The effectiveness of mental practice as a complement to traditional therapy in rehabilitation outcomes of patients status-post total knee arthroplasty

Therapists are challenged daily with establishing care plans and structuring functional activities that will best assist their patients to decrease pain, recover motion and strength, and return to functional, high quality lifestyles. All of this must be accomplished in the most cost efficient manner. This research was designed to investigate the effects of mental practice (MP), when used in conjunction with traditional therapy for patients post-knee replacement surgery, on functional recovery and hospital length of stay.

Twenty-three individuals, post-total knee arthroplasty (TKA), meeting inclusion criteria while in a rehabilitation hospital participated in the study. Participants were randomly assigned, with gender matching, to motivational control and MP (experimental) groups. In addition to their regular therapy programs, members of the control group listened to an audio-tape with progressive relaxation while those of the experimental group participated in an audio-taped guided relaxation followed by MP. The participants' knee range of motion (ROM), knee strength, quality of gait via the Tinetti Gait Assessment, and functional ability via the Functional Independence Measure, were assessed pre- and post- intervention. Hospital length of stay was also measured through chart review.

Post-intervention results revealed significant differences between groups, with the experimental group demonstrating greater improvements than controls in ROM, knee flexion strength, gait quality, and functional ability in stair climbing (p < 0.05). Remarkably, the improvements made by the experimental group were made in a significantly shorter hospital length of stay than those of the controls (p < 0.05).

The main hypothesis of the study was supported; Patients with osteoarthritis, status-post TKA, who received a complement of MP with traditional therapy had enhanced rehabilitation outcomes as compared to a control group of patients who received traditional therapy alone. These results are consistent with those found for other non-therapeutic populations (e.g., Blair, Hall & Leyshon, 1993; Hall, Schmidt, Durand & BuckoIz, 1994). Thus, it is recommended that, in this era of healthcare reform and cost containment, MP should be considered as a potential complement to conventional physical therapy.