Abstract
BACKGROUND: Spinal anesthesia (SA) is widely used for total knee arthroplasty (TKA) due to its advantages in postoperative pain control and reduced opioid use. However, prolonged motor and sensory blockade remains a concern, delaying recovery and increasing patient discomfort. Given the limitations of current pharmacologic and physical therapy strategies in accelerating neural recovery, motor imagery (MI)-a cognitive technique that activates motor and sensory pathways without physical movement-has emerged as a potential neuromodulatory intervention. This study aimed to evaluate the effects of MI combined with active ankle range of motion (ROM) exercises on neural recovery after SA. METHODS: In this prospective, randomized controlled trial, 76 female patients undergoing TKA under SA were enrolled and allocated to either an MI group (n = 40), who performed structured MI-ROM exercises during their post-anesthesia care unit (PACU) stay, or a non-MI group (n = 36), who received guided relaxation. Motor and sensory recovery were assessed at 30, 60, and 90 min postoperatively using the modified Bromage scale, pinprick test, and alcohol cotton test. RESULTS: The MI group demonstrated significantly faster motor recovery at all time points (P = 0.002) and superior sensory recovery via pinprick testing at 60 and 90 min (P = 0.003), while no significant difference was found in alcohol cotton test results (P = 0.314). CONCLUSION: These findings suggest that MI is a feasible, non-invasive intervention that may enhance early motor and sensory recovery after SA, supporting its potential role in improving postoperative outcomes in TKA patients. TRIAL REGISTRATION: Clinical Research Information Service (CRIS), KCT0010364, registered on March 28, 2025; retrospectively registered.