Effects of Balance Training on Balance and Fall Confidence After Hip Replacement Surgery

Total hip arthroplasty (THA) is commonly performed to reduce pain and improve functional mobility in patients with hip joint disorders. However, many patients continue to experience impaired balance control, decreased proprioception, muscle weakness, and fear of falling after surgery. These impairments may negatively affect gait stability, activities of daily living, and quality of life.

Traditional balance training programs mainly focus on static posture control and predictable weight-shifting tasks. However, such approaches may not adequately improve reactive postural control required for unexpected balance disturbances encountered during daily activities. Perturbation-based balance training (PBT) has recently gained attention as an intervention designed to improve reactive balance control by exposing individuals to unexpected external disturbances and encouraging adaptive postural responses.

This study aims to investigate the effects of perturbation-based balance training using pressure biofeedback in patients following total hip arthroplasty. The pressure biofeedback system provides controlled instability and real-time sensory feedback during balance tasks, allowing participants to improve postural control strategies and weight-shifting ability.

Thirty patients who underwent THA will be recruited and randomly assigned to either an experimental group or a control group. The experimental group will receive perturbation-based balance training using pressure biofeedback in addition to conventional physical therapy, while the control group will perform conventional balance training with conventional physical therapy. Interventions will be performed 5 times per week for 6 weeks.

Outcome measures will include balance performance assessed by the Berg Balance Scale (BBS), Functional Reach Test (FRT), and center of pressure (COP) parameters measured using a Wii Balance Board. Falls efficacy will be evaluated using the Falls Efficacy Scale (FES). Hip function and lower extremity function will be assessed using the Harris Hip Score (HHS) and Lower Extremity Functional Scale (LEFS).

The findings of this study may provide evidence supporting the clinical applicability of perturbation-based balance training using pressure biofeedback as an effective rehabilitation strategy for improving postural stability and reducing fall risk after THA.

Inclusion criteria

• Patients who underwent total hip arthroplasty (THA)
• Postoperative period between 2 weeks and 6 months
• Ability to understand and follow therapist instructions
• Able to stand independently with or without an assistive device
• Berg Balance Scale (BBS) score between 21 and 45
• Receiving inpatient rehabilitation and physical therapy

Exclusion criteria

• Severe cognitive impairment (K-MMSE < 18)
• Severe visual impairment or vestibular dysfunction
• Any neurological or musculoskeletal disorder affecting balance other than THA
• Unstable cardiovascular or medical conditions that could interfere with participation
• Inability to safely participate in balance training