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Minerva Ortopedica e Traumatologica 2018 March;69(1):16-21

DOI: 10.23736/S0394-3410.17.03852-8


language: English

Variation in motor performance by the use of attentional focus in patients with knee replacement: a pilot study

Sergio RIGONI , Mario SCAPIN

SSD Physical Medicine and Rehabilitation Hospital of Asiago, Health Units 7 Pedemontana, Asiago, Vicenza, Italy


BACKGROUND: The influence of attentional focus on motor performance has been studied since the seventies thanks to Nideffer experiments. However, the target of such research has always been the analysis of the behavior of a healthy person, particularly athletes. Few studies have been carried out using subjects with different pathologies. Moreover, modern rehabilitation often tends to use internal attentional focuses, a choice not always based on well-founded scientific reasons. The purpose of this work was to check whether different attentional foci, or individual focusing styles, can affect the motor performance in knee replacement patients.
METHODS: This is a single-site, controlled and balanced experiment. We recruited 28 subjects from a pool of post-surgery patients whose knee arthroplasty was done at our facility. These patients were randomly assigned to one of two study group (external or internal attentional focus group). All enrolled subjects were tested with the TAIS-12 Scale to assess whether there could be a correlation between the individual focusing style and the focus type used during the rehabilitation period. After 20 days of intervention we tested the active extension of the operated knee by surface electromyography, and the active range of motion (AROM) by standard goniometric measurements.
RESULTS: The two groups were homogeneous as age and sex; the outcomes for the external attentional focus group were better than for the other group (AROM =1.7±0.77°; EMG =280.25 mV±103.24 mV). No correlation was found between the focusing style identified by the TAIS-12 Scale and the instructions given. Differences in improvement in the articulation range-of-motion were not significant, while the activation peak of the vastus medialis showed statistically significant results.
CONCLUSIONS: The use of external focusing seems to be superior to internal focusing for eliciting muscular activity in the vastus medialis after knee arthroplasty. This statement is in line with the “Constrained Theory” that states that external focus activities are faster and more economical due to the automation of parallel information bypassing cognitive functions. Our proposal for future research is to compile and compare two rehabilitation protocols with opposite focus applied to a larger number of subjects.

KEY WORDS: Range of motion, articular - Electromyography - Arthroplasty, replacement, knee

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