Relationship between Joint Position Sense, Force Sense, and Muscle Strength and the Impact of Gymnastic Training on Proprioception

Assessment of joint position sense in active and passive modes with various elbow flexion angles and movement speeds using an isokinetic dynamometer

BACKGROUND

Joint position sense is the ability to detect body segment position in space and is commonly used to represent proprioceptive performance. The isokinetic dynamometer is frequently used to evaluate elbow joint position sense during active and passive reproduction tasks with various testing protocols. However, few studies have reported the performance of joint position sense under different testing conditions.

OBJECTIVE

To compare elbow joint position sense between active and passive reproduction tasks under different matching speeds and reference targets.

DESIGN

A cross-sectional study.

METHODS

Twenty participants without a history of upper-extremity surgery or neuromuscular diseases that affect the joint position sense of the elbow. Active and passive ipsilateral matching tasks were performed at four movement speeds (0.5°/s, 1°/s, 2°/s, and 4°/s) and three reference targets (elbow flexion at 0°-15°, 45°-60°, and 75°-90°), using an isokinetic dynamometer. The absolute and variable errors of each condition were calculated for comparison.

RESULTS

In active matching task with elbow flexion of 0°-15°, the absolute error at 0.5°/s was significantly larger than that at 2°/s and 4°/s, while the variable error at 1°/s was significantly larger than that at 2°/s. However, no differences were found at elbow flexion angles of 45°-60° and 75°-90°. Larger absolute errors were found at 4°/s with three testing angles in passive matching task.

CONCLUSIONS

This study compared the joint position sense errors under various testing conditions in the active and passive reproduction tasks. The movement speeds and target position effects should be considered during evaluation.

Reference data for the hand grip and palmar pinch force sense errors and the relationship between school-entry-age in young adults

BACKGROUND

Hands execute intricate tasks vital for everyday life and professions such as cooking, tailoring, and craftsmanship.

OBJECTIVE

This study aimed to establish reference data for hand grip and palmar pinch force sense in young adults, accounting for gender differences, and to determine the correlation between these data and school-entry ages.

METHODS

The cross-sectional observational study comprised 284 participants (156 females and 128 males). Demographic details, including age, gender, weight, and height, were recorded. Participant ages ranged from 18 to 29, representing the youth workforce population as defined by the International Labour Organization. Factors like hand dominance and school-entry age were ascertained based on participants' self-reports. Hand grip and palmar pinch force senses were separately assessed in the dominant and non-dominant hands of 130 randomly chosen participants to evaluate test-retest reliability.

RESULTS

Hand grip (dominant: p < 0.001, non-dominant: p = 0.002) and palmar pinch force sense errors were significantly lower in male participants compared to females. Palmar pinch force sense error for the dominant hand was reduced in males (p = 0.002), but no significant disparity existed between genders for the non-dominant hand (p = 0.222). Healthy adults who began school at age five or earlier exhibited a decreased force sense error rate (p < 0.05).

CONCLUSIONS

Force sense error reference values vary based on gender and school-entry age. This reference data will aid rehabilitation specialists working with young adults in physiotherapy and occupational therapy fields in identifying potential impairments.

A multichannel investigation of proprioceptive accuracy

Proprioceptive accuracy (PAc), i.e., the acuity of perception of the state of different parts of the motor system, shows substantial intraindividual differences, and is often considered a general ability. However, it is questionable whether there is an association between accuracies measured with different tests at different body sites. PAc with respect to both knee and elbow joints (joint position reproduction) and the flexors of the upper arms (weight discrimination) was measured in 87 young healthy individuals with regular physical activity across multiple indices. Expected and perceived performance was also assessed for each behavioral task. Frequentist and Bayesian analysis largely supported the idea that PAc with respect to various parts of the motor system are unrelated. No dominant-subdominant differences for actual performance were found; however, PAc for the dominant and subdominant limb were associated in many cases. Finally, perceived performance was related to expected but not to actual performance for all three proprioceptive modalities. In conclusion, actual accuracy of perception of the actual state of a part (i.e., joint, muscle) of the motor system cannot be generalized to other parts. Perceived accuracy, dominantly shaped by expectations, is independent from actual accuracy.

