Comparison of the effects of telerehabilitation and face-to-face spinal stabilisation training on gait biomechanics, balance and joint position sense in transtibial amputees: A randomised controlled, single-blinded study

This study aimed to examine and compare the effects of spinal stabilization training with telerehabilitation, and face-to-face spinal stabilization training on gait, balance, balance confidence, functional mobility, knee and trunk position sense, core muscle function, and endurance in unilateral transtibial amputees at post-treatment and third month. The study included 28 participants, aged 18-65 years. Participants were randomly allocated to either Telerehabilitation or Face-to-Face. The telerehabilitation group received online telerehabilitation spinal stabilization training three times a week for eight weeks, while Face-to-Face group received face-to-face spinal stabilization training during the same period. The gait was evaluated using a gait sensor to ascertain spatio-temporal characteristics, pelvic movements, and asymmetry. The balance was evaluated by the "Four Square Step Test", balance confidence by the "Activities-Specific Balance Confidience Scale", functional mobility by the "Prosthetic Limb Users Survey of Mobility", core muscle function by the "Stabilizer Biofeedback Unit", core muscle endurance by "McGill Endurance Tests", and position sense by a digital inclinometer. All assessments were conducted on three occasions by an assessor who was not aware of the groups. No significant group*time interaction between the groups was found for the variables (p>0.05). However, gait speed (p<0.001), cadence (p<0.001), intact side double stride length (p<0.001), amputee side upward pelvic tilt (p=0.003), intact side downward pelvic tilt (p=0.005), Four Square Step Test (p<0.001), core muscle function and endurance (p<0. 001), Activities-Specific Balance Confidience Scale (p<0.001), Prosthetic Limb Users Survey of Mobility (p<0.001), trunk, amputee knee and intact knee joint position sensations (p<0.001; p<0.001; p=0.019) variables improved in all participants over time (p<0.05). Consequently, telerehabilitation and face-to-face spinal stabilization training yielded comparable outcomes following treatment and at the third month and were not superior to each other. Some gait parameters, balance, balance confidence, functional mobility, joint position sense, core muscle function, and endurance were improved with spinal stabilization training. It was observed that the gains in balance, balance confidence, and functional mobility gained with spinal stabilization training were maintained at follow-up. In light of the aforementioned findings, it is proposed that telerehabilitation with spinal stabilisation training may be employed in amputee rehabilitation in instances where face-to-face application is not feasible.