Comparison of the effect of pre- and post-operative physical therapy versus post-operative physical therapy alone on pain and recovery of function after total knee arthroplasty
Abstract:[Purpose] The aim of the present study was to compare the effect of pre-operative and
post-operative physical therapy versus post-operative physical therapy alone on pain and
recovery of function after total knee arthroplasty. [Subjects and Methods] Fifty patients
(18 males and 32 females) ranging in age from 48 to 80 years (mean 63.28, SD 9.44)
participated in a 6-week two-arm randomized rater-blinded trial. One group received pre-
and post-operative physical therapy whereas the other group received only post… Show more
“…Among the rest 50 studies, 31 studies were excluded, which was attributed to several factors. Lastly, 19 full-text articles were applicable to the present meta-analysis [ 8 – 11 , 14 – 28 ] (Fig. 1 ).…”
Section: Resultsmentioning
confidence: 99%
“…Pain was measured by VAS scores. Six studies [ 8 , 14 , 15 , 21 , 26 , 28 ] (317 patients) reported the effects of pre-habilitation on postoperative pain. In this study, data were extracted twice.…”
Background
There have been controversial findings for the effectiveness of rehabilitation before operation after total knee arthroplasty (TKA). This study aimed to conduct an updated, comprehensive systematic review. On that basis, the review was to be combined with meta-analysis to measure the effects of rehabilitation before operation on functions and pain after TKA.
Methods
Articles were searched by using Central Register of Controlled Trials (CENTRAL), Web of Science, EMBASE, Cochrane, Pubmed, CNKI, Wanfang, Weipu and the Chinese Biomedical Database from the beginning to December 10, 2021. The major outcomes included pain, knee flexion and extension, as well as knee range of motion (ROM). Secondary outcomes included timed-up-and-go (TUG), 6-min walk, and patient-reported functional outcome (the Knee Injury and Osteoarthritis Outcome Score (KOOS) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)). Third outcomes included the length of hospital stay.
Results
Nineteen studies recruiting 1008 patients satisfied with the inclusion criteria. Significant difference was identified in knee flexion, TUG, KOOS (knee-associated life quality and functions in sports and recreation), as well as the length of hospital stay (P < 0.05). Insignificant statistical difference was identified in pain, 6-min walk, ROM, knee extension, KOOS (pain, symptoms and function of daily living) after TKA between the two groups. No difference was found between the groups in WOMAC.
Conclusions
Preoperative rehabilitation could significantly shorten hospital stay, whereas there is not any conclusive evidence of the improvement of postoperative functions. Accordingly, in-depth high-quality studies should be conducted to confirm the effectiveness of preoperative rehabilitation in patients having received TKA.
“…Among the rest 50 studies, 31 studies were excluded, which was attributed to several factors. Lastly, 19 full-text articles were applicable to the present meta-analysis [ 8 – 11 , 14 – 28 ] (Fig. 1 ).…”
Section: Resultsmentioning
confidence: 99%
“…Pain was measured by VAS scores. Six studies [ 8 , 14 , 15 , 21 , 26 , 28 ] (317 patients) reported the effects of pre-habilitation on postoperative pain. In this study, data were extracted twice.…”
Background
There have been controversial findings for the effectiveness of rehabilitation before operation after total knee arthroplasty (TKA). This study aimed to conduct an updated, comprehensive systematic review. On that basis, the review was to be combined with meta-analysis to measure the effects of rehabilitation before operation on functions and pain after TKA.
Methods
Articles were searched by using Central Register of Controlled Trials (CENTRAL), Web of Science, EMBASE, Cochrane, Pubmed, CNKI, Wanfang, Weipu and the Chinese Biomedical Database from the beginning to December 10, 2021. The major outcomes included pain, knee flexion and extension, as well as knee range of motion (ROM). Secondary outcomes included timed-up-and-go (TUG), 6-min walk, and patient-reported functional outcome (the Knee Injury and Osteoarthritis Outcome Score (KOOS) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)). Third outcomes included the length of hospital stay.
Results
Nineteen studies recruiting 1008 patients satisfied with the inclusion criteria. Significant difference was identified in knee flexion, TUG, KOOS (knee-associated life quality and functions in sports and recreation), as well as the length of hospital stay (P < 0.05). Insignificant statistical difference was identified in pain, 6-min walk, ROM, knee extension, KOOS (pain, symptoms and function of daily living) after TKA between the two groups. No difference was found between the groups in WOMAC.
Conclusions
Preoperative rehabilitation could significantly shorten hospital stay, whereas there is not any conclusive evidence of the improvement of postoperative functions. Accordingly, in-depth high-quality studies should be conducted to confirm the effectiveness of preoperative rehabilitation in patients having received TKA.
“…Reasons for exclusion included: 1) Abstract/Title only (e.g., conference proceedings), 2) Duplications, 3) Continuous Passive Motion, 4) Study not yet published, 5) Study terminated, 6) Wrong intervention, study design, or patient population, and 7) Unable to locate/translate study. Finally, 112 RCTs were included in this review [ 18 – 24 , 26 – 130 ]. Fig.…”
Objective
The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation.
Design: Scoping review
Literature search
A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library.
Study selection criteria
All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included.
Data synthesis
The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool.
Results
There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT.
Conclusion
The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER).
Pre-registration
OSF:https://osf.io/9ku8a/
“…Research shows that physical therapy (PT) before a procedure does not appear to influence postoperative outcomes. 22 In a cohort study, Valencia et al 23 found no evidence of benefit for preoperative PT on postoperative PT treatment length or postsurgical outcomes. If patients do not undergo preprocedure PT, physical therapists should provide preoperative teaching, including gait, walker, and exercise instruction, and should identify patients' needs at home.…”
Section: Physical Therapymentioning
confidence: 98%
“…Research shows that physical therapy (PT) before a procedure does not appear to influence postoperative outcomes . In a cohort study, Valencia et al found no evidence of benefit for preoperative PT on postoperative PT treatment length or postsurgical outcomes.…”
Many surgical procedures are performed in outpatient settings, and outpatient joint replacements are one of the emerging trends in orthopedics. Rising consumer demand for value-driven health care, new technology, and pain management advancements, and more physicians training in minimally invasive surgical techniques during their residency have driven this change. When a facility is considering the establishment of an outpatient joint arthroplasty program, leaders must take into consideration the outcomes data from the facility's current joint arthroplasty program. Additional factors in establishing a successful outpatient program include careful patient selection, preoperative patient education, the presence of a case manager, and specialized protocols and techniques.
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