The Effect of Motor Imagery and Motion Observation Training on Pain, Functionality, Balance, and Anxiety After Knee Replacement Surgery: A Randomized Controlled Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 36
- 试验地点
- 1
- 主要终点
- Pain Assessment
研究概览
简要总结
This single-center randomized controlled trial aims to evaluate the effects of motor imagery and action observation training on pain, functionality, balance, and fear of movement in patients after total knee arthroplasty (TKA). The study will be conducted at Simav Doç. Dr. İsmail Karakuyu State Hospital Orthopedics Department with a minimum of 40 participants meeting the inclusion criteria. Participants will be randomly assigned to one of three groups: (1) standard physiotherapy, (2) standard physiotherapy plus motor imagery training, or (3) standard physiotherapy plus action observation training.
All interventions will last six weeks. Standard physiotherapy will include ankle pumping, active-assisted hip and knee flexion, isometric and stretching exercises, cryotherapy, gait, and stair training. The motor imagery group will perform guided imagery sessions using audio recordings describing the physiotherapy exercises and daily activities. The action observation group will observe exercise videos corresponding to the physiotherapy program.
The primary outcomes will include pain, functional level, balance, and kinesiophobia. The study aims to determine whether the addition of mental simulation techniques to standard physiotherapy can enhance postoperative recovery and improve functional outcomes in patients undergoing total knee arthroplasty.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Care Provider, Investigator)
入排标准
- 年龄范围
- 25 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Those diagnosed with degenerative gonarthrosis and who have experienced unilateral TDA
- •Those over 25 years of age
- •Those who have obtained a passing score on the Mini Mental Test (>24)
排除标准
- •Body mass index of 40 kg/m2 or higher,
- •Revision/bilateral TDA,
- •Self-reported sensory, cognitive, neurological or motor impairment that would limit participation in the study; history of psychosis; or concomitant diseases that would negatively affect recovery, such as hemiparesis, peripheral neuropathy, lymphedema or lower extremity amputation.
研究组 & 干预措施
Motor imagery group
In motor imagery training, participants will visualize standard physiotherapy tasks using audio recordings presented as metaphors. Participants will be asked to fully focus on visualizing the movements in a quiet environment. They will also be asked to imagine different activities from daily life, progressing from simple to more challenging. Patients will undergo imagery training with audio recordings of standard physiotherapy exercises for six weeks. The training content will parallel the standard physiotherapy program. Participants in the motor imagery training group will be provided with audio explanations (mp3 files) of the motor imagery session instructions to continue at home. Patients in this group will also watch videos containing nature visuals.
干预措施: Motor imagery training (Other)
Control Group (Traditional Physiotherapy)
Standard physiotherapy exercise routines will include: ankle pumping exercises, passive/active/active assisted hip flexion (straight leg raise), abduction/adduction, passive/active/active assisted hip-knee flexion (starting from 30°-40°), isometric exercises (quadriceps, adductor, gluteal muscles, hamstrings), cryotherapy (3 times a day), and stretching exercises (hamstring, gastro-soleus), along with walker assistance for standing, walking training, and stair training. In addition, participants in this group will be given recordings containing nature sounds and nature videos to listen to and watch after their exercises.
干预措施: Traditional Physiotherapy (Other)
Action observation group
In the action observation group, participants will observe movements by watching videos of standard physiotherapy tasks in addition to standard physiotherapy. The training content will progress in parallel with the standard physiotherapy program. The training content will be prepared by clearly recording frontal or lateral views of all exercises included in the standard physiotherapy curriculum (0-2 week, 2-6 week exercises). Patients in this group will also listen to an audio recording containing relaxing music.
干预措施: Action observation training (Other)
结局指标
主要结局
Pain Assessment
时间窗: after 6 weeks of operation
Pain intensity will be measured using a Visual Analog Scale. It is a 100 mm scale. The patient marks a point on the line between 'no pain' and 'unbearable pain' according to their level of pain during free walking. A higher score means more pain.
