Effectiveness of pre-operative physiotherapy-based programmes on outcomes following total knee arthroplasty: a systematic review and meta-analysis

摘要

Background: The rates of total knee arthroplasty (TKA) procedures have increased over the last 30 years. Prehabilitation has been advocated to enhance strength and functional capability in order to optimize postoperative rehabilitation. Objectives: A systematic review was conducted to determine the effectiveness of pre-operative physiotherapy-based interventions on outcomes following TKA. Methods: Searches of multiple databases of published (MEDLINE, EMBASE, CINAHL, AMED, the Cochrane library database and the PEDro database) and unpublished literature were conducted. All randomized and non-randomized controlled trials assessing pre-operative physiotherapy or exercise training were eligible. The PEDro scale was used to assess methodological quality. Results: Eleven trials including 656 participants were included. There were no statistically significant differences between groups for function as measured by the Western Ontario and McMaster Universities Osteoarthritis function scale, the SF-36 physical function scale, the Hospital for Special Surgery knee rating scale, pain scores, range of motion or length of stay (P>0.05). Of those studies reporting on objective measures of function, five out of eight studies reported no significant difference with the inclusion of preoperative rehabilitation (P>0.05). Interventions based on neuromuscular electrical stimulation or proprioception in the intervention group demonstrated improvements in sit-to-stand and stair climbing/ descending ability (P<0.05) at 12 weeks after TKA.