Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty

Londhe, Sanjay Bhalchandra; Shah, Ravi Vinod; Doshi, Amit Pankaj; Londhe, Shubhankar Sanjay; Subhedar, Kavita; Iyengar, Krishnan R; Mukkannavar, Prashant

doi:10.1186/s42836-020-00063-3

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Regarding the other short-term outcomes, no differences were found with regard to lower extremity strength, knee flexion ROM, or patient-reported quality of life. Arthrofibrosis and the possible requirement for manipulation under anesthesia (MUA) remain a chief concern of proponents of supervised PT after surgery [27]; however, studies that examined MUA rates following surgery demonstrated no differences between the supervised and home PT cohorts [14,[16][17][18]. Finally, no long differences were observed in any of the examined outcomes.…”

Section: Discussionmentioning

confidence: 99%

Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Chaudhry¹,

Hayes²,

Wells³

et al. 2023

Cureus

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Although postoperative physical therapy (PT) has long been considered essential to successful total knee arthroplasty (TKA) recovery, recent literature has suggested that unsupervised home exercise regimens may offer similar benefits to formal supervised sessions. We aimed to compare objectively measured physical function and subjective patient-reported outcomes (PROs) between primary TKA patients who received formal supervised physical therapy sessions and those who received unsupervised home exercise regimens after discharge. Six electronic databases were queried to identify randomized controlled trials comparing supervised physical therapy to unsupervised home exercise regimens in primary TKA patients after discharge. Outcomes of interest included change from baseline in objective measures (knee flexion range of motion (ROM), lower extremity strength, and aerobic capacity) and PROs (physical function and quality of life scores). These outcomes were subdivided into short-term (<6 months from surgery; closest data point to three months is used if multiple measurements were made in this time period) and long-term (≥6 months from surgery; closest data point to 12 months is used if multiple measurements were made in this time period) assessments.A total of 1,884 cases performed in 11 studies were included in this review. There were no significant differences between cohorts with regard to short-term knee flexion ROM (p = 0.7), lower extremity strength (p = 0.6), or patient-reported quality of life (p = 0.5), as well as long-term knee flexion ROM (p = 0.7), patientreported quality of life (p = 0.2), or patient-reported physical outcome scores (p = 0.3). A small difference in short-term patient-reported physical outcomes was observed in favor of the supervised cohort (standardized mean difference (SMD): 0.3 (95% confidence interval (CI): 0.01, 0.6); I 2 = 82%; p = 0.04).Formal supervised physical therapy regimens do not confer clinically significant benefits over unsupervised home exercise regimens following primary TKA. The routine use of supervised physical therapy after discharge may not be warranted. Further study is needed to determine the subset of patients that may benefit from supervised care.

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Section: Discussionmentioning

confidence: 99%

Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Chaudhry¹,

Hayes²,

Wells³

et al. 2023

Cureus

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“…Earlier evidence revealed that frequent physiotherapist's instruction helps the patients improve knee exercises and recovery outcomes. 60 Thus, HCPs should explore establishing a post-discharge joint exercise guidance program based on physiotherapist.…”

Section: Discussionmentioning

confidence: 99%

Pain Catastrophizing, Kinesiophobia and Exercise Adherence in Patients After Total Knee Arthroplasty: The Mediating Role of Exercise Self-Efficacy

Zhou,

Gao,

Gao

et al. 2023

JPR

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To examine whether exercise self-efficacy mediates the contributions of pain catastrophizing and kinesiophobia to exercise adherence in patients after total knee arthroplasty. Patients and Methods: A cross-sectional study design was conducted. A total 211 post-total knee arthroplasty patients were recruited from three orthopedics units of a tertiary hospital in China. Participants were invited to complete questionnaires on pain catastrophizing, kinesiophobia, exercise self-efficacy, and exercise adherence. Mplus 8.3 software was used to construct mediation models. Results: Pain catastrophizing and kinesiophobia were negatively correlated with exercise adherence (r = −0.509, r = −0.605, p < 0.001 respectively), while exercise self-efficacy were positively associated with exercise adherence (r = 0.799, p < 0.001). The results found exercise self-efficacy mediated the correlations of pain catastrophizing and kinesiophobia with exercise adherence after adjusting for demographic and clinical covariates. Pain catastrophizing indirectly affected patients' exercise adherence through its effect on exercise efficacy (indirect effect: −0.412), while Kinesiophobia is directly associated with exercise adherence and also indirectly through exercise self-efficacy (direct effect: −0.184, indirect effect: −0.415). Conclusion: Patients after total knee arthroplasty who have high levels of psychological distress (pain catastrophizing and kinesiophobia) are vulnerable to be non-adherent to exercise behaviors. Exercise self-efficacy explains the effects of pain catastrophizing and kinesiophobia on exercise adherence and may be a key target for measures to improve exercise behaviors in patients after total knee arthroplasty.

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When and How to Mobilize Under Anesthesia After TKA?

Kyriakidis,

Achlatis,

Totlis

et al. 2024

Fast Track Surgery in Hip and Knee Arthroplasty

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Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty

Cited by 3 publications

References 32 publications

Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Pain Catastrophizing, Kinesiophobia and Exercise Adherence in Patients After Total Knee Arthroplasty: The Mediating Role of Exercise Self-Efficacy

When and How to Mobilize Under Anesthesia After TKA?

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