The aim of the study was to investigate the effect of motor imagery with action observation (AOMI) practice during discharge and at short-term on hip abductor strength, lower limb function, and fear of falling (FOF) in individuals with surgically managed proximal femur fracture and to compare them with traditional exercises.
Individuals (n=88) who were surgically treated for proximal femur fracture were randomly assigned to the AOMI (n=44) and traditional exercises (n=44) groups by a blinded assessor. where they received AOMI targeting abductor muscle, traditional exercise and traditional exercises respectively. Before initiation of treatment, the AOMI and traditional exercise components were assessed by six rehabilitation experts and are included upon good agreement on relevance and ease of practice. The AOMI practice was incorporated at 3 levels with increasing difficulty, and the overall session lasted about 30 minutes and practiced twice daily. The traditional exercise session lasted for 30 minutes and was performed with 10 repetitions in 2 sets. These exercises were performed under supervision during hospitalization and continued as a home program till 6 weeks after discharge. All the participants were evaluated for abductor muscle strength using hand-held dynamometer during discharge and follow up at 6 weeks. The lower limb function and FOF were evaluated using Lower Extremity Functional Scale (LEFS) and Falls Efficacy Scale International (FES-I) before surgery, during discharge and follow up at 6 weeks.
The findings demonstrated that AOMI and traditional exercises resulted in comparable changes in abductor muscle strength, function and fear of falling between groups (p0.001). The hip abductor muscle strength improved significantly with a large effect size during discharge and follow up at 6 weeks in favor of AOMI. The MCID for LEFS and the MDC for FES-I exceeded the cutoff value in the AOMI group alone on between group comparison. There was a significant interaction between treatment arms, across times for abductor strength, lower limb function and fear of falling.
The study results support the use of Motor imagery with action observation to improve muscle strength and function without adverse effect when the initiation of traditional exercise is restricted in the post operative period. The fear of falling reduced significantly following its practice. Further studies can evaluate its effect in other categories of hip disorders with more subgroups, and analysis can be extended with long follow-up, including the psychosocial factors.
Motor imagery with action observation (AOMI) could be an alternative and safe method in physiotherapy practice to start early hip abductor strengthening following proximal hip and lower limb skeletal injuries.
Hip abductor weakness
Hip rehabilitation exercises
