Does pre-operative physical therapy improve post-surgical outcomes of patients undergoing a total knee and/or total hip arthroplasty? A systematic review

Gawel, Justina; Brown, Sarah E.; Collins, Jenna; McCallum, Christine

doi:10.3233/ppr-120017

Cited by 5 publications

(8 citation statements)

References 18 publications

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“…Recent systematic reviews and meta-analyses agree there is no definitive evidence as to whether a pre-operative exercise programme accelerates post-surgical recovery of physical function (36)(37)(38)(39)(40). These reviews focused on the effect of certain types of strengthe-ning, flexibility, aerobic or balance exercise; however, precise exercise prescription information pertaining to physiological stress and dosage within the included studies was either missing or inconsistently reported.…”

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confidence: 99%

“…mode, frequency, intensity and duration) in people undergoing TKA. The review addresses a knowledge gap regarding optimal exercises types and dosages, as previous reviews have not explicitly evaluated dosage-response (36)(37)(38)(39)(40). Evidence from this review will facilitate understanding of the benefit and hierarchy of importance of particular preoperative exercise modalities in this patient population.…”

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confidence: 99%

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Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials

Peer¹,

Rush²,

Gallacher³

et al. 2017

J Rehabil Med

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confidence: 99%

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confidence: 99%

Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials

Peer¹,

Rush²,

Gallacher³

et al. 2017

J Rehabil Med

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“…Previous reviews have focused on outcomes relating to preoperative function and pain, the in-hospital experience and long-term recovery 10 12–46. Review conclusions vary based on the outcomes and follow-up times.…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic literature search of MEDLINE, Embase, PsycINFO, CINAHL and The Cochrane Library on 18 December 2018, we identified 36 systematic reviews of preoperative interventions in TKR. Twenty-five of these had searches conducted more than 5 years previously,10 12–35 and nine exclusively reported short-term outcomes (3 months or less after surgery) 36–44. Two more recent reviews considered the outcome of long-term pain45 46 but neither had a registered protocol.…”

Section: Introductionmentioning

confidence: 99%

Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

et al. 2020

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ObjectiveNearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR.DesignMEDLINE, Embase, CINAHL,The Cochrane Libraryand PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation.Primary and secondary outcomesPain at 6 months or longer; adverse events.InterventionsPresurgical interventions aimed at improving TKR outcomes.ResultsEight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions.ConclusionsWe found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR.PROSPERO registration numberCRD42017041382.

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“…In a cohort of 207 patients who underwent a fast-track hip or knee arthroplasty, pain, dizziness and weakness were the main reasons patients remained in hospital at 24 and at 48 hours postoperatively (Husted et al., 2011). A systematic review on preoperative physical therapy reported that the evidence was inconclusive that it improved surgical outcomes for patients undergoing a total knee or hip arthroplasty (Gawel et al., 2013). Two of the studies in this analysis measured length of stay.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the impact of preoperative assessment on length of stay after a total hip arthroplasty

Harte

Hamill

Williams-Condell

et al. 2017

British Journal of Occupational Therapy

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Introduction: To investigate if preoperative assessment delivered by occupational therapists, physiotherapists and social workers for people awaiting a total hip arthroplasty decreased the length of stay in hospital postoperatively. Method: A retrospective data review was conducted on all patients who had a primary total hip arthroplasty across a 6-month period. A total of 101 patients (mean age 67.16 years) was included in this evaluation. Clinical notes were used to determine which patients attended or did not attend preoperative assessment. Statistical modeling was used to analyse the association of a series of variables and time spent in hospital after a total hip arthroplasty. Results: There was no significant difference in the length of stay for patients who attended preoperative assessment (P < 0.05) while patients who were medically unfit, lived alone and/or required a care package experienced a significantly higher length of stay (P < 0.05). Conclusion: These results do not support the British Orthopaedic Association's recommendation that preoperative assessment delivered by allied health professionals helps reduce length of stay. However, it identifies variables which could be managed potentially to reduce length of stay. A large multisite clinical trial is required to determine if preoperative assessment reduces length of stay for people undergoing this surgical procedure.

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Does pre-operative physical therapy improve post-surgical outcomes of patients undergoing a total knee and/or total hip arthroplasty? A systematic review

Cited by 5 publications

References 18 publications

Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials

Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials

Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

Evaluation of the impact of preoperative assessment on length of stay after a total hip arthroplasty

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