Muscle Strength Assessment:
时间窗: after 6 weeks of operation
Muscle strength will be measured using a handheld dynamometer (Lafayette Instrument®) located in the physiotherapy unit, with the knee in a 90° flexion position. The device will be placed on the front surface above the malleoli of the ankle. A maximum isometric contraction in the extension direction will be requested against the device for 5 seconds. Three repetitions of the movement will be performed, and the average will be taken. A 30-second rest break will be given between each contraction. Measurements will be recorded in kilograms. The muscle strength measuring instrument will be obtained from the physiotherapy unit.
Functional Assessment
时间窗: after 6 weeks of operation
The WOMAC will be used for functional assessment. The WOMAC consists of sub-sections for pain, stiffness, and physical function. Higher scores indicate greater pain, stiffness, and worse physical function.
Timed Get Up and Walk (TUG) Test
时间窗: after 6 weeks of operation
This test will be used to assess physical performance. For the test, participants will be asked to get up from a seated position without holding onto the chair's arms, walk 3 meters, return to the chair, and walk back to sit down. The elapsed time will be measured and recorded using a stopwatch. The test will be repeated 3 times, and the average will be taken.
ROM Assessment
时间窗: after 6 weeks of operation
A standard goniometer will be used to assess active ROM. For knee flexion ROM, the fixed arm of the goniometer will be placed parallel to the long axis of the femur. The movable arm will be placed parallel to the long axis of the fibula. The participant will be asked to flex their knee without breaking contact between their foot and the bed. Extension angle will be measured using the same procedure after the heel is placed approximately 15 cm high and the participant is asked to perform active knee extension. Flexion and extension measurements will be repeated 3 times, and the averages will be recorded.
Assessment of Kinesiophobia
时间窗: after 6 weeks of operation
he Tampa Kinesiophobia Scale will be used. The Turkish validity and reliability of the TKÖ, a 17-question scale designed to measure fear of movement, was established by Tunca Yılmaz et al. in 2011. A 4-point Likert scale is used (Strongly disagree: 1, Disagree: 2, Agree: 3, Strongly agree: 4). Questions 4, 8, 12, and 16 are reverse Likert scales; the total scale score is calculated as 33. Individuals will receive a total score between 17 and 68. The higher the score on the scale, the higher the fear of movement.
The Standardized Mini Mental Test (SMMT)
时间窗: after 6 weeks of operation
It is a short, efficient, and standardized method that can be preferred for determining an individual's cognitive level. It is divided into five sections: orientation, recording memory, attention and calculation, recall, and language. There are eleven items for individuals to answer. It is evaluated out of a total of 30 points. The Turkish validity and reliability study was conducted by Güngen et al. In the validity and reliability study, the threshold value was determined as 24 points.
Pain Assessment
时间窗: a day before the operation
Pain intensity will be measured using a Visual Analog Scale. It is a 100 mm scale. The patient marks a point on the line between 'no pain' and 'unbearable pain' according to their level of pain during free walking. A higher score means more pain.
Pain Assessment
时间窗: after 2 weeks of operation
Pain intensity will be measured using a Visual Analog Scale. It is a 100 mm scale. The patient marks a point on the line between 'no pain' and 'unbearable pain' according to their level of pain during free walking. A higher score means more pain.
Muscle Strength Assessment:
时间窗: a day before the operation
Muscle strength will be measured using a handheld dynamometer (Lafayette Instrument®) located in the physiotherapy unit, with the knee in a 90° flexion position. The device will be placed on the front surface above the malleoli of the ankle. A maximum isometric contraction in the extension direction will be requested against the device for 5 seconds. Three repetitions of the movement will be performed, and the average will be taken. A 30-second rest break will be given between each contraction. Measurements will be recorded in kilograms. The muscle strength measuring instrument will be obtained from the physiotherapy unit.
Muscle Strength Assessment:
时间窗: after 2 weeks of operation
Muscle strength will be measured using a handheld dynamometer (Lafayette Instrument®) located in the physiotherapy unit, with the knee in a 90° flexion position. The device will be placed on the front surface above the malleoli of the ankle. A maximum isometric contraction in the extension direction will be requested against the device for 5 seconds. Three repetitions of the movement will be performed, and the average will be taken. A 30-second rest break will be given between each contraction. Measurements will be recorded in kilograms. The muscle strength measuring instrument will be obtained from the physiotherapy unit.
