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| 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 |
| Moutzouri M, Coutts F, Gliatis J, Billis E, Tsepis E, Gleeson N |
| BMC Musculoskeletal Disorders 2019 May 17;20(231):Epub |
| clinical trial |
| 7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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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 (ie, 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 to 5 sessions of approximately 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). 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 versus 12.4 +/- 20.8 N); iPeak Amp. (188 +/- 109.5% versus 25 +/- 105.8%); CSARF (252.0 +/- 101.0 mm2 versus 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. 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).
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