Effectiveness of mental simulation practices after total knee arthroplasty in patients with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Explicit Motor Imaging Abilities Are Similar in Complex Regional Pain Syndrome, Chronic Limb Pain and Healthy Individuals: A Cross-Sectional Study

Background

Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by peripheral, central sensory and motor dysfunction. Implicit motor imagery is known to be impaired in CRPS patients, but evidence for explicit motor imagery is still lacking. Using a self-rated questionnaire, this study aims to compare explicit motor imagery abilities between individuals with CRPS, with chronic limb pain (CLP), and healthy controls, and to also examine differences between affected and unaffected limbs. We hypothesize that both CRPS and CLP patients will show a decrease in motor imagery abilities compared to healthy controls and in their affected limb compared to their own contralateral, unaffected side.

Patients and Methods

In this single-center observational study, 123 participants were recruited (CRPS = 40, chronic limb pain, CLP = 40, and healthy individuals = 43). Participants completed the Movement Imagery Questionnaire-Revised Second (MIQ-RS) once for each side of the body. The total MIQ-RS score, and the kinesthetic and visual subscores were compared between groups and between the affected and unaffected sides.

Results

A high degree of heterogeneity was observed in the explicit motor imagery scores and subscores, regardless of whether the participants were healthy or individuals with chronic pain. The MIQ-RS did not reveal any significant differences in explicit motor imagery abilities, neither between groups nor between the affected and unaffected side. Bayesian testing of the null hypothesis for kinesthetic motor imagery abilities indicated a sevenfold likelihood of no differences between groups and a more than a fivefold likelihood of no differences between sides.

Conclusion

Individuals with CRPS and chronic limb pain displayed preserved explicit motor imagery abilities, notably on the pain side. The preservation of these abilities supports the recommendation of mental imagery therapy to improve motor function and relieve pain in chronic pain patients.

Evaluating the impact of movement representation techniques on recovery outcomes in post-orthopaedic surgery individuals: a systematic review and meta-analysis

BACKGROUND

Although movement representation techniques has originally been used in neurological rehabilitation, growing researches suggests that it may also introduce advantageous effects to individuals with orthopaedic injuries. This systematic review and meta-analysis aimed to investigate the effects of these techniques on pain, range of motion, muscle strength, functional performance and fear of movement in individuals after orthopaedic surgeries.

METHOD

Five electronic databases were searched until April 2024. Two reviewers independently conducted study selection and data extraction. Randomized controlled studies containing individuals after limb surgeries were identified. The quality of enrolled studies and the overall certainty of evidence was assessed by scales, respectively. Egger's test and funnel plot were used to assess publication bias. Subgroup analysis was also conducted to explore the source of heterogeneity.

RESULTS

Twenty-one randomized controlled trials involving 659 postsurgical participants were identified. The meta-analysis suggested moderate-quality evidence of a positive effect on pain intensity (SMD=-0.85; 95% CI -1.26, -0.43; p < 0.001). A low quality of evidence pointed toward a positive effect on functional scales (SMD=-0.84, 95% CI -1.27, -0.41, p < 0.001) and range of motion (SMD = 0.8, 95% CI 0.24, 1.35, p = 0.005). The very low quality of evidence suggested a significant effect on the functional test results (SMD=-0.8, 95% CI -1.01, -0.58, p < 0.001). The results remained nonsignificant for muscle strength and fear of movement. Intervention quantity, Disability of Arm, Shoulder, and Hand (DASH) score and intervention content were the sources of heterogeneity for pain intensity, functional scale score and range of motion, respectively.

CONCLUSION

Compared with conventional rehabilitation, movement representation techniques increase pain relief, functional performance and range of motion. Our results support the use of mental practice techniques in individuals after orthopaedic surgeries, with moderate to very low-quality evidence.

REVIEW REGISTRATION

This trial was registered on PROSPERO on 10 August, 2024 (CRD42024583380).

Approach to Knee Arthropathy through 180-Degree Immersive VR Movement Visualization in Adult Patients with Severe Hemophilia: A Pilot Study

(1) Background: Hemarthrosis is a typical clinical manifestation in patients with hemophilia. Its recurrence causes hemophilic arthropathy, characterized by chronic joint pain. Watching movement recorded from a first-person perspective and immersively can be effective in the management of chronic pain. The objective of this study was to evaluate the effectiveness of an immersive virtual reality intervention in improving the pain intensity, joint condition, muscle strength and range of motion in patients with hemophilic knee arthropathy. (2) Methods: Thirteen patients with hemophilic knee arthropathy were recruited. The patients wore virtual reality glasses and watched a flexion-extension movement of the knee on an immersive 180° video, recorded from a first-person perspective over a 28-day period. The primary variable was the pain intensity (visual analog scale). The secondary variables were the joint status (Hemophilia Joint Health Score), quadriceps and hamstring strength (dynamometry), and range of motion (goniometry). (3) Results: After the intervention period, statistically significant differences were observed in the intensity of the joint pain (Standard error [SE] = 19.31; 95% interval confidence [95%CI] = -1.05; -0.26), joint condition (SE = 18.68; 95%CI = -1.16; -0.52) and quadriceps strength (SE = 35.00; 95%CI = 2.53; 17.47). We found that 38.46% and 23.07% of the patients exhibited an improvement in their quadriceps muscle strength and joint condition above the minimum detectable change for both variables (8.21% and 1.79%, respectively). (4) Conclusions: One hundred and eighty degree immersive VR motion visualization can improve the intensity of joint pain in patients with hemophilic knee arthropathy. An intervention using immersive virtual reality can be an effective complementary approach to improve the joint condition and quadriceps strength in these patients.

Action Observation and Motor Imagery administered the day before surgery enhance functional recovery in patients after total hip arthroplasty: A randomized controlled trial

OBJECTIVE

To investigate the effects of Action Observation and Motor Imagery administered the day before surgery on functional recovery in patients after total hip arthroplasty.

DESIGN

Randomised controlled trial.

SETTING

Humanitas Clinical and Research Center, Milan, Italy.

PARTICIPANTS

Eighty inpatients with end-stage hip osteoarthritis undergoing total hip arthroplasty.

INTERVENTIONS

All patients followed a standardized postoperative rehabilitation program. Experimental group (AO + MI) performed two 12-minute Action Observation and Motor Imagery sessions on the preoperative day, whereas control group underwent usual care consisting of education without any additional preoperative activity.

OUTCOME MEASURES

A blinded physiotherapist assessed participants for functional mobility (Timed Up and Go - TUG) (primary outcome), maximum walking speed (10-Meter Walk Test - 10MWT), pain (Numeric Pain Rating Scale - NPRS) and fear of movement (Tampa Scale of Kinesiophobia - TSK) the day before and at four days after surgery.

RESULTS

No between-group differences were found at baseline. Although TUG and 10MWT worsened in both groups (p < 0.001), better TUG was found for AO + MI group at four days (mean difference -5.8 s, 95% confidence interval from -11.3 to -0.3 s, p = 0.039). NPRS (p < 0.001) and TSK (p = 0.036 for AO + MI group, p = 0.003 for control group) improved after surgery without between-group differences.

CONCLUSIONS

Patients undergoing Action Observation and Motor Imagery on the day before surgery showed less functional decline than control group in the first days after total hip arthroplasty. This intervention may contribute to a safer discharge with higher functional abilities in patients hospitalized for total hip arthroplasty.