Is proprioception affected in those with persistent intra-articular temporomandibular disorders? A cross-sectional study exploring joint position sense and force sense of the jaw

BACKGROUND

Proprioception is an important component of normal jaw function, although to date it is unknown if and how proprioception is affected in those with intra-articular temporomandibular disorders (IA-TMDs). This challenges effective management of this subgroup.

OBJECTIVES

Determine whether differences in local joint position sense and force sense exist between individuals with IA-TMD and those without a jaw problem.

DESIGN

Cross-sectional study.

METHOD

Sixty age and sex matched participants were recruited (n = 30 IA-TMD, n = 30 healthy controls). Temporomandibular joint position sense was tested to one target (50% of maximal mouth opening) using a ruler. Temporomandibular force sense was tested to two targets (50% and 70% of maximal molar pain-free bite force) using a bite sensor. Constant, absolute and variable errors were calculated for each outcome and compared between groups using p-values and 95% confidence intervals for effect size (d).

RESULTS

Significantly greater degrees of constant, absolute and variable error were seen for force sense testing at the 50% target (p < 0.05). No statistically significant difference was observed between groups for joint position sense, or for constant or variable force sense error at the 70% target (p > 0.05). Despite this, all joint position sense and force sense measures demonstrated possible clinical significance (upper limits 95% CI d ≥ 0.5).

CONCLUSIONS

Force sense, particularly at lower levels, appears impaired in those with IA-TMD. Joint position sense and force sense at higher levels appear less affected, although may still be important to consider in the management of IA-TMD in some patients.

Acute responses of strength-related gene expressions to maximum strength and force sense acuity

Background/aim

Although high muscle strength worsens the sense of force, it is unknown whether there is a relationship between this deterioration and the underlying molecular mechanisms. This study examined the relationship between decreased force sense (FS) acuity and strength-related gene expressions.

Materials and methods

Maximal voluntary isometric contraction (MVIC) and FS (50% MVIC) tests were performed on the knee joints of twenty-two subjects. The expression analyses were evaluated by qRT-PCR in blood samples taken before, after MVIC, after 50% MVIC, and 15 min after the test.

Results

MVIC and FS error values were significantly correlated with each other (r = .659, p = .001). The qRT-PCR analyses demonstrated that the expressed mRNAs of the interleukin 6 (IL-6), alpha-actinin 3 (ACTN3), angiotensin-converting enzyme (ACE), brain-derived neurotrophic factor (BDNF), and ciliary neurotrophic factor receptor (CNTFR) genes dramatically increased until 50% MVIC and subsequently decreased 15 min after the exercise (p < .05). The muscle-specific creatine kinase (CKMM), myosin light chain kinase (MLCK), and G-protein β3 subunit (GNB3) genes reached their peak expression levels 30 min after MVIC (p < .05). ACE and ACTN3 gene expression increased significantly in parallel with the increased FS error (p < .05). These gene expression fluctuations observed at 50% MVIC and after the rest could be related to changes in cellular metabolism leading to fatigue.

Conclusion

The time points of gene expression levels during exercise need to be considered. The force acuity of those whose maximal force develops too much may deteriorate.

The measurement of proprioceptive accuracy: A systematic literature review

BACKGROUND

Proprioceptive accuracy refers to the individual's ability to perceive proprioceptive information, that is, the information referring to the actual state of the locomotor system, which originates from mechanoreceptors located in various parts of the locomotor system and from tactile receptors located in the skin. Proprioceptive accuracy appears to be an important aspect in the evaluation of sensorimotor functioning; however, no widely accepted standard assessment exists. In this systematic review, our goal was to identify and categorize different methods that are used to assess different aspects of proprioceptive accuracy.

METHODS

A literature search was conducted in 5 different databases (PubMed, SPORTDiscus, PsycINFO, ScienceDirect, and SpringerLink).

