Jade Clawson

RMTS Presentation Handout

October 2, 2019

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

OBJECTIVES
 Purpose of the Article
 Why this article is relevant to RMTS
 List the article's strengths, weaknesses, and reliability
 Discuss relevant and important information from the article
 Discuss how we can apply this research to improve patient care
 Reference information

PURPOSE
Use outcomes such as muscular strength, activation, and size to compare the effects of an early initiated home-
based rehabilitative sensorimotor training program with functional exercise training (the control) in post-op TKA
patients ages 65-80 years old. a

RELEVENCE TO RMTS
 Baby boomers are the fastest growing age group in the United States. b
 Currently 14.5% of the nation's population is age 65+. b
 By year 2029, the national population of those age 65+ will be approximately 20%. b
 In 2010, “prevalence of TKAs were higher among women than among men and increased with age,
reaching 10.38% for total knee replacement at eighty years.” c

STRENGTHS
 Statically significant results in all aspects
 Enough participants
 Educated inclusion and exclusion criteria
 Ethically approved
 “Every effort was made to preclude bias”
 Same surgeon performed the TKAs
WEAKNESSES
 Parent article is unavailable
 Doesn’t list all the therapeutic activities and
exercises in the article
 This article is only one of two research
articles that have studied this exact topic

RELIABILITY
 All patients provided written informed consent
 The study was ethically approved by two Institutional Committees
 All participants underwent a standardized post-surgery care-protocol involving bedside physiotherapy and
gait-retraining up to hospital discharge (4-5 days post TKA) with hospital PTs
 Experimental and control groups were prescribed identical procedures, number of exercises, and total
program duration.
 Statistical significance was accepted at p<0.05. a
EXPREIMENTAL VS. CONTROL GROUP
 EXPERIMENTAL: The SMT exercises included agility and perturbation training techniques that did not
require any specialized equipment. Exercise challenges and progression were achieved by using pillows
instead of foam pads, plastic cups for obstacles, and different strategies such as DL balance vs. SL balance,
and EO vs. EC balance activities. d

 CONTROL: The control group performed basic strengthening and stretching techniques such as Isometric
and AAROM exercise, heel slides, quad sets, ankle pumps, bike, knee extension stretch, SLR, SAQ, side-
lying hip abduction, wall slides, step ups, etc. d

RESULTS AND CONCLUSION

 Outcome data was collected at 0 weeks (pre-surgery), 8 weeks post-surgery, and 14 weeks post-surgery.
 Patients’ compliance to exercise showed a 10% difference in favor of the SMT group.
 The SMT group yielded superior gains in muscle strength, activation, and size (P<0.001), in quadriceps
muscle strength (p=0.001), in normalized peak amplitude (P<0.001), and in cross sectional area of the
rectus femoris in a relaxed and contracted state.
 The only area where the two groups showed similar improvement over the 14 week period was in ROM.
 The experimental group has superior gains in knee flexion, but they exhibited approximately the same
amount of improvement when comparing knee extension. The control group gained an average of 2°
more in knee extension (P<0.005).

 A prescribed equivalent volume of 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 a TKR. a

SMT Vs. Strengthening and Stretching Results

300
258.4 252
250 223.5
188.1
200
156.7
141.9
150
107.3103.7
100 81.2

50 26.3 27.7
13.6
-0.2 1.6
0
Peak Amplitude Performance Knee Extension ROM Flexion ROM Extension Cross Sectional Cross Sectional
-50
Capability EMG Peak Force Area of Rectus Area of Rectus
(iRMS) Femoris Relaxation Femoris
Contraction

Experimental Control

REFERENCE INFORMATION:
a. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525469/pdf/12891_2019_Article_2575.pdf
b. https://www.jmu.edu/socwork/documents/Quick%20Facts%20State%20of%20the%20Older%20Adult.pdf
c. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4551172/pdf/jbjsam.n01141.pdf
d. https://www.jospt.org/doi/10.2519/jospt.2005.35.7.424