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Jamebozorgy A, Bolghanabadi Z, Mahdizadeh A, Irani A. Effect of Neurofeedback on Postural Balance and Attention of Women With Knee Osteoarthritis After Bilateral Total Knee Replacement. jrehab 2020; 21 (1) :40-53
URL: http://rehabilitationj.uswr.ac.ir/article-1-2567-en.html

Objective: As life expectancy increases, the incidence of degenerative diseases such as osteoarthritis also increases. Dynamic balance is one of the essential factors that affect the mobility and daily living activity of patients suffering from knee osteoarthritis after undergoing Bilateral Total Knee Replacement (BTKR) surgery. Traditional rehabilitation approaches are based on reducing pain and increasing muscle strength, which are applied topically on the knee area. One of the new methods used to improve balance is neurofeedback, which acts at the central nervous system level. This pilot study aims to examine the effect of neurofeedback on dynamic stability and sustained attention in women who underwent BTKA.
Materials & Methods: This is a quasi-experiment study with a pre-test/post-test design and no control group. The study population consisted of all patients with BTKA referred to the outpatient clinic of the Department of Occupational Therapy at Shahid Beheshti University of Medical Sciences from April 2017 to September 2017. Of these patients, 8 female patients with a mean age of 67.5 years (3 months had passed since their surgery) were selected using a convenience sampling method and based on the inclusion and exclusion criteria. 
Results: The inclusion criteria were being over 55 years old; having a history of BTKR surgery in the last 2 to 4 months; being able to walk independently; using a cement prosthesis; lacking a record of cognitive problems (mini-mental state exam score> 20), cardiovascular diseases, uncontrolled high blood pressure, visual impairment, drug abuse or alcohol use, vestibular disorders that can impair balance, use of neuroleptics and sedatives; not receiving neurofeedback before this study, or undergoing surgery in other joints of lower limbs, such as ankle or hip. The exclusion criteria were the absence of more than two sessions from therapeutic protocol and unwillingness to collaborate in the research process. All patients received 8 sessions of standard neurofeedback training. Assessments were done at three times: before the intervention, and at the 4th and 8th sessions using vigilance subscale of Vienna test system and Biodex balance system (dynamic stability level 6 test). Data analysis was done in SPSS V. 22 using repeated-measures ANOVA and paired-samples t test. P<0.05 was considered as the significance level. There was a significant improvement in the mean score of dynamic stability after neurofeedback training (P<0.05), but the mean scores of sustained attention did not change significantly (P>0.05). However, the mean reaction time decreased significantly (P<0.05). Moreover, a gradual increase in the beta wave was observed during treatment, but it was not statistically significant.
Conclusion: Neurofeedback training can improve dynamic stability in female patients with knee osteoarthritis 4 months after BTKR surgery, but it has limited effects on their sustained attention. Therefore, this non-invasive and uncomplicated program can be used as a complementary treatment method for the rehabilitation of these patients.