RESULTS

Overall, 1139 scientific papers reporting 1346 methods were included in this review. The methods assess 8 different aspects of proprioception: (a) the perception of joint position, (b) movement and movement extent, (c) trajectory, (d) velocity, and the sense of (e) force, (f) muscle tension, (g) weight, and (h) size. They apply various paradigms of psychophysics (i.e., the method of adjustment, constant stimuli, and limits).

CONCLUSION

As the outcomes of different tasks with respect to various body parts show no associations (i.e., proprioceptive accuracy is characterized by site-specificity and method-specificity), the appropriate measurement method for the task needs to be chosen based on theoretical considerations and/or ecological validity.

Elbow Joint Position and Force Senses in Young and Adult Untrained People and Gymnasts

Joint position (JPS) and force senses (FS) are the proprioception modalities. While the development of JPS was investigated both in children/adult and athlete/untrained conditions, there is a lack of insight into the development of FS. Overall, 28 gymnasts and 25 untrained controls underwent proprioception testing. They were divided into two groups: 9 to 11-year-old boys (13 gymnasts and 10 non-athletes) and 18 to 25-year-old adults (15 gymnasts and 15 non-athletes). The testing was performed at an isokinetic dynamometer and included elbow JPS and FS (20% and 50% maximal voluntary contraction) tasks. Children had two times higher error in JPS (p < 0.01) and 50% higher errors in FS of both flexor (p < 0.001) and extensor muscles (p < 0.05) in comparison with adults. Only in the 50% maximal voluntary contraction task, gymnasts showed 33% lower error than the controls (p < 0.01). Untrained boys presented 54%, 132%, and 169% higher error for elbow flexor performance than young gymnasts, untrained adults, and adult gymnasts, respectively (p < 0.01). The 9 to 11-year-old participants were characterized by a lower precision of JPS and FS performance in comparison with adults. Gymnastic training can possibly accelerate the development of FS when higher loads are considered.

Reliability of Cervicocephalic Proprioception Assessment: A Systematic Review

OBJECTIVE

The purpose of this systematic review was to determine the reliability and, where possible, the validity of cervicocephalic proprioceptive (CCP) tests in healthy adults and clinical populations.

METHODS

A systematic search, utilizing 7 databases from the earliest possible date to April 14, 2021, identified studies that measured reliability of CCP tests. Studies were screened for eligibility, and included studies were appraised using Quality Appraisal Tool for Studies of Diagnostic Reliability (QAREL) and Quality Assessment and Diagnostic Accuracy Studies-2 Tool (QUADAS-2) tools. Validity outcomes were assessed for included studies.

RESULTS

Of 34 included studies, 29 investigated reliability for sense of position tests, 10 involved sense of movement tests, and 1 used a sense of force test. The head to neutral test was reliable and valid when 6 or more repetitions were performed within the test, discriminating between those with and without neck pain. Head tracking tests were reliable with 6 repetitions, and 1 study found discriminative validity in a whiplash population. Studies that found discriminative validity in sense of position reported mean joint position error generally >4.5° in the neck pain group and <4.5° in the asymptomatic group. No sense of force test was applied to a clinical population. Convergent validity analysis showed that these proprioceptive tests have low correlations with each other.

CONCLUSION

The reliability and validity of CCP tests for sense of position and movement are dependent upon equipment and repetitions. Six repetitions are generally required for good reliability, and joint position error >4.5° is likely to indicate impairment in sense of position.

Exploring Sex Differences and Force Level Effects on Grip Force Perception in Healthy Adults

This study aimed to explore the effect of sex and force level on grip force reproduction in healthy adults by conducting a force reproduction task. Participants (n = 28) were instructed to replicate a range of reference grip force levels (10-130 N in 10 N increments). We found that women (absolute error: 16.2 ± 8.7 N) replicated these force levels more accurately than men (absolute error: 23.1 ± 9.5 N) at higher force levels (90-130 N). Furthermore, the force reproductions were most accurate at the 30-50 N range for men and the 50-60 N range for women. These results may offer significant insights into the higher rates of musculoskeletal disorders among women, enabling researchers and clinicians to design novel interventions and tools that can improve grip force perception and reduce hand injury rates in both men and women.

