Efficacy of Proprioceptive Neuromuscular Facilitation Exercise Program in Total Hip 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. Western-Ontario and McMaster Universities Osteoarthritis Index (WOMAC)

   Time frame: Change from Baseline WOMAC at 8 weeks

   Functionality level in the patient group with knee OA was measured using WOMAC. WOMAC consists of 3 main headings: pain intensity, stiffness and physical function. The individuals included in the study are asked to score each item between 0 (no pain, stiffness, difficulty) and 5 (very severe pain, stiffness, difficulty). The total score ranges from 0 (no disability) to 96 (complete disability).

3. 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.

4. One Leg Standing Test (OLST)

   Time frame: Change from Baseline OLST at 8 weeks

   The subject is tested standing on one leg using the right and left legs respectively. The test is repeated on a hard surface with eyes open and closed. The subject is asked to place both hands on the hips and look at a target on the wall at eye level at a distance of 1 meter. The subject is asked to stand with one leg in a 90 degree flexion position and the other leg in a standing position. A stopwatch is used to record the time the subject can maintain the test position. If the subject can hold the position for more than 30 seconds, the test is terminated and the elapsed time is recorded.

5. Five Times Sit to Stand Test (5TSST)

   Time frame: Change from Baseline 5TSST at 8 weeks

   A chair without armrests, with a 28.5 cm deep seat and backrest and adjustable height is used for the tests. Subjects start in a seated position, with their arms in the desired position and their backs against the chair backrest. The following verbal instructions are given: "Please stand up and sit down 5 times as quickly as possible. Straighten your knees when standing up and lean your back against the backrest when sitting down." Timing with the digital stopwatch is started manually with the instruction "Start" and stopped when the subject's back touches the backrest after the fifth standing up.

6. Fear-Avoidance Beliefs Questionnaire (FABQ)

   Time frame: Change from Baseline FABQ at 8 weeks

   The FABQ consists of 16 items and is divided into 2 subscales. The items are scored on a 7-point Likert scale (from strongly disagree to strongly agree). The score of each subscale is used independently. Higher scores represent more fear avoidance beliefs.

7. Falls Efficacy Scale International (FES-I)

   Time frame: Change from Baseline FES-I at 8 weeks

   The FES-I is a self-report questionnaire, providing information on level of concern about falls during activities of daily living. The questionnaire contains 16 items scored on a four-point scale (1 = not at all concerned to 4 = very concerned) providing a total score ranging from 16 (absence of concern) to 64 (extreme concern).

8. Hip joint proprioception measurement

   Time frame: Change from Baseline proprioception measurement at 8 weeks

   Patients were placed in a supine position and blindfolded to eliminate visual cues. The test started at neutral position (0°) and patient actively fexed the hip toward the fexion target position of 45°, which was indicated by a mechanical obstruction. After holding that position for 5 s, patient focused and remembered the angle, and brought the joint actively back to the neutral starting position. Then, patient was asked to actively reproduce the target position without the mechanical obstruction and hold at where he/she felt it was the just position. Five repetitions were performed for each leg and "absolute angular error" values were obtained from the start and stop angles.