Sensorimotor training prior total knee arthroplasty and effects on functional outcome: A systematic review and meta-analysis |
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| Institution: | 1. Group in Physiotherapy of the Ageing Processes: Social and Healthcare Strategies, Department of Physiotherapy, Universitat de València, Spain;2. IRIMED Joint Research Unit (La Fe – Universitat de València), Spain;3. Department of Physiotherapy, Universitat de València, Spain;4. Group in Physiotherapy, Technology and Research, Department of Physiotherapy, Universitat de València, Spain;5. Hospital Universitari I Politècnic La Fe, Valencia, Spain;1. Department of Anatomy, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria;2. Department of Physiotherapy, Enugu State University Teaching Hospital Park Lane, Enugu, Enugu State, Nigeria;1. Department of Kinesiology and Health, Georgia State University, Atlanta, GA, 30303, United States;2. School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, United States;1. Laboratoire HandiBio – EA 4322, University of Toulon, France;2. AUCTUS, INRIA, University of Bordeaux Sud-Ouest, France;1. Department of Community Medicine & Rehabilitation Physiotherapy, Umeå University, Umeå, Sweden;2. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway;3. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Sweden;1. MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, United States;2. Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, United States |
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| Abstract: | BackgroundAltered muscle activation patterns and proprioception, loss of strength, and weight bearing asymmetries are common limitations after total knee arthroplasty, which can also affect balance. Therefore, preoperative sensorimotor training has been proposed to enhance surgical outcome.Research questionIs preoperative sensorimotor training effective in improving functional outcome in patients undergoing total knee arthroplasty? Does preoperative sensorimotor training affect secondary outcomes such as balance, pain, and quality of life?MethodsA systematic review and meta-analysis were conducted by searching PEDro, MEDLINE, Embase, Cochrane Library, and Scopus databases from inception to May 2020. Studies were eligible if participants underwent total knee arthroplasty after two or more weeks of preoperative sensorimotor training. A meta-analysis compared the effects of such interventions with standard care before and after surgery using standardized mean differences (SMD) with 95 % confidence interval (CI). Functional outcome was the primary measure. Balance, pain, and quality of life were also outcomes of interest.ResultsOf the 384 items identified, 7 met the inclusion criteria, and 332 participants were assessed. There was limited evidence suggesting that preoperative sensorimotor training enhanced self-reported function (SMD, 0.89; 95 % CI, 0.16–1.62), functional performance (SMD, 0.56; 95 % CI, 0.19 to 0.93), or knee function (SMD = 0.22–1.05) compared with conventional care. Moderate quality evidence suggested that benefits were only maintained in terms of functional performance up to 3 months after surgery (SMD = 0.37; 95 % CI, 0.13 to 0.62). The outcome was similar after one year.SignificanceCompared with conventional care, preoperative sensorimotor training may enhance early postoperative functional recovery, with no additional benefits on balance, knee function, or pain. The outcome is the same one year after surgery, regardless of whether such training is implemented. Further investigation is needed to determine whether sensorimotor training may be a feasible conservative treatment for severe knee osteoarthritis. |
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| Keywords: | Knee Arthroplasty Sensorimotor training Preoperative |
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