Inter-Limb Asymmetry in Force Accuracy and Steadiness Changes after a 12-Week Strength Training Program in Young Healthy Men

The study aimed to investigate the impact of a 12-week strength training program on force accuracy and steadiness changes in lower limbs in young healthy men. Twenty subjects with a dominant right lower limb were included. They performed a force matching task both pre and post strength training program. The ability to reproduce force was determined by calculating three errors: absolute error (AE), constant error (CE), and variable error (VE). After intervention AE and VE improved in both legs indicating higher improvement in the dominant leg (p = 0.032 for AE and p = 0.005 for VE). However, CE improved only in the dominant leg (p = 0.001). We conclude that strength training improved the accuracy and consistency of force in a force reproduction task. This improvement was more evident in the dominant lower limb. Most likely, the inter-limb asymmetry in changes of force application ability caused by strength training is due to the different mechanisms responsible for the control of voluntary movements in the dominant and non-dominant lower limb.

Force-velocity relationship profile of elbow flexors in male gymnasts

Background

The theoretical maximum force (F₀), velocity (V₀), and power (P_max) of athletes calculated from the relationship between force and velocity (F-V relationship) and the slope of the F-V relationship, reflect their competitive and training activity profiles. Evaluating the F-V relationship of athletes facilitates categorizing the profiles of dynamic muscle functions in relation to long-term sport-specific training. For gymnastics, however, no studies have tried to examine the profiles of F-V relation and power output for upper limb muscles in relation to the muscularity, while the use of the upper extremities in this sport is very unique as described earlier.

Purpose

It was hypothesized that the F-V relationship of the elbow flexion in gymnasts might be characterized by low capacity for generating explosive force, notably in terms of the force normalized to muscle size.

Methods

The F₀, V₀, and P_max derived from the force-velocity relationship during explosive elbow flexion against six different loads (unloaded condition, 15, 30, 45, 60, and 75% of maximal voluntary isometric elbow flexion force (MVF_EF)) for 16 gymnasts (GYM) and 22 judo athletes (JD). F₀ and P_max were expressed as values relative to the cross-sectional area index (CSA_index) of elbow flexors (F₀/CSA_index and P_max/CSA_index, respectively), which was calculated from muscle thickness in the anterior upper arm. The electromyogram (EMG) activities of the biceps brachii (BB) during the maximal isometric and dynamic tasks were also determined.

Results

There were no significant differences in CSA_index of elbow flexors between GYM and JD. MVF_EF/CSA_index for GYM was significantly lower than that for JD. Force was linearly associated with velocity in the dynamic elbow flexion for all the participants (r =  − 0.997 to −0.905 for GYM, r =  − 0.998 to −0.840 for JD). F₀, F₀/ CSA_index, V₀, P_max, P_max/CSA_index, and MVF_EF were significantly lower in GYM than in JD. The activity levels of BB during the dynamic tasks tended to be lower in GYM than in JD at load of <45%MVC.

Conclusion

Gymnasts cannot generate explosive elbow flexion force corresponding to their muscle size. This may be due to low neuromuscular activities during the maximal dynamic tasks against relatively low loads.

INFLUENCE OF FOAM ROLLING ON ELBOW PROPRIOCEPTION, STRENGTH, AND FUNCTIONAL MOTOR PERFORMANCE

CONTEXT

Foam rolling has recently been used frequently to increase flexibility. However, its effects on proprioception, strength and motor performance are not well known. In addition, very few studies have examined the effects of foam rolling in the upper extremity.

OBJECTIVE

To investigate the effects of foam rolling on elbow proprioception, strength, and functional motor performance in healthy individuals.

DESIGN

Randomized controlled study.

SETTING

Exercise laboratory of X Department, X University.

PATIENTS OR OTHER PARTICIPANTS

Sixty healthy participants (mean age=22.83±4.07 years).

INTERVENTION(S)

We randomly assigned participants into two groups: the foam rolling group (FRG) (4 weeks of foam rolling for the biceps brachii muscle) and control group (CG) (no foam rolling).

