This systematic review and meta-analysis investigates the correlation of preoperative and intraoperative factors with physical function 1 year after total knee arthroplasty in patients with knee osteoarthritis.

IntroductionOne in five patients undergoing total knee arthroplasty (TKA) experience unchanged or worse pain and physical function 1 year after surgery. Identifying risk factors for unfavourable outcomes is necessary to develop tailored interventions to minimise risk. There is a need to review more current literature with updated methodology that addresses the limitations of earlier systematic reviews and meta-analyses. We present a Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols compliant protocol for a systematic review and meta-analysis of predictors of chronic pain and impaired function after TKA.Methods and analysisThis review will include prospective longitudinal observational studies, or randomised trials (including cluster and crossover designs) that report arm-wise predictors of chronic postsurgical pain or impaired physical function at 3 months, 6 months or 12 months. A comprehensive literature search of studies published between 2000 and 2019 will be performed in Medline, Embase, CINAHL, Cochrane Library and PEDro. Blinded assessment with consensus agreement will be applied for inclusion of studies, data extraction and assessment of bias risk (Quality in Prognosis Studies tool). The co-primary outcomes, pain and impaired function, at 12 months after TKA will be analysed separately. Estimates of association between each outcome and any preoperative or intraoperative factor that may predict chronic pain or impaired physical function will be extracted from the included studies, where possible. For randomised studies, results will only be extracted from TKA arms (or the first period of crossover trials). Estimates of association from the primary evidence will be synthesised narratively, and quantitatively using multivariate meta-analysis to provide ‘pooled’ estimates of association. Subgroup and sensitivity analyses will be performed. Certainty of evidence for each predictor will be derived from the Grading of Recommendations Assessment, Development and Evaluation framework.Ethics and disseminationNo ethical issues are associated with this project. The results from this review will be published in peer-reviewed journals and presented at international conferences.PROSPERO registration numberCRD42018079069.

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Background It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA and/or fitness could help guide the development of targeted exercise interventions to treat PSF. Aims Our systematic review and meta-analysis aimed to investigate PSF’s associations with PA and fitness. Summary of review Following a registered protocol, we included studies with cross-sectional or prospective observational designs, published in English or a Scandinavian language, that reported an association of PSF with PA and/or fitness in adult stroke survivors. We searched Medline, Embase, AMED, Cinahl, PsycInfo, ClinicalTrials.gov, and World Health Organization’s International Clinical Trials Registry Platform from inception to Nov 30, 2022. Risk of bias was assessed using Quality in Prognosis Studies. Thirty-two unique studies (total n=4721 participants, 55% male), and three study protocols were included. We used random-effects meta-analysis to pool data for PA and fitness outcomes, and vote-counting of direction of association to synthesize data that could not be meta-analyzed. We found moderate-certainty evidence of a weak association between higher PSF and impaired fitness (meta r=−0.24; 95% CI=−0.33, −0.15; n=905, 7 studies), and very low-certainty evidence of no association between PSF and PA (meta r=−0.09; 95% CI=−0.34, 0.161; n=430, 3 studies). Vote-counting showed a higher proportion of studies with associations between higher PSF and impaired fitness (p̂=0.83; 95% CI=0.43, 0.97; p=0.22, n=298, 6 studies), and with associations between higher PSF and lower PA (p̂=0.75; 95% CI=0.47, 0.91; p=0.08, n=2566, 16 studies). Very low- to moderate-certainty evidence reflects small study sample sizes, high risk of bias, and inconsistent results. Conclusions The meta-analysis showed moderate-certainty evidence of an association between higher PSF and impaired fitness. These results indicate that fitness might protect against PSF. Larger prospective studies, and randomized controlled trials evaluating the effect of exercise on PSF is needed to confirm these findings. This study had no funding. PROSPERO 2021 CRD42021216435