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Table 2 Study intervention description based on the TIDieR checklist

From: Home-based motor imagery intervention improves functional performance following total knee arthroplasty in the short term: a randomized controlled trial

Item

 

Experimental group

Control group

1

Brief name

Motor imagery practice (MIp) + routine physical therapy (RPT)

RPT (usual care) alone

2

Why

Both interventions were compared directly in OA patients submitted to TKA with following reasons:

1) TKA patients are unable to undertake conventional strength training in the early period following surgery, whereas quadriceps strength is a major determinant of general physical function following TKA.

2) MIp does not elicit pain or any side effects during practice, nor does it require any additional fees and special condition, except a quiet space where the trainee/patient can relax and train.

3) It is assumed that strength decrease following TKA is largely influenced by plasticity in neural drive (central level), rather than peripheral level. Thus, including MIp in addition to RPT may have a positive effect on maximal voluntary activation level (a proxy of the central neural drive).

4) When added to RPT, MIp might have favourable effects on both task-specific (near transfer) and general physical function (far transfer), which remains unclear in TKA population.

5) If so, MIp might be a suitable adjunct tool to RPT intended to improve rehabilitation of TKA patients, without additional costs for patients and the health care system.

3

What: materials

No restriction was placed on materials used (for example: bed, chair, pillow, crutches, steppers, stairs), while the use of additional mechanical (for example: continuous passive motion—only allowed during hospitalization) or electrical therapy devices (for example: neuromuscular stimulation) was avoided.

Hospitalization: patients had one-to-one therapy (MIp) in sitting position (based on the current patient’s physical state). The therapist guided the patient throughout the practice protocol.

After hospital discharge (at home): MIp practice was delivered by audio mp3 file.

Hospitalization: the patients engaged in conversation with the therapist about their health status, rehabilitation progression based on predefined goals.

After hospital discharge (at home): none in particular, the patients were called by phone (3× per week, on consecutive days) and asked about their subjective health status, treatment adherence and rehabilitation progress.

4

What: procedures

During hospitalization, all the enrolled patients underwent the same functional exercise-based rehabilitation programme aimed to improve knee range of motion, increase knee and hip muscle strength, stretch the posterior and anterior aspect of the thigh muscles, prevent thrombosis, and help acquire the most important functional strategies for activities of daily living. First, the subjects received one daily continuous passive motion (CPM) session (Kinetec Performa), beginning on the second day after TKA (after recovery unit) until discharge (4 to 8 days). The CPM session lasted 45 min, including a 5-min warm-up period. Further, the exercise programme consisted of 60 min of one-to-one therapy: 5–10 min warm-up and cool-down periods including passive and active stretching of lower limb muscle groups; knee flexion (heel sledge in bed); plantar flexion of ankles (supine); hip abduction and adduction (supine); supine straight leg raises (for the operated leg—the patients used the help of contralateral leg); walking with aids, sit-to-stand from chairs of various heights (exercises adopted based on injured knee flexion and pain level); standing calf raises; standing hip flexion and extension; walking up and down the stairs (using crutches and/or handrail), arm raises, and shoulder range of motion.

MIp additionally performed a mental simulation of maximal isometric contraction only. Patients were instructed to sit on a chair and to imagine the operated leg flexed at 60° at the knee joint while listening to the therapist or to an audio tape with detailed practice instructions.

 

5

Who provides

During the hospitalization period, the exercise programme was provided by experienced physical therapist blinded for patients’ intervention allocation.

Home-based intervention was conducted by patients themselves.

6

How

Both interventions were conducted individually in one-to-one sessions (during the hospitalization period), whereas following hospital discharge the patients trained alone.

7

Where

Both interventions took place in the hospital (orthopaedic ward programme) and at patients’ homes.

8

When and how much

The programme began on the second post-surgery day and lasted 4 weeks in total. The first part of the programme was performed during the hospitalization period (6 days on average), whereas after the hospital discharge the patients continued with the allocated intervention at their homes.

All patients, regardless of their allocation to groups, performed an RPT programme 5 times a week, 2 times per day (lasting 45 to 60 min per session). Each exercise was planned in a progressive manner, meaning:

-Strength exercises: starting with two sets and 10 repetitions per week—then adding 2 repetitions in the second and 3 and 5 more repetitions in the third week and fourth week, respectively;

-Stretching exercises: starting with 3 repetitions and 15-s holds per week—then adding 5 more seconds each week;

-Walking exercise: trying to walk for 10 min on level ground—then adding 5 min every week.

  

MIp was planned in a progressive manner.

It was performed in two sets of 25 repetitions with 2 min of inter-set rest period, for two weeks, with 10 repetitions added in weeks 3 and 4, respectively. Each MViC repetition was sustained for 5 s and followed by a 5-s inter-repetition rest period. Additionally, after every fifth contraction, participants had 20 s of rest to minimize mental fatigue. Following 5 days of MI practice, the participants were advised to take a break from MI for two consecutive days.

 

9

Tailoring

The exercise programme content was tailored to each patient’s preferences based on their self-perceived level of pain and current function (mainly knee flexion movement).

10

Modifications

No modification occurred during the study.

11

How well

Regardless of group assignment, participants were called by principal investigator on a weekly basis and monitored for adherence to the prescribed treatment for both RPT and MIp sessions.

12

The adherence to the prescribed MI post-rehabilitation was as high as 98%.

The adherence to RPT was high, 98% and 96% for MIp and CON group, respectively.