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


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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databases of published (MEDLINE, EMBASE, CINAHL, AMED, the Cochrane library database and the PEDro database) and unpublished literature were conducted.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.
机译:背景:在过去30年中,全膝关节置换术(TKA)的手术率有所增加。提倡术前康复以增强力量和功能能力,以优化术后康复。目的:进行了系统评价,以确定基于术前物理治疗的干预措施对TKA术后预后的有效性。方法:检索多个已出版的数据库(MEDLINE,EMBASE,CINAHL,AMED,Cochrane图书馆数据库和PEDro数据库)和未发表的文献。所有评估术前理疗或运动训练的随机和非随机对照试验均符合条件。 PEDro量表用于评估方法学质量。结果:共纳入11个试验,包括656名参与者。通过西安大略省和麦克马斯特大学的骨关节炎功能量表,SF-36身体功能量表,特种外科医院的膝关节评分量表,疼痛评分,运动范围或住院时间所测,两组之间的功能差异无统计学意义(P> 0.05)。在那些报告了客观功能指标的研究中,八分之五的研究报告说,术前康复与否无显着差异(P> 0.05)。在干预组中,基于神经肌肉电刺激或本体感受的干预措施表明,在TKA后12周,坐姿和楼梯爬升/下降能力得到了改善(P <0.05)。



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