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JFSF Vol 4, No 1, March 2019, p.20-25

doi: 10.22540/JFSF-04-020


Original Article

The benefits to functional ambulation and physical activity of group-based rehabilitation in frail elderly Bulgarians undergoing total knee arthroplasty. Preliminary results

Julian Krumov1, Vasil Obretenov1, Alexandrina Vodenicharova2, Kostantin Kanalev3, Vladimir Stavrev4, Troycho Troev5, Jannis Papathanasiou6

  1. Clinic of Orthopedics and Traumatology, Military Medical Academy Varna, Bulgaria
  2. Department of Health Policy and Management Faculty of Public Health, Medical University of Sofia, Bulgaria
  3. Department of Physical Education and Sport, Faculty of Medicine, Medical University of Plovdiv, Bulgaria
  4. Department of Orthopedics and Traumatology, Medical University of Plovdiv, Bulgaria
  5. Department of Physical Medicine and Rehabilitation, Military Medical Academy, Sofia, Bulgaria
  6. Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Bulgaria, Department of Imaging, Allergology & Physiotherapy, Medical University of Plovdiv, Bulgaria

Keywords: Knee Osteoarthritis, Group-based Rehabilitation, Frailty, PASE, Total Knee Arthroplasty


Objectives: Frailty is a geriatric syndrome associated with increased vulnerability of older adults. Knee osteoarthritis (OA) is the most prevalent joint disease and one of the leading causes of disability and poor physical activity (PA) of elderly individuals worldwide. Total knee arthroplasty TKA has been recognized as an effective surgical treatment in end-stage of knee OA. There is a lack of consensus regarding the universally accepted rehabilitation protocol for frail elderly subjects after TKA. Aim: to evaluate the potential benefits in functional ambulation (FA) and PA among frail elderly Bulgarian subjects underwent TKA, a novel group-based rehabilitation protocol was performed from the subjects. Materials and methods: A total of 130 frail elderly Bulgarian TKA recipients (67 women and 63 men aged 72, 69 ± 0.44,) were included. FA was assessed by the six-minute walking distance (6MWD). PA was evaluated by the PASE questionnaire. Participants were evaluated one week before TKA, as well as 3 and 6 months after the group-based rehabilitation. Results: Significant increase in FA was observed at the third and sixth month after the group-based intervention (p< 0.001). PASE score, was increased at the third and sixth month after the group-based intervention (p<0.001, r2=0.74). Conclusions: Our results suggest that the applied group-based intervention led to a significant improvement in FA as well as in PA of frail elderly subjects over the first six months after the group-based intervention.