Effects of motor imagery on strength, range of motion, physical function, and pain intensity in patients with total knee arthroplasty: A systematic review and meta-analysis

Abstract Background In the early stages of total knee arthroplasty (TKA) rehabilitation, in which physical function in general can be affected, motor imagery (MI) might play a relevant role. Objective To assess the impact of MI on strength, active range of motion (ROM), pain intensity, and physical function in patients with TKA. Methods We conducted a systematic review and meta-analysis of randomised controlled trials. Pooled effects were calculated as standardised mean differences (SMDs) and 95% confidence intervals (CIs) for the relevant outcomes using random effects model. The certainty of evidence was assessed with GRADE approach. Results This review included 7 articles. The addition of MI to standard therapy, based on low quality of evidence, showed a moderate increase in quadriceps strength (4 studies; SMD: 0.88; 95% CI: 0.42, 1.34) and a small reduction in pain intensity (SMD: 0.63; 95% CI: 0.08, 1.19). It is unclear whether MI can provide beneficial effects for active ROM and function. Conclusions There is low to very low-quality evidence that adding an MI intervention to standard rehabilitation for patients with TKA may improve quadriceps strength and pain intensity, but the effects of MI on ROM and physical function is unclear.