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Background  Motor imagery (MI) is effective in improving motor performance in the healthy asymptomatic adult population. However, its possible effects among older orthopaedic patients are still poorly investigated. Therefore, this study explored whether the addition of motor imagery to routine physical therapy reduces the deterioration of quadriceps muscle strength and voluntary activation (VA) as well as other variables related to motor performance in patients after total knee arthroplasty (TKA).    Methods  Twenty-six patients scheduled for TKA were randomized to either MI practice combined with routine physical therapy group (MIp) or to a control group receiving physical therapy alone (CON). MIp consisted of maximal voluntary isometric contraction (MViC) task: 15 min/day in the hospital, then 5 times/week in their homes for 4 weeks. MViC and VA of quadriceps muscle, knee flexion and extension range of motion, pain level, along with a Timed Up-and-Go Test (TUG) and self-reported measure of physical function (assessed using the Oxford Knee Score questionnaire [OKS]) were evaluated before (PRE) and 1 month after surgery (POST).    Results  Significantly better rehabilitation outcomes were evident on the operated leg for the MIp group compared to CON: at POST, the MIp showed lower strength decrease ( p  = 0.012,  η   2    =  0.237) and unaltered VA, significantly greater than CON ( p  = 0.014,  η   2    =  0.227). There were no significant differences in knee flexion and extension range of motion and pain level ( p  > 0.05). Further, MIp patients performed better in TUG ( p  < 0.001,  η   2    =  0.471) and reported better OKS scores ( p  = 0.005,  η   2    =  0.280). The non-operated leg showed no significant differences in any outcomes at POST (all  p  > 0.05). In addition, multiple linear regression analysis showed that failure of voluntary activation explained 47% of the quadriceps muscle strength loss, with no significant difference in perceived level of pain.    Conclusion  MI practice, when added to physical therapy, improves both objective and subjective measures of patients’ physical function after TKA, and facilitates transfer of MI strength task on functional mobility.    Trial registration  Retrospectively registered on  ClinicalTrials.gov  NCT03684148

journal of orthopaedic surgery and research

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