MAIN OUTCOME MEASURE(S)

We evaluated proprioception (joint position sense [JPS] and force matching), biceps brachii muscle strength, and functional motor performance (modified pull-up test [MPUT], closed kinetic chain upper extremity stability test [CKCUEST], and push-up test) at the baseline, and at the end of the 4th week and 8th week.

RESULTS

JPS at 45° elbow flexion, muscle strength, CKCUEST, and push-up test results improved after foam rolling and improvement was maintained at the follow-up (p<0.017). While the changes in groups for the results of proprioception and CKCUEST were similar among the three time points (p>0.05), there were significant improvements for the muscle strength from baseline to the second evaluation, and from baseline to the follow-up (p<0.001) in the FRG compared to the CG (p=0.004). The FRG was superior to the CG in the improvement of push-up test results among the three time points (p=0.040, p=0.001, p<0.001). Other data did not change (p>0.05).

CONCLUSION

Foam rolling is effective in improving elbow JPS in small flexion angles, biceps brachii strength, and some parameters of upper extremity functional motor performance. These effects are maintained 4 weeks after application.

Cardiac and Proprioceptive Accuracy Are Not Related to Body Awareness, Perceived Body Competence, and Affect

Interoception in the broader sense refers to the perception of internal states, including the perception of the actual state of the internal organs (visceroception) and the motor system (proprioception). Dimensions of interoception include (1) interoceptive accuracy, i.e., the ability to sense internal changes assessed with behavioral tests, (2) confidence rating with respect to perceived performance in an actual behavioral test, and (3) interoceptive sensibility, i.e., the self-reported generalized ability to perceive body changes. The relationship between dimension of cardioceptive and proprioceptive modalities and their association with affect are scarcely studied. In the present study, undergraduate students (N = 105, 53 males, age: 21.0 ± 1.87 years) filled out questionnaires assessing positive and negative affect (Positive and Negative Affect Schedule), interoceptive sensibility (Body Awareness Questionnaire), and body competence (Body Competence Scale of the Body Consciousness Questionnaire). Following this, they completed a behavioral task assessing cardioceptive accuracy (the mental heartbeat tracking task by Schandry) and two tasks assessing proprioceptive accuracy with respect to the tension of arm flexor muscles (weight discrimination task) and the angular position of the elbow joint (joint position reproduction task). Confidence ratings were measured with visual analog scales after the tasks. With the exception of a weak association between cardioceptive accuracy and the respective confidence rating, no associations between and within modalities were found with respect to various dimensions of interoception. Further, the interoceptive dimensions were not associated with state and trait positive and negative affect and perceived body competence. In summary, interoceptive accuracy scores do not substantially contribute to conscious representations of cardioceptive and proprioceptive ability. Within our data, non-pathological affective states (PANAS) are not associated with the major dimensions of interoception for the cardiac and proprioceptive modalities.

Effects of 2 Different External Loads on Joint Position Sense and the Relationship Between Muscle Strength and Force Sense

CONTEXT

Joint position sense (JPS) tests of proprioception lack ecological validity because the testing conditions are so different from the normal function that they can contribute little to understanding the role proprioception plays in daily and sporting activities.

OBJECTIVE

To evaluate the effect of low and high external load on the knee JPS and to investigate the relationship between maximum voluntary isometric contraction and force sense (FS).

DESIGN

Experimental study.

SETTING

Research laboratory.

PARTICIPANTS

A total of 47 volunteers with no history of knee pathology.

INTERVENTIONS

Three active JPS tests performed with no load, low load, and high load were compared at the 45° target angle. For isometric FS test, 50% load was used. For isotonic low load and high load JPS tests, 30% and 70% loads were applied, respectively.

MAIN OUTCOME MEASURES

To analyze obtained data set 2-way multiple analysis of variance, repeated measures of analysis of variance, paired sample t test, and the Pearson correlation coefficient were used.

