What is the effect of sensori-motor training on functional outcome and balance performance of patients' undergoing TKR? A systematic review.

OBJECTIVES Total knee replacement (TKR) has a beneficial effect on patients' functional ability; however, incidence of falls and deficits on proprioception are not restored even 1-year after surgery. Early and intensive exercise post-TKR has received limited endorsement in the literature. The aim of this review was to systemically identify and critically appraise clinical studies investigating the effect of sensori-motor training on functional and balance performance in TKR patients. DATA SOURCES The electronic databases Cochrane Library, MEDLINE, EMBASE, CINAHL, PEDro and the register of current controlled trials were searched up to September 2014. REVIEW METHODS Two independent reviewers used predefined inclusion and exclusion criteria to identify all eligible articles. Eligible articles were summarized and critically reviewed, using the PEDro scale. RESULTS Two hundred and seventy six articles were screened, six were included. The studies, presented the results of 409 patients (269 intervention, 140 control). A range of rehabilitation protocols were defined by components of proprioception, postural control, balance perturbation and coordination. All studies supported the use of sensori-motor training as an additional element in patients' rehabilitation protocols. Clinical performance-based tests (more than relevant patient-reported measures) showed that functional ability and balance were improved compared to controls. The robustness of evidence was compromised because most of the studies were underpowered. CONCLUSIONS Limited robust (Ia) evidence supports the equal effectiveness of functional rehabilitation program as a functional rehabilitation enhanced with sensori-motor elements in patients post-TKR. However, dose-response parameters of exercise eliciting improvement warrant further investigation.