Evaluating the impact of movement representation techniques on recovery outcomes in post-orthopaedic surgery individuals: a systematic review and meta-analysis.

Abstract

Background: Although movement representation techniques has originally been used in neurological rehabilitation, growing researches suggests that it may also introduce advantageous effects to individuals with orthopaedic injuries. This systematic review and meta-analysis aimed to investigate the effects of these techniques on pain, range of motion, muscle strength, functional performance and fear of movement in individuals after orthopaedic surgeries.

Method: Five electronic databases were searched until April 2024. Two reviewers independently conducted study selection and data extraction. Randomized controlled studies containing individuals after limb surgeries were identified. The quality of enrolled studies and the overall certainty of evidence was assessed by scales, respectively. Egger's test and funnel plot were used to assess publication bias. Subgroup analysis was also conducted to explore the source of heterogeneity.

Results: Twenty-one randomized controlled trials involving 659 postsurgical participants were identified. The meta-analysis suggested moderate-quality evidence of a positive effect on pain intensity (SMD=-0.85; 95% CI -1.26, -0.43; p < 0.001). A low quality of evidence pointed toward a positive effect on functional scales (SMD=-0.84, 95% CI -1.27, -0.41, p < 0.001) and range of motion (SMD = 0.8, 95% CI 0.24, 1.35, p = 0.005). The very low quality of evidence suggested a significant effect on the functional test results (SMD=-0.8, 95% CI -1.01, -0.58, p < 0.001). The results remained nonsignificant for muscle strength and fear of movement. Intervention quantity, Disability of Arm, Shoulder, and Hand (DASH) score and intervention content were the sources of heterogeneity for pain intensity, functional scale score and range of motion, respectively.

Conclusion: Compared with conventional rehabilitation, movement representation techniques increase pain relief, functional performance and range of motion. Our results support the use of mental practice techniques in individuals after orthopaedic surgeries, with moderate to very low-quality evidence.

Review registration: This trial was registered on PROSPERO on 10 August, 2024 (CRD42024583380).