Early initiation of home-based sensori-motor training improves muscle strength, activation and size in patients after knee replacement: a secondary analysis of a controlled clinical trial

Abstract

Background There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR. Methods A controlled clinical trial was conducted at the Orthopedic University Hospital of Rion, Greece involving allocation concealment to patients. Fifty-two patients electing to undergo TKR were randomised to either early-initiated SMT [experimental] or functional exercise training [control] in a home-based environment. Groups were prescribed equivalent duration of exercise during 12-weeks, 3–5 sessions of ~ 40 min per week of home-based programmes. Muscle strength and activation (peak force [PF]; peak amplitude [Peak Amp.] and root mean square of integrated electromyography [RMS iEMG]), muscular size (including rectus femoris muscle cross-sectional area [CSA RF ]), and knee ROM were assessed on three separate occasions (pre-surgery [0 weeks]; 8 weeks post-surgery; 14 weeks post-surgery). Results Patients undertaking SMT rehabilitation showed significantly greater improvements over the 14 weeks compared to control in outcomes including quadriceps PF (25.1 ± 18.5 N vs 12.4 ± 20.8 N); iPeak Amp. (188 ± 109.5% vs 25 ± 105.8%); CSA RF (252.0 ± 101.0 mm 2 vs 156.7 ± 76.2 mm 2 ), respectively ( p < 0.005); Knee ROM did not offer clinically relevant changes ( p : ns) between groups over time. At 14 weeks post-surgery, the SMT group’s and control group’s performances differed by relative effect sizes (Cohen’s d ) ranging between 0.64 and 1.06. Conclusion A prescribed equivalent time spent in SMT compared to usual practice, delivered within a home-based environment, elicited superior restoration of muscle strength, activation and size in patients following TKR. Trial registration ISRCTN12101643 , December 2017 (retrospective registration). Electronic supplementary material The online version of this article (10.1186/s12891-019-2575-3) contains supplementary material, which is available to authorized users.

Rehabilitation for Total Knee Arthroplasty: A Systematic Review

“…The literature searches yielded 22,361 citations (for all topics addressed in the full report). We found 1016 citations to retrieve for full-text screening (Appendix D, Supplemental Digital Content 1, http://links.lww.com/PHM/B644) of which 53 studies (49 RCTs and 4 NRCSs) reported in 61 articles evaluated the effectiveness of rehabilitation among patients who had undergone TKA 26–86 …”

“…Li et al 50 had no in-person component and compared remote patient education promoting physical activity (by telephone, once a month for 6 mos) to no patient education. Moutzouri et al 61 compared two patient self-guided interventions intended to be performed by patients independently at home (focal sensorimotor exercise training vs. functional exercise training). Several studies had self-guided components in addition to in-person supervised rehabilitation in either or both arms or compared some form of supervised rehabilitation to self-guided rehabilitation in the comparison arm.…”

“…Of the 15 studies 26,[29][30][31]36,38,43,48,55,59,62,66,75,79,81 that reported ROM data from various outcome measures, including active and passive knee ROM for extension and flexion of the knee joint, 13 reported comparable ROM between arms at follow-up measured between 3 and 12 mos after TKA across the various interventions and comparisons. Moutzouri et al 61,62 showed significant improvements in active knee ROM flexion among patients randomized to early self-managed focal sensorimotor exercise training compared with patients randomized to functional exercise training. Li et al 48 found significant differences between groups in extension ROM (but not flexion ROM) among patients randomized to Tai Chi compared with patients randomized to rehabilitation at 3 mos after TKA.…”

“…Heikkilä et al 41 (2017) reported patients randomized to homebased rehabilitation showed increased knee extension (MD = 70, 95% CI = 33 to 108) and knee flexion strength (MD = 30, 95% CI = 17 to 43) compared with patients randomized to usual care (no additional rehabilitation after discharge) at 14 mos after TKA. Moutzouri et al 61,62 reported that patients randomized to early self-managed focal sensorimotor exercise training had improved peak force (N) compared with patients randomized to functional exercise training (MD = 12.1, 95% CI = 3.9 to 20.2). Vuorenmaa et al 81 reported that patients randomized to home exercise had significantly improved isometric knee flexion (but not extension; MD = NR; P = 0.009) compared with patients randomized to control (no additional guidance after baseline measurements).…”

The Effects of 12-Weeks of Sensorimotor Exercise on Pain, Strength, Pelvic Drop, and Dynamic Knee Valgus in Males With Patellofemoral Pain Syndrome

“…The control group received no treatment program and did not use analgesics. SME was selected based on a previous study [24] and all designed movements were extracted from valid studies and sources [24][25][26][27][28]. This treatment protocol included three stages; static, dynamic, and functional.…”