Graded Motor Imagery and Total Knee Arthroplasty

Not Applicable

Recruiting

• Conditions: Total Knee Arthroplasty
• Interventions: Other: Graded Motor Imagery; Other: Standard Rehabilitation

• Registration Number: NCT05138406
• Lead Sponsor: Inonu University

Brief Summary

This study was planned to investigate the long-term effectiveness of the early application of graded motor imagery therapy on pain parameters, functional performance, motor imagery skill, and kinesiophobia in individuals who underwent total knee arthroplasty surgery after knee osteoarthritis.

Detailed Description

Participants aged 45-80 who are scheduled for total knee arthroplasty surgery after knee osteoarthritis will be included. Participants will be selected from the relevant population using a nonprobability random sampling method. Participants who agree to participate in the study and meet the inclusion criteria will be assigned to one of the groups (conventional rehabilitation-only or conventional rehabilitation with graded motor imagery) using the closed envelope method. Evaluations will be made one day before surgery, 6 weeks and 6 months after surgery for each group. Pain Visual Analog Scale; pressure pain threshold algometer; central sensitization Central Sensitization Inventory; the joint range of motion goniometer; muscle strength handheld dynamometer; kinesiophobia Tampa Kinesiophobia Scale; functional mobility and mental stopwatch Timed get up and go test; choice task Recognise™ application; motor imagery skill Movement Imagery Questionnaire-3; functional assessment Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); The catastrophic degree of pain is planned to be evaluated with the Pain Catastrophizing Scale.

Study Timeline

• Study First Submitted: 2021-10-28
• Study First Submitted QC: 2021-11-17
• Study First Posted: 2021-12-01
• Study Start: 2022-02-28
• Status Verified: 2022-11
• Last Update Submitted: 2022-11-10
• Last Update Posted: 2022-11-14
• Primary Completion: 2023-04-01
• Study Completion: 2023-06-01

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 18

Inclusion Criteria

• Diagnosed with knee osteoarthritis and being on the waiting list to receive unilateral total knee arthroplasty
• Approved by the orthopedist for early physiotherapy treatment after total knee arthroplasty

Exclusion Criteria

• • Individuals undergoing revision total knee arthroplasty or undergoing bilateral total knee arthroplasty,
• Contralateral knee osteoarthritis (defined by activity greater than 4/10 pain)
• Having undergone any physical therapy intervention or other surgery in the last 6 months
• Any neurological, cardiac, pulmonary or psychiatric disease (eg, uncontrolled diabetes mellitus, neoplasms, uncontrolled blood pressure, neurological conditions) before or after surgery;
• Fracture, infection in the acute postoperative phase or presence of fever
• Cognitive impairments that alter the probability of correct understanding of the motor imagery program
• Body mass index > 35 kg / m2
• Difficulties with understanding or communication
• Insufficient knowledge of Turkish to follow the study instructions.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Graded Motor Imagery	Standard Rehabilitation	Individuals will receive standard rehabilitation and graded motor imagery treatment.
Graded Motor Imagery	Graded Motor Imagery	Individuals will receive standard rehabilitation and graded motor imagery treatment.
Standard Rehabilitation Group	Standard Rehabilitation	Standard rehabilitation will be applied.

Primary Outcome Measures

Name	Time	Method
Pain intensity	6 months after surgery	Pain at rest and during activity will be evaluated with the help of the Visual Analogue Scale (VAS). The VAS is a 10 cm scale that rates 0 points as "no pain" and 10 points as "worst pain imaginable".
WOMAC	6 months after surgery	Functional status will be assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). It consists of three subgroups as pain (5 items), stiffness (2 items) and physical function (17 items) and a total of 24 items. Each item has an evaluation score of 0 = none, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe.

Secondary Outcome Measures

Name	Time	Method
Pressure pain threshold	6 months after surgery	A pressure algometer (digital algometer) will be used. It will be evaluated at four test sites at the knee (medial and lateral edge of the patella, lateral and medial femoral condyles) and one distal painless zone at the wrist extensors (5 cm distal to the lateral epicondyle).; It will be pressed with increasing pressure and the individual will be asked to say "yes" as soon as the participant feels pain or discomfort. Three attempts will be made at each point with a 30-second rest and the averages recorded.
Central sensitization	6 months after surgery	It will be evaluated with the Central Sensitization Inventory. It consists of 2 parts, part A, which evaluates the symptoms thought to be associated with central sensitization syndromes, and part B, which quickly questions whether the patient has received a specific diagnosis before. In part A, there are 25 items that question the frequency of symptoms seen in central sensitization syndromes and are scored between 0-100 points. Each symptom is defined as "never" (0 points) if the patient never experiences that symptom, "rarely" (1 point) if rarely, "sometimes" if sometimes (2 points), "frequently" (3 points) if often It is recorded as "always" (4 points). As the patient's central sensitization inventory score increases, it is thought that he has more symptoms related to central sensitization. In part B, it is questioned whether the patient has ever been diagnosed with any of the diseases included in the central sensitization syndromes by any physician.
Joint Range of Motion	6 months after surgery	Active knee flexion and extension angle will be evaluated.
Quadriceps muscle strength	6 months after surgery	It will be measured during maximum voluntary isometric contraction using a hand-held muscle tester. After a warm-up test attempt, participants will be asked to extend their knees with maximum force against the device for five seconds. Two trials separated by a rest period of 120 seconds will be performed and averaged.
Kinesiophobia	6 months after surgery	The Tampa Kinesiophobia Scale will be used. A 4-point Likert score (1=I totally disagree, 2=Agree, 3=Disagree, 4=Totally agree) is used for each question in the scale. As a result of the survey, the person gets a total score between 17-68. A high score on the scale indicates a high level of kinesiophobia.
Functional mobility	6 months after surgery	The Timed Up and Go test will be used. While the patient is sitting in a chair; will be asked to get up from the chair, walk 3 meters as fast as possible, turn around and sit back in the chair. The time elapsed while the patient performs the test will be recorded.
Mental chronometry delta time	6 months after surgery	Timed Get Up and Go test will be used. It compares the time between the actual movement time and the imagined similar task time. At the end of the tests, mental chronometer measurements are calculated in terms of delta time with the formula '(real movement-imagined movement)/\[(real movement+imagined movement)/2\]x100'.
Laterality task	6 months after surgery	Right-left discrimination will be evaluated using the Recognise™ application. The percentage of correct answers and reaction time will be recorded.
Movement Imagery Questionnaire-3 (MIQ-3)	6 months after surgery	It is a questionnaire that evaluates the imagery of four movements consisting of knee bending, jumping, arm movement and bending. It consists of three subscales and a total of 12 items evaluating external visual imagery, internal visual imagery, and kinesthetic imagery. Before starting the questionnaire, participants are given definitions of external visual imagery, internal visual imagery, and kinesthetic imagery. Before scoring each movement, the person is asked to perform the movement, then the movement is visualized three times. It is scored on a scale from 1 to 7. 1 point means "very difficult to see/feel", while 7 points means "very easy to see/feel".
Pain Catastrophizing Scale	6 months after surgery	There are 13 states on the scale that describe different feelings and thoughts that may be associated with pain. Participants in each of these situations; 0: None, 1: Mildly, 2: Moderately, 3: Mostly, 4: Always. The total score is between 0-52; It is obtained by summing all 13 items.

Trial Locations

Locations (1)

Inonu Unıversity; 🇹🇷 Malatya, Turkey