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Mental simulation practice has beneficial effects on patients' physical function following lower limb arthroplasty: a systematic review and meta-analysis [with consumer summary]
Paravlic AH, Tod D, Milanovic Z
Archives of Physical Medicine and Rehabilitation 2020 Aug;101(8):1447-1461
systematic review

OBJECTIVE: To determine the effectiveness of mental simulation practice (MSP) on measures of physical function recovery in patients who have undergone a joint replacement surgery of lower limbs. DATA SOURCES: A systematic review was conducted using CINAHL, PubMed/Medline, Embase, SPORT Discus, PEDro, Cochrane Register of Controlled Trials and Google Scholar from earliest record to 16th August 2019. STUDY SELECTIONS: The following inclusion criteria were used to determine eligibility for studies: (1) randomised and matched controlled trials recruiting male and female adults who underwent primary unilateral joint arthroplasty; (2) the study examined effects of MSP intervention on measures of physical function recovery (both performance-based and patient self-reported); (3) measures of interest were compared between MSP and control groups. A total of eight papers (seven studies) met the inclusion criteria and were included. DATA EXTRACTION: Data were extracted by one reviewer and checked by a second reviewer, independently. DATA SYNTHESIS: When compared to standard physical therapy (SPT), MSP showed an effect on physical function in general (effect size (ES) 0.67, 95% CI 0.38 to 0.96, n = 7), maximal voluntary strength of knee extensor muscles of the affected leg (ES 1.41, 95% CI 0.64 to 2.18, n = 2), brisk walking speed (ES 1.20, 95% CI 0.58 to 1.83, n = 2), brisk walking speed with dual task (ES 1.02, 95% CI 0.41 to 1.63, n = 2), timed up-to go test (ES 0.96, 95% CI 0.15 to 1.77, n = 3) and active flexion of the affected leg (ES 0.70, 95% CI 0.29 to 1.11, n = 4). Finally, meta-regression analysis revealed that effects of MSP were significantly predicted only by total number of training sessions per study. CONCLUSIONS: The present meta-analysis demonstrated that MSP intervention has multiple positive effects on measures of physical function recovery in patients who have undergone total knee or hip replacement surgery in comparison with SPT. Thus, MSP can be applied as an effective complementary therapy to SPT in physical rehabilitation of this specific population, especially in the early post-acute and acute phase.

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