Home-based motor imagery intervention improves functional performance following total knee arthroplasty in the short term: a randomized controlled trial

Abstract

Background Motor imagery (MI) is effective in improving motor performance in the healthy asymptomatic adult population. However, its possible effects among older orthopaedic patients are still poorly investigated. Therefore, this study explored whether the addition of motor imagery to routine physical therapy reduces the deterioration of quadriceps muscle strength and voluntary activation (VA) as well as other variables related to motor performance in patients after total knee arthroplasty (TKA). Methods Twenty-six patients scheduled for TKA were randomized to either MI practice combined with routine physical therapy group (MIp) or to a control group receiving physical therapy alone (CON). MIp consisted of maximal voluntary isometric contraction (MViC) task: 15 min/day in the hospital, then 5 times/week in their homes for 4 weeks. MViC and VA of quadriceps muscle, knee flexion and extension range of motion, pain level, along with a Timed Up-and-Go Test (TUG) and self-reported measure of physical function (assessed using the Oxford Knee Score questionnaire [OKS]) were evaluated before (PRE) and 1 month after surgery (POST). Results Significantly better rehabilitation outcomes were evident on the operated leg for the MIp group compared to CON: at POST, the MIp showed lower strength decrease (p = 0.012, η2= 0.237) and unaltered VA, significantly greater than CON (p = 0.014, η2= 0.227). There were no significant differences in knee flexion and extension range of motion and pain level (p > 0.05). Further, MIp patients performed better in TUG (p < 0.001, η2= 0.471) and reported better OKS scores (p = 0.005, η2= 0.280). The non-operated leg showed no significant differences in any outcomes at POST (all p > 0.05). In addition, multiple linear regression analysis showed that failure of voluntary activation explained 47% of the quadriceps muscle strength loss, with no significant difference in perceived level of pain. Conclusion MI practice, when added to physical therapy, improves both objective and subjective measures of patients’ physical function after TKA, and facilitates transfer of MI strength task on functional mobility. Trial registration Retrospectively registered on ClinicalTrials.govNCT03684148

Mental Simulation Practice Has Beneficial Effects on Patients’ Physical Function Following Lower Limb Arthroplasty: A Systematic Review and Meta-analysis

“…973 articles did not meet the inclusion criteria, while 8 articles that met the inclusion criteria were included in the systematic review and meta-analysis. Majority of included studies were designed as randomised controlled studies (n=6) 11,15,16,18,[30][31][32] , whereas only one was a non-randomised controlled study. 17 Two different journal articles 15,30 reported divergent and valuable information from a single study.…”

“…Majority of included studies were designed as randomised controlled studies (n=6) 11,15,16,18,[30][31][32] , whereas only one was a non-randomised controlled study. 17 Two different journal articles 15,30 reported divergent and valuable information from a single study. Thus, data from each article were extracted separately, then presented combined where applicable throughout this review.…”

“…All studies recruited older patients with 65.1 yrs. of age on average, scheduled for joint replacement primarily because of osteoarthritis of the knee (n=5) 15,16,18,30,31 or hip (n=3). 11,17,33 A detailed description of the interventions is presented in Table 1.…”

“…Experimental conditions included SPT + motor imagery practice only (n=4) 15,16,30,33 or SPT + MI in combination with action observation (n=1), 11 SPT + action observation only (n=2) 17,18 or SPT + guided imagery practice only (n=1) 31 . Studies differed in the focus of MSP.…”

Efficacy and safety of a self-developed home-based enhanced knee flexion exercise program compared with standard supervised physiotherapy to improve mobility and quality of life after total knee arthroplasty: a randomized control study

“…According to our experience, some patients in home-based exercise programs usually exhibit poor knee flexion, which influences body function and satisfaction with surgery. Home tele-rehabilitation guidance for patients undergoing TKA has been developed from standardized home-based exercise programs in recent years due to advances in technology [ 9 , 10 ]. However, due to economic conditions and the medical input of local districts, telecare is not widely used.…”