Effectiveness of postdischarge interventions for reducing the severity of chronic pain after total knee replacement: systematic review of randomised controlled trials

Wylde, Vikki; Dennis, Jane A; Gooberman-Hill, Rachael; Beswick, Andrew D

doi:10.1136/bmjopen-2017-020368

Cited by 20 publications

(21 citation statements)

References 53 publications

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“…Nonetheless, increasing evidence shows that a significant proportion of patients experiences a poor response to TKA (i.e. show no or little improvement) in terms of chronic knee pain [1,2], functional disability [3,4], poor quality of life (QoL) [5], and dissatisfaction after TKA [6][7][8][9][10][11][12][13]. However, both in research and in clinical practice it is challenging to identify those patients with an unfavourable course after TKA, as different definitions of non-response are being used.…”

Section: Introductionmentioning

confidence: 99%

Definitions of poor outcome after total knee arthroplasty: an inventory review

Molder

Smolders

Heesterbeek

et al. 2020

BMC Musculoskelet Disord

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Background: A significant proportion of patients experiences poor response (i.e. no or little improvement) after total knee arthroplasty (TKA) because of osteoarthritis. It is difficult to quantify the proportion of patients who experiences poor response to TKA, as different definitions of, and perspectives (clinician's and patient's) on poor response are being used. The aim of this study was therefore to review the literature and summarize definitions of poor response to TKA. Methods: A systematic search was performed to identify and review studies that included dichotomous definitions of poor outcome after primary TKA. The type, amount and combination of domains (e.g. functioning), outcome measures, type of thresholds (absolute/relative, change/cut-off), values and moments of follow-up used in definitions were summarized. Results: A total of 47 different dichotomous definitions of poor response to TKA were extracted from 2163 initially identified studies. Thirty-six definitions incorporated one domain, seven definitions comprised two domains and four definitions comprised three domains. Eight different domains were used in identified definitions: pain, function, physical functioning, quality of life (QoL), patient satisfaction, anxiety, depression and patient global assessment. The absolute cutoff value was the most common type of threshold, with large variety in value and timing of follow-up. Conclusions: Our inventory review shows that definitions of poor response to TKA are heterogeneous. Our findings stresses the need for an unambiguous definition of poor response to draw conclusions about the prevalence of poor-responders to TKA across hospitals and countries, and to identify patients at risk.

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Section: Introductionmentioning

confidence: 99%

Definitions of poor outcome after total knee arthroplasty: an inventory review

Molder

Smolders

Heesterbeek

et al. 2020

BMC Musculoskelet Disord

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“…Second, both groups had access to usual care and private PT because we wanted to assess the effectiveness of the intervention as implemented within the NHS setting. Very few trials compare a PT intervention to no care , and the purpose of our trial was to evaluate if the addition of group‐based PT to usual care could improve patient outcomes. This resulted in approximately one‐half of participants in both arms using usual care or private PT during the follow‐up, although PT usage was balanced between trial arms, and adjustment in sensitivity analyses produced similar results.…”

Section: Discussionmentioning

confidence: 99%

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

Lenguerrand

Artz

Marques

et al. 2020

Arthritis Care & Research

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Objective. To evaluate the long-term clinical effectiveness of a novel group-based outpatient physical therapy (PT) following total knee replacement (TKR).Methods. In this 2-center, unblinded, superiority, randomized controlled trial, 180 patients on a waiting list for primary TKR due to osteoarthritis were randomized to a 6 session group-based outpatient PT intervention and usual care (n = 89) or usual care alone (n = 91). The primary outcome was patient-reported functional ability measured by the Lower Extremity Functional Scale at 12 months postoperative. Secondary outcomes included knee symptoms, depression, anxiety, and satisfaction. Questionnaires were completed preoperatively and at 3, 6, and 12 months postoperatively.Results. The mean difference in function between groups was 4.47 (95% confidence interval [95% CI] 0.20, 8.75; P = 0.04) at 12 months postoperative, favoring the intervention. The mean difference in function between groups decreased over time, from 8.1 points at 3 months (95% CI 3.8, 12.4; P < 0.001) to 5.4 (95% CI 1.1, 9.8; P = 0.015) at 6 months postoperative. There were no clinically relevant differences in any secondary outcomes between groups, although patients in the intervention group were more likely to be satisfied with their PT. No serious adverse events related to the intervention were reported.Conclusion. Supplementing usual care with this group-based outpatient PT intervention led to improvements in function at 12 months after TKR, although the magnitude of the difference was below the minimum clinically important difference of 9 points. However, patient satisfaction was higher in the intervention group, and there was some evidence of clinically relevant improvements in function at 3 months.

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“…A systematic review of physiotherapy, compared with no therapy, starting immediately after a total knee replacement, found evidence for only a small mean between-group difference in pain 36 . Another systematic review evaluated the effect of post-discharge rehabilitation and physiotherapy interventions in the rst 3 months on the development of chronic pain after a total knee replacement 37 .…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of the Effectiveness of Rehabilitation Therapy to Treat People with Chronic Knee Pain Following A Total Knee Replacement.

Johns

Naylor

Thirugnanam

et al. 2020

Preprint

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Background:Chronic knee pain after a total knee replacement has been estimated to affect 10 to 30% of patients and is related to dissatisfaction with surgery, reduced function and reduced quality of life. Rehabilitation is often prescribed in the subacute period post-operatively, but it may offer benefit to the increasing numbers of patients with chronic pain after their knee replacement. The aim of this systematic review is to evaluate the effectiveness of rehabilitation to improve pain, function and quality of life in people with chronic knee pain persisting for more than 3 months following a total knee replacement.Methods: The systematic review was conducted following PRISMA guidelines with a search of the online databases Ovid Medline, Embase via Ovid, CINAHL Plus, PsycINFO, Ovid Emcare and Proquest from their earliest date to July 12, 2020. The search criteria included English language randomised controlled trials of rehabilitation strategies in any setting to treat people with chronic knee pain, defined as knee pain persisting for more than 3 months, following a total knee replacement. Rehabilitation programs included exercise therapy, patient education, cognitive and mind-body strategies and self-management and excluded medication trials, procedural techniques and complementary therapies. Results:There were 254 abstracts screened for eligibility with 13 remaining for full-text screening. Following full-text screening, there were no studies that met the eligibility criteria for evaluating rehabilitation therapy to treat chronic knee pain persisting for more than 3 months following a total knee replacement.Conclusion:Despite the high volume of knee replacement surgery and the high incidence of moderate to severe chronic pain ensuing, there is currently no evidence available that rehabilitation commencing three months after surgery can effectively treat chronic pain and disability following a total knee replacement.

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Effectiveness of postdischarge interventions for reducing the severity of chronic pain after total knee replacement: systematic review of randomised controlled trials

Cited by 20 publications

References 53 publications

Definitions of poor outcome after total knee arthroplasty: an inventory review

Definitions of poor outcome after total knee arthroplasty: an inventory review

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

A Systematic Review of the Effectiveness of Rehabilitation Therapy to Treat People with Chronic Knee Pain Following A Total Knee Replacement.

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