Original article
Action Observation Treatment Improves Recovery of Postsurgical Orthopedic Patients: Evidence for a Top-Down Effect?

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Abstract

Bellelli G, Buccino G, Bernardini B, Padovani A, Trabucchi M. Action observation treatment improves recovery of postsurgical orthopedic patients: evidence for a top-down effect?

Objective

To assess whether action observation treatment (AOT) may also improve motor recovery in postsurgical orthopedic patients, in addition to conventional physiotherapy.

Setting

Department of rehabilitation.

Participants

Patients (N=60) admitted to our department postorthopedic surgery were randomly assigned to either a case (n=30) or control (n=30) group. Exclusion criteria were age 18 years or younger and 90 years or older, Mini-Mental State Examination score of 21 of 30 or lower, no ambulating order, advanced vision impairment, malignancy, pneumonia, or heart failure.

Interventions

All participants underwent conventional physiotherapy. In addition, patients in the case group were asked to observe video clips showing daily actions and to imitate them afterward. Patients in the control group were asked to observe video clips with no motor content and to execute the same actions as patients in the case group afterward. Participants were scored on functional scales at baseline and after treatment by a physician blinded to group assignment.

Main Outcomes Measures

Changes in FIM and Tinetti scale scores, and dependence on walking aids.

Results

At baseline, groups did not differ in clinical and functional scale scores. After treatment, patients in the case group scored better than patients in the control group (FIM total score, P=.02; FIM motor subscore, P=.001; Tinetti scale score, P=.04); patients in the case group were assigned more frequently to 1 crutch (P=.01).

Conclusions

In addition to conventional physiotherapy, AOT is effective in the rehabilitation of postsurgical orthopedic patients. The present results strongly support top-down effects of this treatment in motor recovery, even in nonneurologic patients.

Section snippets

Participants

All patients consecutively admitted to our Department of Rehabilitation and Aged Care for postorthopedic (hip fracture or hip or knee replacement) surgery rehabilitation from November 2008 to November 2009 were eligible for this study if the surgical intervention was the first during their lifetime and time from surgery to department admission ranged from 3 to 10 days. On admission at t0, a standardized multidimensional assessment was performed to evaluate the patient's eligibility criteria,

Results

Of 72 potentially eligible patients, 60 fulfilled the inclusion criteria, agreed to participate, and were enrolled in this study. Patients were randomly assigned to the case (n=30) and control groups (n=30). None of the patients was absent from scheduled sessions during the study, and all completed the treatment.

Clinical features of the 2 groups are listed in table 2. Baseline comparisons showed that age, sex, type of orthopedic surgical intervention, time from surgery to randomization,

Discussion

The present findings clearly show that AOT is a useful approach in the rehabilitation of postsurgical orthopedic patients and may be complementary or alternative to current well-assessed rehabilitation treatments. To date, AOT has been used in only the recovery of upper-limb function in long-term patients after stroke. A functional magnetic resonance imaging study,18 including a small group (N=8) of patients who underwent AOT, showed functional reorganization of the motor system, especially in

Conclusions

The present study further supports the potential application of AOT, clearly showing a positive effect of this approach even in rehabilitation of patients with nonneurologic diseases, such as recovery from orthopedic surgery. In more general terms, the present findings suggest a top-down effect, showing that reorganization of motor representations at a central level (occurring during AOT) may positively influence action execution, even when the skeletal structures to implement the movement are

Acknowledgments

We thank Marina Marazzi, MD, Fabio Guerini, MD, Salvatore Speciale, MD, Valeria Tirelli, MD, Renato Turco, MD, Tiziana Torpilliesi, MD, Eleonora Ricci, MD, and Tommaso Luccarini, physiotherapist, for support in collecting data.

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