Efficacy of Proprioceptive Neuromuscular Facilitation Exercise Programme in Patients With 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. 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. Knee Joint Proprioception Measurement

   Time frame: Change from Baseline Knee Joint Proprioception Measurement at 8 weeks

   The inclinometer is placed distal to the tibial tuberosity. In full knee extension, the patient is asked to perform a single leg squat with eyes closed or unable to see the leg being tested. He/she is allowed to support with his/her hands to prevent loss of balance. When the knee flexion angle of 30° is reached, the patient is asked to stop and stay at this point for 5 seconds. Then return to full knee extension. This movement is repeated 3 times. This time, without any stop command, the patient is asked to reach the same 30° knee flexion angle as in the previous exercises. This application is also repeated 3 times. The "absolute angle difference", which is the difference between the targeted angle in each repetition and the angle realized by the patient, is recorded. The arithmetic mean of the 3 repetitions' absolute angle difference is recorded as the result data.

4. Modified Four Square Step Test (mFSST)

   Time frame: Change from Baseline mFSST at 8 weeks

   A suitable background is divided into four identical squares with a "+" shaped line using tape. The squares are numbered with numbers between 1-4 in a clockwise direction and this sequence is explained to the participant. The patient steps from the starting point to squares 1,2,3 and 4 in a way that the direction remains the same and without stepping on the lines. The test is terminated when the last foot contact is interrupted at square 4. The time elapsed during the main measurement is recorded with a stopwatch.

5. Figure 8 Walking Test (F8WT)

   Time frame: Change from Baseline F8WT at 8 weeks

   Participants are instructed to stand at the midpoint between two cones (1.52 m apart) and look at one of the cones. Participants are asked to walk in a circle of 8 around the cones at a comfortable speed and direction of their choice. The stopwatch is stopped while returning to the starting point. The elapsed time and the number of steps taken are recorded.

6. Berg Balance Scale (BBS)

   Time frame: Change from Baseline BBS at 8 weeks

   The 14 items in the scale assess static sitting and standing balance as well as expected balance during activities. Scoring is done on a 5-point scale that takes into account whether the patient can perform the task safely and independently and is usually based on a specific time interval. Normal performances are rated from 0 (unable to perform) to 4 points (normal performance). Scores on individual items are summed for a total score, with a maximum score of 56 points.

7. Activity Specific Balance Confidence Scale (ABC)

   Time frame: Change from Baseline ABC at 8 weeks

   This scale includes 16 tasks related to indoor and outdoor activities of daily living to measure balance confidence in older people with various levels of function. Scores for each question range from 0% (no confidence) to 100% (full confidence). Higher scores indicate greater confidence.

8. Tampa Scale for Kinesiophobia (TSK)

   Time frame: Change from Baseline TSK at 8 weeks

   The questionnaire is a 17-item scale developed to measure fear of movement/reinjury. The normal score range is between 17 and 68.