Abstract
BackgroundThere 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.MethodsA 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 [CSARF]), and knee ROM were assessed on three separate occasions (pre-surgery [0 weeks]; 8 weeks post-surgery; 14 weeks post-surgery).ResultsPatients 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%); CSARF (252.0 ± 101.0 mm2 vs 156.7 ± 76.2 mm2), 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.ConclusionA 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 registrationISRCTN12101643, December 2017 (retrospective registration).
Highlights
There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR)
The pattern of enhanced gains in neuromuscular capacity associated with SMT within this study mimicked those noted previously for functional (TUG) and SM performance [22]
It is physiologically plausible that given the prominent strength response to doses of focal SM training stimuli, the latter may have characteristics which are capable of physiologically potentiating the recovery of strength capacity
Summary
There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). 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. Within Europe, more than 0.1% of national populations elect to undergo total knee replacements (TKR) annually [1,2,3] with 20–30% of patients dissatisfied with the outcome at the end of the pathway of care [4]. Functional rehabilitative training has conventionally incorporated muscle strengthening stimuli within functional weight-bearing exercises [13,14,15,16], but has not been capable of counteracting the post-surgery deficits in strength and disordered movement patterns [15,16,17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