Functional Assessment
时间窗: a day before the operation
The WOMAC will be used for functional assessment. The WOMAC consists of sub-sections for pain, stiffness, and physical function. Higher scores indicate greater pain, stiffness, and worse physical function.
Functional Assessment
时间窗: after 2 weeks of operation
The WOMAC will be used for functional assessment. The WOMAC consists of sub-sections for pain, stiffness, and physical function. Higher scores indicate greater pain, stiffness, and worse physical function.
Timed Get Up and Walk (TUG) Test
时间窗: a day before the operation
This test will be used to assess physical performance. For the test, participants will be asked to get up from a seated position without holding onto the chair's arms, walk 3 meters, return to the chair, and walk back to sit down. The elapsed time will be measured and recorded using a stopwatch. The test will be repeated 3 times, and the average will be taken.
Timed Get Up and Walk (TUG) Test
时间窗: after 2 weeks of operation
This test will be used to assess physical performance. For the test, participants will be asked to get up from a seated position without holding onto the chair's arms, walk 3 meters, return to the chair, and walk back to sit down. The elapsed time will be measured and recorded using a stopwatch. The test will be repeated 3 times, and the average will be taken.
ROM Assessment
时间窗: a day before the operation
A standard goniometer will be used to assess active ROM. For knee flexion ROM, the fixed arm of the goniometer will be placed parallel to the long axis of the femur. The movable arm will be placed parallel to the long axis of the fibula. The participant will be asked to flex their knee without breaking contact between their foot and the bed. Extension angle will be measured using the same procedure after the heel is placed approximately 15 cm high and the participant is asked to perform active knee extension. Flexion and extension measurements will be repeated 3 times, and the averages will be recorded.
ROM Assessment
时间窗: after 2 weeks of operation
A standard goniometer will be used to assess active ROM. For knee flexion ROM, the fixed arm of the goniometer will be placed parallel to the long axis of the femur. The movable arm will be placed parallel to the long axis of the fibula. The participant will be asked to flex their knee without breaking contact between their foot and the bed. Extension angle will be measured using the same procedure after the heel is placed approximately 15 cm high and the participant is asked to perform active knee extension. Flexion and extension measurements will be repeated 3 times, and the averages will be recorded.
Assessment of Kinesiophobia
时间窗: a day before the operation
he Tampa Kinesiophobia Scale will be used. The Turkish validity and reliability of the TKÖ, a 17-question scale designed to measure fear of movement, was established by Tunca Yılmaz et al. in 2011. A 4-point Likert scale is used (Strongly disagree: 1, Disagree: 2, Agree: 3, Strongly agree: 4). Questions 4, 8, 12, and 16 are reverse Likert scales; the total scale score is calculated as 33. Individuals will receive a total score between 17 and 68. The higher the score on the scale, the higher the fear of movement.
Assessment of Kinesiophobia
时间窗: after 2 weeks of operation
he Tampa Kinesiophobia Scale will be used. The Turkish validity and reliability of the TKÖ, a 17-question scale designed to measure fear of movement, was established by Tunca Yılmaz et al. in 2011. A 4-point Likert scale is used (Strongly disagree: 1, Disagree: 2, Agree: 3, Strongly agree: 4). Questions 4, 8, 12, and 16 are reverse Likert scales; the total scale score is calculated as 33. Individuals will receive a total score between 17 and 68. The higher the score on the scale, the higher the fear of movement.
The Standardized Mini Mental Test (SMMT)
时间窗: a day before the operation
It is a short, efficient, and standardized method that can be preferred for determining an individual's cognitive level. It is divided into five sections: orientation, recording memory, attention and calculation, recall, and language. There are eleven items for individuals to answer. It is evaluated out of a total of 30 points. The Turkish validity and reliability study was conducted by Güngen et al. In the validity and reliability study, the threshold value was determined as 24 points.
The Standardized Mini Mental Test (SMMT)
时间窗: after 2 weeks of operation
It is a short, efficient, and standardized method that can be preferred for determining an individual's cognitive level. It is divided into five sections: orientation, recording memory, attention and calculation, recall, and language. There are eleven items for individuals to answer. It is evaluated out of a total of 30 points. The Turkish validity and reliability study was conducted by Güngen et al. In the validity and reliability study, the threshold value was determined as 24 points.
次要结局
未报告次要终点