Effect of Group‐Based Outpatient Physical Therapy on Function After Total Knee Replacement: Results From a Multicenter Randomized Controlled Trial

Lenguerrand, Erik; Artz, Neil; Marques, Elsa; Sanderson, Emily; Lewis, Kristina H.; Murray, James R. D.; Parwez, Tarique; Bertram, Wendy; Beswick, Andrew D; Burston, Amanda; Gooberman-Hill, Rachael; Blom, Ashley W; Wylde, Vikki

doi:10.1002/acr.23909

Cited by 17 publications

(43 citation statements)

References 40 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One study compared a high-intensity progressive rehabilitation versus low-intensity rehabilitation without progression (Bade 2017). Eight other studies had appropriate progression coded in one arm and no progression in the comparison arm (Brun-Olsen 2013, Fransen 2017, Lenguerrand 2020, Liao 2020, Madsen 2013, Hamilton 2020, Piva 2019.…”

Section: Post-acute Phase Rehabilitationmentioning

confidence: 99%

“…Interventions were delivered in various settings (and often, in combinations of settings). Ten studies evaluated one or both rehabilitation arms in outpatient settings exclusively , DeJong 2020, Lenguerrand 2020, Liao 2015, Pua 2017, Petterson 2009, Shanb 2014, Petersen 2018. Four studies evaluated one or both rehabilitation arms at home exclusively (Li 2015, Minns Lowe, 2012, Moutzouri, 2018, Moffet, 2015.…”

Section: Post-acute Phase Rehabilitationmentioning

confidence: 99%

“…We found 26 studies that reported on body structure and function outcomes following postacute rehabilitation, with various comparators: 17 studies ( , Bade 2017, Fransen 2017, Heikkilä 2017, Kauppila 2010, Lenguerrand 2020, Li 2015, Liao 2015, Liao 220, Madsen 2013, Minns Lowe 2012, Monticone 2013, Moutzouri 2018, Schache 2019, Vuorenmaa 2014) compared novel rehabilitation programs with various comparators (less intensive rehabilitation or no care); one study ) compared different (hypothesized equivalent) rehabilitation programs, no studies compared rehabilitation programs with different timing and/or intensity; four studies , Moffet 2015, Tousignant 2011) compared rehabilitation programs delivered in different settings or by different personnel, and five studies (Demircioglu 2015, Petterson 2009, Peterson 2018, Shanb 2014) compared rehabilitation programs with or without an adjunctive modality (Tables 42 to 47). The outcome domains included: symptoms, pain, range of motion, muscle strength, energy and vigor, and emotional functioning.…”

Section: Body Structure and Function Outcomes Following Post-acute Rehabilitationmentioning

confidence: 99%

“…Eleven studies , Lenguerrand 2020, Minns Lowe 2012, Monticone 2013, Schache 2019, Moffet 2015, DeJong 2020, Demircioglu 2015, Petersen 2018) reported data on symptoms using the stiffness component of the WOMAC and the symptoms component of the KOOS (Table 42). Most (n=9) studies observed no differences between groups at follow-up ranging from 3 to 12 months after TKA.…”

Section: Symptomsmentioning

confidence: 99%

“…We found pain data reported in 22 studies , Fransen 2017, Heikkilä 2017, Lenguerrand 2020, Li 2015, Liao 2015, Liao 2020, Minns Lowe 2012, Monticone 2013, Moutzouri 2018, Schache 2019, Vuorenmaa 2014, Moffet 2015, DeJong 2020, Demircioglu 2015, Petersen 2018, Petterson 2009) (Table 43), using six different outcome measures assessed between 3 and 12 months after surgery. Ten of the 13 studies that compared a novel (hypothesized better) rehabilitation program with various comparators found no difference in pain measures between groups.…”

Section: Painmentioning

confidence: 99%

See 4 more Smart Citations

Prehabilitation and Rehabilitation for Major Joint Replacement

Konnyu¹,

Thoma²,

Bhuma³

et al. 2021

View full text Add to dashboard Cite

Objectives. This systematic review evaluates the rehabilitation interventions for patients who have undergone (or will undergo) total knee arthroplasty (TKA) or total hip arthroplasty (THA) for the treatment of osteoarthritis. We addressed four Key Questions (KQs): comparisons of (1) rehabilitation prior (“prehabilitation”) to TKA versus no prehabilitation, (2) comparative effectiveness of different rehabilitation programs after TKA, (3) prehabilitation prior to THA versus no prehabilitation, (4) comparative effectiveness of different rehabilitation programs after THA. Data sources and review methods. We searched Medline®, PsycINFO®, Embase®, the Cochrane Register of Clinical Trials, CINAHL®, Scopus®, and ClinicalTrials.gov from Jan 1, 2005, to May 3, 2021, to identify randomized controlled trials (RCTs) and adequately adjusted nonrandomized comparative studies (NRCSs). We evaluated clinical outcomes selected with input from a range of stakeholders. We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. Meta-analysis was not feasible, and evidence was synthesized and reported descriptively. The PROSPERO protocol registration number is CRD42020199102. Results. We found 78 RCTs and 5 adjusted NRCSs. Risk of bias was moderate to high for most studies. • KQ 1: Compared with no prehabilitation, prehabilitation prior to TKA may increase strength and reduce length of hospital stay (low SoE) but may lead to comparable results in pain, range of motion (ROM), and activities of daily living (ADL) (low SoE). There was no evidence of an increased risk of harms due to prehabilitation (low SoE). • KQ 2: Various rehabilitation interventions after TKA may lead to comparable improvements in pain, ROM, and ADL (low SoE). Rehabilitation in the acute phase (initiated within 2 weeks of surgery) may lead to increased strength (low SoE) but result in similar strength when delivered in the post-acute phase (low SoE). No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period following TKA. Compared with various controls, post-acute rehabilitation may not increase the risk of harms (low SoE). • KQ 3: For all assessed outcomes, there is insufficient (or no) evidence addressing the comparison between prehabilitation and no prehabilitation prior to THA. • KQ 4: Various rehabilitation interventions after THA may lead to comparable improvements in pain, strength, ADL, and quality of life. There is some evidence of no increased risk of harms due to the intervention (low SoE). • There is insufficient evidence regarding which patients may benefit from (p)rehabilitation for all KQs and insufficient evidence regarding comparisons of different providers and different settings of (p)rehabilitation for all KQs. There is insufficient evidence on costs of (p)rehabilitation and no evidence on cost effectiveness for all KQs. Conclusion. Despite the large number of studies found, the evidence regarding various prehabilitation programs and comparisons of rehabilitation programs for TKA and THA is ultimately sparse. This is a result of the diversity of interventions studied and outcomes reported across studies. As a result, the evidence is largely insufficient or of low SoE. New high-quality research is needed, using standardized intervention terminology and core outcome sets, especially to allow network meta-analyses to explore the impact of intervention attributes on patient-reported, performance-based, and healthcare-utilization outcomes.

