Adding visual feedback–based rehabilitation to conventional physiotherapy may improve gait speed, walking symmetry, and pelvic control following total hip arthroplasty (THA).
In a study, researchers randomly assigned 90 patients aged 55 to 80 years who underwent unilateral THA through a direct lateral approach to visual feedback–based (VFB) rehabilitation plus conventional therapy or conventional physiotherapy alone. The VFB group received 30 minutes of technology-assisted training followed by 30 minutes of conventional therapy, whereas the control group received 60 minutes of conventional therapy. Both groups completed treatment 5 days per week for 6 weeks, with no losses to follow-up.
The researchers evaluated gait performance and pelvic kinematics at baseline and after 6 weeks using the G-WALK inertial sensor. Assessments included gait speed, cadence, symmetry, and pelvic movement. Secondary clinical measures included pain intensity, functional independence, and ambulation capacity, assessed using the Visual Analog Scale, Barthel Index, and Functional Ambulation Category, respectively. Independent assessors blinded to treatment allocation conducted the evaluations.
At 6 weeks, mean gait speed increased from 0.52 to 0.83 m/s in the VFB group compared with 0.53 to 0.74 m/s in the control group. The between-group difference at follow-up was 0.09 m/s. Cadence increased from about 60 to 91 steps/min with VFB rehabilitation vs. 61 to 82 steps/min with conventional therapy.
Gait symmetry also improved more in the VFB group. The mean symmetry index increased from 71.11 to 86.69 in the intervention group vs. 72.23 to 81.30 in the control group. At follow-up, pelvic tilt measurements reached 84.81 in the VFB group vs. 78.83 in the control group, while pelvic obliquity measurements reached 65.57 vs. 55.07, respectively. The researchers interpreted these differences as evidence of improved pelvic movement and gait coordination.
Despite differences in objective gait measurements, both groups demonstrated comparable improvements in clinical outcomes. Mean Barthel Index scores increased from about 43 to 87 in the VFB group vs. 44 to 84 in the control group. Pain scores decreased from about 46 to 10 in both groups. Functional Ambulation Category scores improved, reaching about 4 in both groups, without a statistically significant between-group difference.
Exploratory multiple factor analysis and hierarchical clustering identified distinct postoperative recovery profiles. Patients receiving VFB rehabilitation were predominantly represented in a higher-functioning cluster characterized by improved pelvic symmetry and gait efficiency, whereas the alternative cluster reflected persistent gait asymmetries. These analyses suggested differences in overall biomechanical recovery patterns between the treatment groups, although the findings were exploratory.
The 0.09-m/s between-group difference in gait speed fell slightly below the commonly reported minimal clinically important difference of 0.10 to 0.14 m/s following THA. Consequently, the observed improvement may not have reached a threshold perceived by patients as functionally meaningful during early recovery.
Several limitations warrant consideration. The study included a modest sample from a single Italian inpatient rehabilitation center, and all patients underwent THA through a direct lateral approach, limiting generalizability to other surgical approaches and rehabilitation settings. Outcomes were assessed only after 6 weeks, leaving the durability of improvements uncertain. Exploratory multivariate and clustering analyses were conducted post hoc without prespecified power calculations, and secondary gait comparisons were not adjusted for multiple testing. The reported between-group differences also did not meet the stricter statistical threshold specified in the study tables.
“Future research with medium- to long-term follow-up is needed to determine whether these early advantages are sustained over 6 to 12 months,” wrote lead study author Riccardo Spanò, MD, of the S. Anna Institute in Italy, and colleagues.
The study authors reported no conflicts of interest.
Source: JBJS Open Access