RESULTS

JPS was not affected by gender (male and female) and activity levels (sedentary, recreational, and trained). Results of the repeated measure of analysis of variance demonstrated the significant main effect of loads (P = .001). Significant differences were found between no load, low load, and high load JPS (P = .001). A positive and significant correlation was found between maximum voluntary isometric contraction and FS error values (r = .41, P = .001).

CONCLUSIONS

The results suggest that as the load level increases, the knee JPS improves. Knee JPS assessed under external load may be a more appropriate alternative to the nature of the sport. Those with higher muscle strength have a worse FS.

Short-term retention of proprioceptive information

The Joint Position Reproduction test (JPR), one of the most widely used measurements to estimate proprioceptive accuracy, requires the short term storage of proprioceptive information. It has been suggested that visuospatial sketchpad plays a fundamental role in the memorization of proprioceptive information. The current study aimed to investigate this assumption. To do so, we developed and used a novel JPR protocol to measure the retention capacity with respect to sequences of different positions. Our goal was to develop the original task further to make it comparable with other widely used short-term memory measurements, in which the memory capacity was determined by the number of the items participants retain (memory span). We compared participants’ (N=39) performance in this task to that of results of Corsi block-tapping task (capacity of the visuospatial sketchpad) and Digit span task (capacity of the phonological loop). Proprioceptive memory capacity did not correlate either with spatial or verbal memory capacity. The exploratory analysis revealed that proprioceptive span correlated positively with the performance if 5 joint positions had to be retained. Further associations with verbal span for 6 or 7 positions, and spatial span for 5 positions were found. Our findings do not support the idea that visuospatial sketchpad plays a fundamental role in the storage of proprioceptive information. The independence of span measures indicates that proprioceptive information might be stored in a subsystem independent of the visuospatial sketchpad or phonological loop.

Proprioception but not cardiac interoception is related to the rubber hand illusion

The rubber hand illusion (RHI) is a widely used tool in the study of multisensory integration. It develops as the interaction of temporally consistent visual and tactile input, which can overwrite proprioceptive information. Theoretically, the accuracy of proprioception may influence the proneness to the RHI but this has received little research attention to date. Concerning the role of cardioceptive information, the available empirical evidence is equivocal. The current study aimed to test the impact of proprioceptive and cardioceptive input on the RHI. 60 undergraduate students (32 females) completed sensory tasks assessing proprioceptive accuracy with respect to the angle of the elbow joint, a heartbeat tracking task assessing cardioceptive accuracy (the Schandry-task) and the RHI. We found that those with more consistent joint position judgements (i.e., less variable error) in the proprioceptive task were less prone to the illusion, particularly with respect to disembodiment ratings in the asynchronous condition. Systematic error, indicating a systematic distortion in position judgements influenced the illusion in the synchronous condition. Participants with more proprioceptive bias toward the direction of the rubber hand in the proprioceptive test reported a stronger felt embodiment. The results are in accordance with Bayesian causal inference models of multisensory integration. Cardioceptive accuracy, however, was not associated with the strength of the illusion. We concluded that individual differences in proprioceptive processing impact the RHI, while cardioceptive accuracy is unrelated to it. Theoretical and practical relevance of the findings are discussed.

Role of Proprioception in Slow and Rapid Movements

This study aimed to compare the contributions of sources of proprioception to the reproduction accuracy of relatively slower and more rapid arm movements. We recruited 34 volunteers and gave them dart throwing tasks under two different durations followed by joint position sense (JPS) tests and force sense (FS) tests at the elbow and the wrist. We found moderately positive correlations between slow movement performance and proprioceptive acuity with FS (wrist) and JPS (elbow), accounting for 52% of the absolute errors ( p <  .001), and, with FS (wrist), accounting for 50% of the variable error ( p <  .001). Moreover, we observed a smaller correlation between rapid movement performance and proprioceptive acuity, accounting for 17% of absolute errors with JPS (elbow; p =  .008) and 11% of variable error ( p =  .033). These results suggest that relatively slow movement performance is partly determined by performers’ proprioceptive acuity of the movement-related limbs. Relatively rapid movement performance is also affected by correctional proprioceptive feedback, though to a lesser degree.

