Osteoarthritis Outcome Score, KOOS), joint position sense (JPS), postural sway (force platform), and balance (Timed Up-and-Go; TUG test, Berg Balance Scale; BBS) were evaluated at baseline, six weeks, and six months post-intervention. A two-way repeated measures ANOVA analysis was applied with significance set at p < .05.ResultsThe PNF + FV group showed significant improvements compared to the control group in NPRS, KOOS, TUG, BBS, displacement parameters, and absolute error scores (p < .05). The PNF + FV group showed earlier improvements compared to the PNF group, indicating faster adjustments due to the combined effect of PNF and FV. Additionally, the PNF + FV group showed greater improvement in TUG, BBS, KOOS sport, anterior-posterior displacement distance, and absolute error scores at 25° compared to the PNF group (p < .05). PNF exercises improved knee ROM (p < .05) with no additional effect from FV.ConclusionsA 6-week protocol combining PNF exercises and FV significantly improved balance, knee joint position sense, knee functional ability, and pain intensity in older adults after TKA due to osteoarthritis. These findings suggest faster and more effective rehabilitation, potentially reducing postoperative disorders and future injury risks. Further research is needed to investigate the combination of FV and PNF.

Keywords: PNF; focal tendon vibration; knee osteoarthritis; physiotherapy; total knee arthroplasty.