Effectiveness of Dual Task Training in Total Knee Arthroplasty

Primary outcomes

1. Visual Analog Scale (VAS)

   Time frame: Change from Baseline VAS at 8 weeks

   On a 10 cm straight line or numeric scale, the patient is asked to mark the pain they feel (0: no pain, 10: excruciating pain).

2. Knee Society Short Form (KSSF)

   Time frame: Change from Baseline KSSF at 8 weeks

   The scale is a 9-item measure developed to assess total knee arthroplasty patients' satisfaction, expectations, physical activities, and clinical and functional status in the preoperative and postoperative period, reported by both the physician and the patient.

3. Mini-Mental State Examination (MMSE)

   Time frame: Change from Baseline MMSE at 8 weeks

   The mini mental test is categorized under five main headings: orientation (10 points), recording memory (3 points), attention and calculation (5 points), recall (3 points) and language (9 points). The scale is scored out of a total of 30 points and has two different variants for educated and uneducated people. Traditionally, scores between 24 and 30 are considered normal. A score below 24 indicates cognitive impairment. 18-23 is considered as mild dementia, 12-17 as moderate dementia and below 12 as severe dementia.

4. Dual-Task Questionnaire (DTQ)

   Time frame: Change from Baseline DTQ at 8 weeks

   The questionnaire consists of 10 items and each question is rated out of 5 points (ranging from 0 "never" to 4 "very often" or N/A "not applicable"). The score obtained is the average score per question (i.e. total score/10 for the questionnaire).

5. Cognitive Timed Up and Go Test (CTUG)

   Time frame: Change from Baseline CTUG at 8 weeks

   Patients are first asked to stand up from a sitting position, walk 3 m at their normal speed, turn around, walk back to the chair and sit down. Walking aids are allowed. Patients are asked to perform this test while performing a cognitive dual task (subtract 2 continuously starting from 100).

6. Lower Extremity Motor Coordination Test (LEMCT)

   Time frame: Change from Baseline LEMCT at 8 weeks

   The test requires subjects sitting in a chair to alternately touch a proximal and distal target placed 30 cm apart on the floor with their feet within a 20-second period. A higher score indicates better motor coordination (13).

7. 3 Meter Backward Walk Test (3MBWT)

   Time frame: Change from Baseline 3MBWT at 8 weeks

   A distance of 3 meters is measured and marked. Children are asked to walk backwards safely when the signal is given and stop when they reach the marked point. They are allowed to look behind them if necessary. Measurements are repeated 3 times and the average time is recorded.

8. 10-Meter Walk Test (10MWT)

   Time frame: Change from Baseline 10MWT at 8 weeks

   A 10 meter long track is marked. Participants are instructed to "walk comfortably, at your usual pace" until they reach the end of the marked path. A member of the research team simultaneously measures the walking time with a stopwatch, starting the stopwatch as soon as the participant's lead foot crosses the first mark and stopping it when the participant's lead foot crosses the last mark. Distance and second data are used to determine walking speed.

9. Walking Impact Scale (Walk-12)

   Time frame: Change from Baseline Walk-12 at 8 weeks

   The test consists of 12 items asking about self-perceived walking limitations over the past 2 weeks in activities related to walking, running, climbing stairs, standing, walking distance and effort, need for support indoors and outdoors, elements of gait quality and concentration while walking. The scale has five response options: 1 = not at all, 2 = a little, 3 = moderately, 4 = somewhat and 5 = extremely. In clinical practice, the response options for each item are summed to obtain a total score ranging from 12 to 60 points.

10. Reaction Time Measurement (RTM)

    Time frame: Change from Baseline RTM at 8 weeks

    A platform with a circle on it is used to measure the stepping reaction. The participant standing outside the hoop is given a voice command and asked to step the relevant limb into the hoop. The time between immediately after the command and the first contact phase of stepping into the hoop is taken into account. The video images are evaluated with the Kinovea program using slow motion technology.