Interaction between position sense and force control in bimanual tasks

Background

Several daily living activities require people to coordinate the motion and the force produced by both arms, using their position sense and sense of effort. However, to date, the interaction in bimanual tasks has not been extensively investigated.

Methods

We focused on bimanual tasks where subjects were required:

(Experiment 1) to move their hands until reaching the same position – equal hand position implied identical arm configurations in joint space - under different loading conditions;

(Experiment 2) to produce the same amount of isometric force by pushing upward, with their hands placed in symmetric or asymmetric positions.

The arm motions and forces required for accomplishing these tasks were in the vertical direction. We enrolled a healthy population of 20 subjects for Experiment 1 and 25 for Experiment 2. Our primary outcome was the systematic difference between the two hands at the end of each trial in terms of position for Experiment 1 and force for Experiment 2. In both experiments using repeated measure ANOVA we evaluated the effect of each specific condition, namely loading in the former case and hand configuration in the latter.

Results

In the first experiment, the difference between the hands’ positions was greater when they were concurrently loaded with different weights. Conversely, in the second experiment, when subjects were asked to exert equal forces with both arms, the systematic difference between left and right force was not influenced by symmetric or asymmetric arm configurations, but by the position of the left hand, regardless of the right hand position. The performance was better when the left hand was in the higher position.

Conclusions

The experiments report the reciprocal interaction between position sense and sense of effort inbimanual tasks performed by healthy subjects. Apart for the intrinsic interest for a better understanding of basic sensorimotor processes, the results are also relevant to clinical applications, for defining functional evaluation and rehabilitative protocols for people with neurological diseases or conditions that impair the ability to sense and control concurrently position and force.

Total Knee Arthroplasty in Patients With Knee Osteoarthritis: Effects on Proprioception. A Systematic Review and Best Evidence Synthesis

BACKGROUND

Impact of total knee arthroplasty (TKA) on proprioception remains to be determined. The aim of this systematic review is to analyze factors influencing proprioception in patients with knee osteoarthritis (OA) undergoing TKA.

METHODS

A systematic literature search was conducted on 3 medical electronic databases: PubMed, PeDRO, and Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used. Risk of bias analysis and best evidence synthesis were performed. Three main aspects were investigated: the presence of preoperative, surgical, and postoperative factors influencing proprioception in OA patients undergoing TKA.

RESULTS

Search identified 1601 records. After screening, 19 papers were used for the analysis of 676 patients. Proprioception generally improved but often remained impaired after surgery. Strong evidence was found for no influence of prosthesis design on proprioception. Moderate evidence was found for patellar resurfacing not affecting proprioception, varus deformity negatively influencing proprioception, and time elapsed from surgery positively influencing proprioception. Limited evidence was found for valgus deformity, OA grade, intact anterior cruciate ligament, and anteroposterior joint laxity negatively affecting knee proprioception, and for muscle strength and sensorimotor training not affecting proprioception. Finally, conflicting evidence was found for better postoperative proprioception vs preoperative level.

CONCLUSION

Proprioception in OA patients undergoing TKA improves but remains impaired after surgery. The best evidence synthesis demonstrated no influence of prosthetic design, while the role of the treatment remains unclear. This warrants for further research efforts to study proprioceptive impairment to better manage OA patients undergoing TKA.

Effect of Force Sense to Active Joint Position Sense and Relationships between Active Joint Position Sense, Force Sense, Jumping and Muscle Strength

We aimed to investigate the effect of external load on the joint position sense (JPS) accuracy and its relation to the target jump height. The present study also aimed to explore the relationship between force sense (FS) and maximum voluntary isometric contraction (MVIC). Participants' MVIC levels were determined during the 45-degree knee extension task. Then, participants were asked to execute a knee JPS task with external load (EL-JPS) and with no-load (EL-JPS). To assess jumping accuracy participants were instructed to jump with their 50% of maximum jump height. Results indicated that EL-JPS error values were lower than NL-JPS. EL-JPS was correlated to jumping errors. However, the relationship between NL-JPS and jumping errors was not significant. A significant correlation was found between MVIC and FS errors.