Enhanced education and physiotherapy before knee replacement; is it worth it? A systematic review

Association between household income and the outcome of arthroplasty: a register-based study of total hip and knee replacements

“…Revision may be an outcome that is not affected by patients' own input into their care, such as compliance with advice on healthy living or the conduct of physical exercise. For instance, the type of physical exercise either before or after joint arthroplasty has not been shown to have a decisive impact on the outcome of arthroplasty [16][17][18]. This may imply that Quintile 1 41 38 44 39 48 43 39 47 30 27 31 28 34 31 28 34 Quintile 2 40 38 41 37 44 40 36 44 33 30 33 30 36 34 31 37 Quintile 3 44 39 43 39 46 43 39 46 34 29 34 31 36 33 31 36 Quintile 4 45 38 43 40 47 43 40 47 34 31 34 31 36 32 30 35 Quintile 5 49 41 46 43 50 45 41 49 38 33 37 34 39 36 33 38 Arch Orthop Trauma Surg (2014) 134:1767-1774 1771 patients' own competences and activities may not have a major effect on the outcome of arthroplasty.…”

Can we just call everything physiotherapy?

“…We read the paper of Jordan and colleagues [1] on the usefulness of physiotherapy care before total knee replacement (TKR) with great interest. The authors narratively synthesized eleven studies on preoperative exercise therapy for TKR that they extracted from six different electronic databases.…”

“…We wonder whether the authors actually answered their research question. Jordan et al [1] state that "approximately 20% of patients are unsatisfied following TKR in terms of pain relief and function". Yet, they did not specify their eligibility criteria towards identifying studies that actually targeted persons at risk for unsatisfactory outcomes following TKR.…”

“…Interestingly we hardly see people take the variation in quality of the therapeutic intervention into account [5,6]. One could argue that the majority of the interventions of the studies included in the review of Jordan et al (2014) can be classified as being poorly administered physiotherapy (i.e., not reflecting, high quality, day-to-day clinical practice). Interventions that lack intensity, do not monitor progression, and/or are generally poorly thought out, thus have little potential for effectiveness and should perhaps be weighted differently in syntheses of the literature [5].…”

“…Interventions that lack intensity, do not monitor progression, and/or are generally poorly thought out, thus have little potential for effectiveness and should perhaps be weighted differently in syntheses of the literature [5]. The two points addressed above are not exclusive for the study of Jordan et al (2014), yet reflect common practice in physiotherapy research, where we put emphasis on methodological validity and forgo therapeutic validity [4]. To improve upon this fallacy we really need to rethink the way we set up exercise programs in randomized clinical trials.…”