title: What is the effect of sensori-motor training on functional outcome and balance performance of patients' undergoing TKR? A systematic review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  The electronic databases Cochrane Library, MEDLINE, EMBASE, CINAHL, PEDro and the register of current controlled trials were searched up to September 2014.
  
  
  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.
authors.affiliation: Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece, Aigion, Greece. Electronic address: moutzouri_marie@yahoo.com.
authors.forename: M
authors.initials: M
authors.lastname: Moutzouri
authors.affiliation: School of Health Sciences Queen Margaret University, UK.
authors.forename: N
authors.initials: N
authors.lastname: Gleeson
authors.affiliation: Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece, Aigion, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Billis
authors.affiliation: Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece, Aigion, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Panoutsopoulou
authors.affiliation: Orthopedic Surgery Department, University Hospital of Patras, Greece.
authors.forename: J
authors.initials: J
authors.lastname: Gliatis
mesh_terms: D000203:Activities of Daily Living; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D056228:Feedback, Sensory; D006801:Humans; D004856:Postural Balance / Q000502:physiology*; D011434:Proprioception / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function
keywords: Balance control; Balance training; Knee replacement; Proprioception training; Sensori-motor training; Systematic review