Purpose The aim of the present study was to evaluate the efficacy and safety of non‐supervised home‐based exercise versus individualized and supervised programs delivered in clinic‐based settings for the functional recovery immediately after discharge from a primary TKA. Methods Medline, Embase, Cochrane, and PEDro databases were screened, from inception to April 2015, in search for randomized clinical trials (RCT) of home‐based exercise interventions versus individualized and supervised outpatient physical therapy after primary TKA. Target outcomes were: knee range of motion (ROM), patient‐reported pain and function, functional performance, and safety. Risk of bias was assessed with the PEDro scale. After assessing homogeneity, data were combined using random effects meta‐analysis and reported as standardized mean differences or mean differences. We set a non‐inferiority margin of four points in mean differences. Results The search and selection process identified 11 RCT of moderate quality and small sample sizes. ROM active extension data suitable for meta‐analysis was available from seven studies with 707 patients, and ROM active flexion from nine studies with 983 patients. Most studies showed no difference between groups. Pooled differences were within the non‐inferiority margin. Most meta‐analyses showed significant statistical heterogeneity. Conclusion Short‐term improvements in physical function and knee ROM do not clearly differ between outpatient physiotherapy and home‐based exercise regimes in patients after primary TKA; however, this conclusion is based on a meta‐analysis with high heterogeneity. Level of evidence I.

No abstract

Negative affect appears frequently in rheumatic diseases, but studies about their importance and prevalence in systemic sclerosis patients are scarce, and the results are inconclusive separately. We conducted a comprehensive search on April 2013 of PubMed, Medline, and PsycINFO databases to identify original research studies published. A total of 48 studies were included in this systematic review. We found negative emotions have very high levels in these patients, compared to both healthy population other chronic rheumatic patients assessed with the same instruments and cutoffs. Depression has been, of the three negative emotions that we approach to in this review, the most widely studied in systemic sclerosis, followed by anxiety. Despite the fact that anger is a common emotion in these diseases is poorly studied. Methodologic issues limited the ability to draw strong conclusions from studies of predictors. Disease-specific symptoms (swollen joints, gastrointestinal and respiratory symptoms and digital ulcers) and factors related to physical appearance were associated with negative emotions. Interdisciplinary care and biopsychosocial approach would have a great benefit in the clinical management of these patients.

Reproducibility of the UCOASMI seems very high, and apparently more reliable than conventional measures of mobility.