Effectiveness of a Community-based Multi-modal Tai Chi Rehabilitation Program for Patients After Total Knee Arthroplasty

Acceptability and Feasibility of a Community-based Strength, Balance and Tai Chi Rehabilitation Program in Improving Physical Function and Balance of Patients After Total Knee Arthroplasty: a Pilot Randomized Controlled Trial

The rate of falls in patients after total knee arthroplasty (TKA) is high and related to lower limb muscle weakness and poor balance control. However, since routine post-TKA rehabilitation is uncommon, it is paramount to explore alternative strategies to enhance balance and physical functioning in post-TKA patients. As Tai Chi is a proven strategy for improving balance in older people, the proposed study aims to determine the feasibility and acceptability of a 12-week community-based post-TKA multimodal Tai Chi program and to collect preliminary data with respect to the efficacy of such a program in improving balance and physical functioning in post-TKA patients as compared to usual postoperative care.

This is a single-blinded 2-arm RCT. TKA participants will be randomized to either a 12-week community-based rehabilitation program starting at 12 weeks after TKA, or usual post-operative care without outpatient physiotherapy. A third group of asymptomatic controls will be recruited to provide comparisons at various time points. All post-TKA participants will undergo five clinical assessments: 1 week before TKA, and at 6, 12, 24 and 52 weeks after TKA. The untreated asymptomatic controls will be assessed at baseline, and 12 and 52 weeks from baseline

Inclusion Criteria:

1. 60 years or above;
2. candidates for primary unilateral TKA who are placed on the TKA waiting list for less than 1 month before their surgery;
3. living independently in the community

Exclusion Criteria:

1. living in assisted living facilities, requiring nursing care, or planning to reside away from the hospital district within 1 year.
2. unstable medical conditions,
3. fracture of lower limbs,
4. malignancy in the last five years,
5. lower limb prosthesis/amputation,
6. congenital defect that is considered to cause the present complaint,
7. systemic inflammatory and autoimmune diseases,
8. previous osteotomy,
9. neurological diseases (e.g. Parkinson's disease, stroke),
10. blindness, revision TKA,
11. complications after primary TKA,
12. cognitive impairment with a Mini-Mental State Examination score < 19
13. prior experience in practicing Tai Chi exercise for at least 3 months