Browsing by Person "Moutzouri, Maria"

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Corrigendum to What is the effect of sensori-motor training on functional outcome and balance performance of patients' undergoing TKR? A systematic review- [Physiotherapy 102 (2016) 136-144]
(Elsevier, 2016-12-01) Moutzouri, Maria; Gleeson, Nigel; Billis, E.; Panoutsopoulou, I.; Gliatis, J.
Early initiation of home-based sensori-motor training improves muscle strength, activation and size in patients after knee replacement: A secondary analysis of a controlled clinical trial
(Springer Nature, 2019-05-17) Moutzouri, Maria; Coutts, Fiona; Gliatis, John; Billis, Evdokia; Tsepis, Elias; Gleeson, Nigel
Background There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR.
Early self-managed focal sensorimotor rehabilitative training enhances functional mobility and sensorimotor function in patients following total knee replacement: a controlled clinical trial
(SAGE Publications, 2018-02-23) Moutzouri, Maria; Gleeson, Nigel; Coutts, Fiona; Tsepis, Elias; John, Gliatis
Objective: To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. Design: A single-blind controlled clinical trial. Setting: University Hospital of Rion, Greece. Subjects: A total of 52 participants following total knee replacement. Outcome measures: The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8-weeks post surgery, and 14-weeks post surgery). Intervention: Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3-5 sessions/week (35-45-minutes). Results: Consistently greater improvements (F2,98-=-4.3 to 24.8; P-<-0.05) in group mean scores favour the experimental group compared to the control group: Timed Up and Go (7.8--2.9-seconds vs. 4.6--2.6-seconds); balance (2.1--0.9 vs. 0.7--1.2); joint position error (13.8--7.3 vs. 6.2--9.1); Knee Outcome Survey Activities of Daily Living Scale (44.2--11.3 vs. 26.1--11.4); and pain (5.9--1.3-cm vs. 4.6--1.1-cm). Patterns of improvement for the experimental group over time were represented by a relative effect size range of 1.3-6.5. Conclusions: Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.
THE EFFECTS OF ENHANCED SENSORI-MOTOR REHABILITATION ON INDICES OF FUNCTIONAL PERFORMANCE IN PATIENTS UNDERGOING TOTAL KNEE REPLACEMENT
(2019) Moutzouri, Maria
The primary aim of this thesis addressed a knowledge gap regarding whether sensori-motor training (SMT) stimuli implemented early post-surgery are capable of targeting persisting sensori-motor and neuromuscular deficits in TKR patients’ performance. Therefore, the effects of early enhanced sensori-motor training (ESMET) on self-reported and objective measures of physical function, sensori-motor, neuromuscular, and musculoskeletal performance capabilities of patients undergoing total knee replacement (TKR) were investigated. In order to assess the effects of SMT on patients’ functional mobility and sensori-motor function, as well as indirectly investigating the mechanism underpinning any observed effects, relevant outcome measures used in the literature were reviewed for their clinimetric properties. Indices of functional performance, as reflected by the Timed Up and Go Test (as primary outcome), balance-related performance, sensori-motor performance, neuromuscular performance, muscle size and knee ROM, as well as patient-reported measures (PROMs), were selected on the basis of their clinimetric utility to best reflect the outcome of the SMT intervention. A clinical survey of Greek physiotherapists’ perspectives revealed that contemporary usual care management of TKR-related rehabilitation incorporated in the majority of cases home-based exercises with emphasis on knee ROM and muscle strengthening (Moutzouri et al, 2016b). A first systematic review including studies with IIc-IV level of evidence (Moutzouri et al, 2016c), revealed that patients undergoing TKR surgery experience persisting deficits in static and dynamic balance and incidence of falls remain within the pre-surgery levels. In parallel, a second systematic review evaluating preliminary effects of contemporary functional physiotherapy programmes being augmented by SMT in TKR clinical population, revealed statistically significant greater effects for balance performance but not for functional capabilities. However, the number of studies that had met inclusion criteria was small (n = 5) and the nature of their designs, which had been as pilot studies in the majority of cases, precluded conclusive findings. Following preliminary investigations of reproducibility of measurement and related clinimetric characteristics of outcomes, the main aspect of the thesis reported on the findings of a novel randomised control trial (Moutzouri et al,2017), in which the effects of a newly formulated time-matched sensori-motor exercise training programme [ESMET] was compared with those from a functional exercise training programme [FET] (representing the control condition and usual care practice, and which have been characterised by the findings of the aforementioned clinical survey) during rehabilitation following TKR. Participants (n= 52) were allocated to 12-week programmes of rehabilitation, initiated in the second week post-surgery, and assessed at pre-surgery (0 weeks), 8 weeks post-surgery, and at 14 weeks post-surgery on outcomes which included indices of self-reported and objective measures of physical function, sensori-motor, neuromuscular, and musculoskeletal performance capabilities. The findings revealed significant advantages for the new sensori-motor focused rehabilitation on several outcomes (relative effect size range at 14 weeks post-surgery ~ 0.5 to 2.1), including a significant group by time interaction (F(1.7,82.5)GG = 11.0; p <0.005) for the study’s primary outcome (Timed Up and Go Test), favouring ESMET over FET by ~ 35 %. However, the study’ findings need to be interpreted with caution due to the single-blind nature of the study. Key words: total knee replacement; knee osteoarthritis, Rehabilitation; Balance; sensori-motor training
Greek Physiotherapists' Perspectives on Rehabilitation Following Total Knee Replacement: a Descriptive Survey
(Wiley, 2016-05-16) Moutzouri, Maria; Gleeson, Nigel; Billis, Evdokia; Tsepis, Elias; Gliatis, John
Background and Purpose: In Greece, as in many countries, there is a scarcity of evidence in the type of physiotherapy services offered for the rehabilitation of total knee replacement (TKR). Despite the number of TKRs annually performed in Greece (over 10,000), there are no available clinical guidelines as to the content of best physiotherapy practice. The aim of this nationwide survey undertaken by physiotherapists treating TKR patients post-operatively was to record standard practice and services available in Greece. Methods: Design: cross-country survey Ten per cent of all registered physiotherapists working in public/private sectors were recruited. The developed survey comprised of questions regarding therapists' profile, protocols implemented at different stages of rehabilitation and the aims and modalities used. Results: A 58.7% response rate was achieved, where 36% (47/132) of respondents were treating patients in the inpatient phase and 64% (85/132) after hospital discharge. Patients in Greece are discharged with a home-based exercise program (56.7%) and, to a lesser extent, are referred to rehabilitation centres (13.3%). Strengthening, range of movement and functionality seemed to be the primary goals especially in the inpatient phase, whereas in the outpatient phase, apart from the larger differences identified, functionality and balance training were more frequently reported. Conclusions: No significant variations in practice were found during inpatient rehabilitation, whilst there seemed to be diversity across outpatient physiotherapy programs. The current survey suggests that patient's general health and psychological and behavioural issues are the criteria by which physiotherapists select the volume of implemented exercise and progression. However, no specific guidelines were followed. 2016 John Wiley & Sons, Ltd.
The effect of total knee arthroplasty on patients' balance and incidence of falls: a systematic review
(Springer, 2016-10-19) Moutzouri, Maria; Gleeson, Nigel; Billis, E.; Tsepis, E.; Panoutsopoulou, I.; Gliatis, J.
Purpose: Despite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature. Methods: A systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool. Results: Thirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III. Conclusions: Findings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II-III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place. 2016 The Author(s)