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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2015

Open Access 01-12-2015 | Research article

Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis

Authors: Neil Artz, Karen T Elvers, Catherine Minns Lowe, Cath Sackley, Paul Jepson, Andrew D Beswick

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

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Abstract

Background

Rehabilitation, with an emphasis on physiotherapy and exercise, is widely promoted after total knee replacement. However, provision of services varies in content and duration. The aim of this study is to update the review of Minns Lowe and colleagues 2007 using systematic review and meta-analysis to evaluate the effectiveness of post-discharge physiotherapy exercise in patients with primary total knee replacement.

Methods

We searched MEDLINE, Embase, PsycInfo, CINAHL and Cochrane CENTRAL to October 4th 2013 for randomised evaluations of physiotherapy exercise in adults with recent primary knee replacement.
Outcomes were: patient-reported pain and function, knee range of motion, and functional performance. Authors were contacted for missing data and outcomes. Risk of bias and heterogeneity were assessed. Data was combined using random effects meta-analysis and reported as standardised mean differences (SMD) or mean differences (MD).

Results

Searches identified 18 randomised trials including 1,739 patients with total knee replacement. Interventions compared: physiotherapy exercise and no provision; home and outpatient provision; pool and gym-based provision; walking skills and more general physiotherapy; and general physiotherapy exercise with and without additional balance exercises or ergometer cycling.
Compared with controls receiving minimal physiotherapy, patients receiving physiotherapy exercise had improved physical function at 3–4 months, SMD −0.37 (95% CI −0.62, −0.12), and pain, SMD −0.45 (95% CI −0.85, −0.06). Benefit up to 6 months was apparent when considering only higher quality studies.
There were no differences for outpatient physiotherapy exercise compared with home-based provision in physical function or pain outcomes. There was a short-term benefit favouring home-based physiotherapy exercise for range of motion flexion.
There were no differences in outcomes when the comparator was hydrotherapy, or when additional balancing or cycling components were included. In one study, a walking skills intervention was associated with a long-term improvement in walking performance. However, for all these evaluations studies were under-powered individually and in combination.

Conclusion

After recent primary total knee replacement, interventions including physiotherapy and exercise show short-term improvements in physical function. However this conclusion is based on meta-analysis of a few small studies and no long-term benefits of physiotherapy exercise interventions were identified. Future research should target improvements to long-term function, pain and performance outcomes in appropriately powered trials.
Appendix
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Metadata
Title
Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis
Authors
Neil Artz
Karen T Elvers
Catherine Minns Lowe
Cath Sackley
Paul Jepson
Andrew D Beswick
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-015-0469-6

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