Predictors of chronic pain and level of physical function in total knee arthroplasty: a protocol for a systematic review and meta-analysis

Abstract

IntroductionOne in five patients undergoing total knee arthroplasty (TKA) experience unchanged or worse pain and physical function 1 year after surgery. Identifying risk factors for unfavourable outcomes is necessary to develop tailored interventions to minimise risk. There is a need to review more current literature with updated methodology that addresses the limitations of earlier systematic reviews and meta-analyses. We present a Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols compliant protocol for a systematic review and meta-analysis of predictors of chronic pain and impaired function after TKA.Methods and analysisThis review will include prospective longitudinal observational studies, or randomised trials (including cluster and crossover designs) that report arm-wise predictors of chronic postsurgical pain or impaired physical function at 3 months, 6 months or 12 months. A comprehensive literature search of studies published between 2000 and 2019 will be performed in Medline, Embase, CINAHL, Cochrane Library and PEDro. Blinded assessment with consensus agreement will be applied for inclusion of studies, data extraction and assessment of bias risk (Quality in Prognosis Studies tool). The co-primary outcomes, pain and impaired function, at 12 months after TKA will be analysed separately. Estimates of association between each outcome and any preoperative or intraoperative factor that may predict chronic pain or impaired physical function will be extracted from the included studies, where possible. For randomised studies, results will only be extracted from TKA arms (or the first period of crossover trials). Estimates of association from the primary evidence will be synthesised narratively, and quantitatively using multivariate meta-analysis to provide ‘pooled’ estimates of association. Subgroup and sensitivity analyses will be performed. Certainty of evidence for each predictor will be derived from the Grading of Recommendations Assessment, Development and Evaluation framework.Ethics and disseminationNo ethical issues are associated with this project. The results from this review will be published in peer-reviewed journals and presented at international conferences.PROSPERO registration numberCRD42018079069.

Factors Correlated With Physical Function 1 Year After Total Knee Arthroplasty in Patients With Knee Osteoarthritis

“…and research librarians, with feedback from the research team. 14 Published studies from January 1, 2000, to October 8, 2021, were systematically searched, with no language restrictions, in Medline (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO), Cochrane Library, and Physiotherapy Evidence Database. References were managed using Endnote X8 software version 20.2.1 (Clarivate Analytics).…”

“…Subject headings and keywords for each database are described in eTable 5 in the Supplement , and full search strategies for each database are defined in the protocol. 14 …”

“…Data from included studies were extracted to a standardized extraction form, with details in the published protocol. 14 Data included study design, sample size, country, age, sex, body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]), outcome measures used, data collection time points, statistical analyses, and estimates of association. One reviewer performed data extraction (U.O.…”

A new multivariate meta-analysis model for many variates and few studies

“…This work was motivated by an ongoing systematic review of factors that may predict chronic pain and physical function after total knee arthroplasty (TKA) [14]. About 20% of patients who undergo TKA experience post-surgical pain and reduced function [1], and numerous prognostic factors have been studied.…”

“…We converted correlation coefficients using Fisher's z-transform (hyperbolic arctangent function) prior to meta-analysis. Further details are given in our protocol [14].…”