Aug 15, 2025
Mental practice to increase functional recovery after knee replacement: a systematic review
- Andrea Giacovazzo1,
- Marco Pietro Parente2,
- Luca Turone3,
- Riccardo Rosa1,
- Daniela Platano1,4,
- Lisa Berti1,4
- 1Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;
- 2Center for Mind/Brain Sciences-CiMeC, University of Trento, Rovereto, Italy;
- 3Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy;
- 4Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
Protocol Citation: Andrea Giacovazzo, Marco Pietro Parente, Luca Turone, Riccardo Rosa, Daniela Platano, Lisa Berti 2025. Mental practice to increase functional recovery after knee replacement: a systematic review. protocols.io https://dx.doi.org/10.17504/protocols.io.j8nlkyoe6g5r/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: August 14, 2025
Last Modified: August 15, 2025
Protocol Integer ID: 224701
Keywords: Total Knee Replacement, knee arthroplasty, rehabilitation, mental practice, Systematic review, functional recovery, rehabilitation following total knee replacement, systematic review people with knee replacement, physiotherapy, motor training, functional tests knee replacement, functional recovery after knee replacement, rehabilitation after tka, systematic review total knee arthroplasty, knee motor function, conventional rehabilitation program, rehabilitation, mental practice training, knee replacement, effect of mental practice, functional recovery, mental practice, standard physiotherapy, stage knee oa, relative to standard physiotherapy, recovery, functional outcome, complementary therapeutic strategy, several disability
Abstract
Total Knee Arthroplasty (TKA) is considered the gold standard for the treatment of end-stage knee OA (1). Rehabilitation after TKA is essential to allow patients to return to work and leisure activities but several disabilities remain after the conventional rehabilitation program in a large number of patients. Complementary therapeutic strategies to improve functional outcome are needed. Preliminary studies (2,3) suggested that mental practice training could increase recovery. For this reason, we aim to conduct a systematic review to compare the effect of mental practice relative to standard physiotherapy on knee motor function.
Guidelines
Inclusion Criteria
Inclusion criteria were defined using the PICO framework. We consider only Randomized Control Trial that combine mental stimulation strategies and conventional physiotherapy compared to conventional physiotherapy alone in the post-surgical management of knee replacement. We will assess efficacy on knee motor function.
Information sources and search strategy
We will search MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science.
Study records management, selection and data collection
We will use Zotero software (5) to manage citations retrieved through the electronic searches. Two independent reviewers will determine studies eligible for the inclusion; any discrepancies will be resolved by discussion or with the consultation of a third reviewer. The same two reviewers will extract general characteristics (publication date, study design, description of the intervention and comparator, sample size) and specific information (training characteristics, outcome measures and study results) of included studies on a standardized extraction form.
Risk of bias assessment
Two reviewers will independently assess the risk of bias of included studies using the version two of the Cochrane Collaboration’s tool for assessing risk of bias (RoB-2) (6). Discrepancies will be resolved by discussion or with the consultation of a third reviewer.
Data synthesis
We plan to combine data in meta-analyses. We will express the overall estimation of mental practice training effect as mean difference (MD) with 95% confidence interval (CI) when studies use similar scale or as standardized mean difference (SMD) with 95% confidence interval (CI) if studies will use different scales/instruments to assess the same outcome. We will use RevMan 5.4 software.
Troubleshooting
METHODS
Systematic review. Reporting will follow the Preferred Reporting Item of Systematic reviews and Meta-analysis (4).
Inclusion Criteria
Inclusion criteria were defined using the PICO framework. We consider only Randomized Control Trial that combine mental stimulation strategies and conventional physiotherapy compared to conventional physiotherapy alone in the post-surgical management of knee replacement. We will assess efficacy on knee pain and motor function.
Information sources and search strategy
We will search MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science.
Study records management, selection and data collection
We will use Zotero software (5) to manage citations retrieved through the electronic searches. Two independent reviewers will determine studies eligible for the inclusion; any discrepancies will be resolved by discussion or with the consultation of a third reviewer. The same two reviewers will extract general characteristics (publication date, study design, description of the intervention and comparator, sample size) and specific information (training characteristics, outcome measures and study results) of included studies on a standardized extraction form.
Risk of bias assessment
Two reviewers will independently assess the risk of bias of included studies using the version two of the Cochrane Collaboration’s tool for assessing risk of bias (RoB-2) (6). Discrepancies will be resolved by discussion or with the consultation of a third reviewer.
Data synthesis
We plan to combine data in meta-analyses. We will express the overall estimation of mental practice training effect as mean difference (MD) with 95% confidence interval (CI) when studies use similar scale or as standardized mean difference (SMD) with 95% confidence interval (CI) if studies will use different scales/instruments to assess the same outcome. We will use RevMan 5.4 software.
Protocol references
1) Steinhaus ME, Christ AB, Cross MB. Total Knee Arthroplasty for Knee Osteoarthritis: Support for a Foregone Conclusion? HSS J. 2017;13(2):207-210.
2) Ferrer-Peña R, Cuenca-Martínez F, Romero-Palau M, Flores-Román LM, Arce-Vázquez P, Varangot-Reille C, Suso-Martí L. 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. Braz J Phys Ther. 2021 Nov-Dec;25(6):698-708.
3) Li R., Du, J., Yang, K. et al. Effectiveness of motor imagery for improving functional performance after total knee arthroplasty: a systematic review with meta-analysis. J Orthop Surg Res 17, 65 (2022).
4) Page M J, McKenzie J E, Bossuyt P M, Boutron I, Hoffmann T C, Mulrow C D et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021; 372:n71.
5) Takats, S., Stillman, D., Cheslack-Postava, F., Bagdonas, M., Jellinek, A., Najdek, T., Petrov, D., Rentka, M., 26 Venčkauskas, A. (2023). Zotero (6.0.26) [Windows 10]. Corporation for Digital Scholarship.
6) Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:4898.