Is physical rehabilitation superior to no physical rehabilitation following total knee arthroplasty? A systematic review and meta-analysis

Abstract

Introduction: Physical rehabilitation is widely used following total knee arthroplasty (TKA), while no consensus has been reached regarding the optimal dosage, frequency and modality. Before a standardized protocol can be established, it is important to investigate the true efficacy for physical rehabilitation following TKA. Objective: To examine if physical rehabilitation is superior to no physical rehabilitation following total knee arthroplasty in terms of patient-reported outcomes for function and pain. Methods: The search strategy was conducted in five databases (MEDLINE, Embase, Cinahl, CENTRAL and SPORTDiscus) with eligibility criteria for inclusion being: Randomised controlled trials comparing patients receiving physical rehabilitation with a group receiving no physical rehabilitation following unilateral TKA. Potential sources of bias were assessed according to the Cochrane Risk of Bias Tool. The Consensus on Exercise Reporting Template (CERT) was used to extract and report exercise interventions from the included trials. Results: Only two of 3254 identified trials fulfilled the eligibility criteria and were included. The two trials were judged as being of moderate to good methodological quality, but lacking in the reporting of their exercise interventions. Difference in outcome measurements and interventions makes between-study comparison inconclusive. Conclusions: No conclusion regarding the superiority of physical rehabilitation to no-intervention following TKA can be drawn from the results of this systematic review. Further research is required to establish the true effectiveness of physical rehabilitation following TKA. Systematic review registration number: PROSPERO 2018 CRD42018094785.

Physical rehabilitation versus no physical rehabilitation after total hip and knee arthroplasties: Protocol for a pragmatic, randomized, controlled, superiority trial (The DRAW1 trial)

“…When compared to no or minimal physical rehabilitation, physiotherapy exercises seem superior for improvements in physical function, pain and range of motion up to 3–6 months following TKA 7 . We recently undertook a systematic review 18 of RCTs that compared physical rehabilitation strictly to a “no physical rehabilitation” comparator on patient-reported outcomes for function and pain and identified only two trials 19 , 20 . The review was inconclusive, and we – along with others 7 – call for sufficiently powered trials that investigate physical rehabilitation after THA and TKA against no physical rehabilitation comparators.…”

What is the effect of supervised rehabilitation regime vs. self-management instruction following unicompartmental knee arthroplasty? – a pilot study in two cohorts

“…It has been difficult to show superiority of high‐intensity [10, 11] or supervised [12] rehabilitation exercise regimes over less intense or home‐based regimes on post‐operative recovery outcomes, such as functional performance and muscle strength. So, because it seems difficult to substantially impact post‐operative recovery after TKA when different rehabilitation exercise regimes are compared, we have recently asked whether rehabilitation exercise is superior to no rehabilitation exercise after TKA [13, 14]. This question is also relevant in UKA where the surgical trauma is smaller and where few studies have compared different rehabilitation regimes after UKA [15].…”