show abstract

Section: Post-acute Phase Rehabilitationmentioning

confidence: 99%

Section: Post-acute Phase Rehabilitationmentioning

confidence: 99%

Section: Body Structure and Function Outcomes Following Post-acute Rehabilitationmentioning

confidence: 99%

Section: Symptomsmentioning

confidence: 99%

Section: Painmentioning

confidence: 99%

See 3 more Smart Citations

Prehabilitation and Rehabilitation for Major Joint Replacement

Konnyu¹,

Thoma²,

Bhuma³

et al. 2021

View full text Add to dashboard Cite

show abstract

Exercise and Pain Neuroscience Education for Patients With Chronic Pain After Total Knee Arthroplasty

Larsen,

Skou,

Laursen

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceUp to 20% of patients develop chronic pain after total knee arthroplasty (TKA), yet there is a scarcity of effective interventions for this population.ObjectiveTo evaluate whether neuromuscular exercise and pain neuroscience education were superior to pain neuroscience education alone for patients with chronic pain after TKA.Design, Setting, and ParticipantsA superiority randomized clinical trial was conducted at 3 outpatient clinics at Aalborg University Hospital in Denmark. Participants with moderate-to-severe average daily pain intensity and no signs of prosthesis failure at least 1 year after primary TKA were included. Participant recruitment was initiated on April 12, 2019, and completed on October 31, 2022. The 12-month follow-up was completed on March 21, 2023.InterventionsThe study included 24 sessions of supervised neuromuscular exercise (2 sessions per week for 12 weeks) and 2 total sessions of pain neuroscience education (6 weeks between each session) or the same pain neuroscience education sessions alone. The interventions were delivered in groups of 2 to 4 participants.Main Outcomes and MeasuresThe primary outcome was change from baseline to 12 months using the mean score of the Knee Injury and Osteoarthritis Outcome Score, covering the 4 subscales pain, symptoms, activity of daily living, and knee-related quality of life (KOOS4; scores range from 0 to 100, with higher scores indicating better outcomes). The outcome assessors and statistician were blinded. All randomized participants were included in the intention-to-treat analysis.ResultsAmong the 69 participants (median age, 67.2 years [IQR, 61.2-71.9 years]; 40 female [58%]) included in the study, 36 were randomly assigned to the neuromuscular exercise and pain neuroscience education group, and 33 to the pain neuroscience education–alone group. The intention-to-treat analysis showed no between-group difference in change from baseline to 12 months for the KOOS4 (7.46 [95% CI, 3.04-11.89] vs 8.65 [95% CI, 4.67-12.63] points; mean difference, −1.33 [95% CI, −7.59 to 4.92]; P = .68). Among the 46 participants who participated in the 12-month assessment in the 2 groups, 16 (34.8%) experienced a clinically important improvement (a difference of ≥10 points on the KOOS4) with no between-group difference. No serious adverse events were observed.Conclusions and RelevanceIn this randomized clinical trial, the results demonstrated that neuromuscular exercises and pain neuroscience education were not superior to pain neuroscience education alone in participants with chronic pain after TKA. Approximately one-third of the participants, regardless of intervention, experienced clinically important improvements. Future studies should investigate which patient characteristics indicate a favorable response to exercises and/or pain neuroscience education.Trial RegistrationClinicalTrials.gov Identifier: NCT03886259

show abstract

Traversing the Challenges Facing Meaningful Interpretation of Randomized Controlled Trials With Concurrent Economic Evaluations

Davis

Adjetey

2022

Arthritis Care & Research

View full text Add to dashboard Cite

Effect of Group‐Based Outpatient Physical Therapy on Function After Total Knee Replacement: Results From a Multicenter Randomized Controlled Trial

Cited by 17 publications

References 40 publications

Prehabilitation and Rehabilitation for Major Joint Replacement

Prehabilitation and Rehabilitation for Major Joint Replacement

Exercise and Pain Neuroscience Education for Patients With Chronic Pain After Total Knee Arthroplasty

Traversing the Challenges Facing Meaningful Interpretation of Randomized Controlled Trials With Concurrent Economic Evaluations

Contact Info

Product

Resources

About