R W Jordan1, N A Smith2, G S Chahal3, C Casson4, M R Reed5, A P Sprowson6. 1. University Hospitals Coventry and Warwickshire, United Kingdom. Electronic address: Robert.jordan@doctors.org.uk. 2. University of Warwick, United Kingdom. Electronic address: Nicholas.smith@warwick.ac.uk. 3. University Hospitals Coventry and Warwickshire, United Kingdom. Electronic address: Gurdip.chahal@uhcw.nhs.uk. 4. Northumbria Healthcare NHS Foundation Trust, United Kingdom. Electronic address: Clare.casson@nhct.nhs.uk. 5. Northumbria Healthcare NHS Foundation Trust, United Kingdom. Electronic address: Mike.reed@nhs.net. 6. University of Warwick, United Kingdom. Electronic address: a.p.sprowson@warwick.ac.uk.
Abstract
BACKGROUND: Around 20% of knee replacement have an unsatisfactory outcome. Pre-operative physiotherapy and education have been proposed to improve post-operative outcomes. OBJECTIVES: This systematic review evaluated whether these factors improved length of stay and patient reported outcomes after knee replacement surgery. DATA SOURCES: Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO and PEDro were searched on the 1st January 2013. STUDY SELECTION OR ELIGIBILITY CRITERIA: Randomised or quasi-randomised studies assessing either pre-operative education or physiotherapy on patients undergoing a planned total or partial knee replacement were included in the review. Only studies with a control group receiving a defined standard of pre-operative care were included. RESULTS: Eleven studies met the inclusion criteria set. Two studies analysed the effect of pre-operative education, seven pre-operative treatment by a physiotherapist and two studies used both factors. No study found significant differences in validated joint specific patient reported outcome measures. The education studies found a decrease in pre-operative expectation and an improvement in knowledge, flexion and regularity of exercise. Two studies found an improvement in muscle strength in the group treated by a physiotherapist at three months. The combination of education and physiotherapy was shown to reduce patient length of stay and cost in one study. CONCLUSION: The evidence reviewed is insufficient to support the implementation of either pre-operative education or physiotherapy programmes. The combination of pre-operative education and treatment by a physiotherapist may reduce the medical costs associated with surgery.
BACKGROUND: Around 20% of knee replacement have an unsatisfactory outcome. Pre-operative physiotherapy and education have been proposed to improve post-operative outcomes. OBJECTIVES: This systematic review evaluated whether these factors improved length of stay and patient reported outcomes after knee replacement surgery. DATA SOURCES: Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO and PEDro were searched on the 1st January 2013. STUDY SELECTION OR ELIGIBILITY CRITERIA: Randomised or quasi-randomised studies assessing either pre-operative education or physiotherapy on patients undergoing a planned total or partial knee replacement were included in the review. Only studies with a control group receiving a defined standard of pre-operative care were included. RESULTS: Eleven studies met the inclusion criteria set. Two studies analysed the effect of pre-operative education, seven pre-operative treatment by a physiotherapist and two studies used both factors. No study found significant differences in validated joint specific patient reported outcome measures. The education studies found a decrease in pre-operative expectation and an improvement in knowledge, flexion and regularity of exercise. Two studies found an improvement in muscle strength in the group treated by a physiotherapist at three months. The combination of education and physiotherapy was shown to reduce patient length of stay and cost in one study. CONCLUSION: The evidence reviewed is insufficient to support the implementation of either pre-operative education or physiotherapy programmes. The combination of pre-operative education and treatment by a physiotherapist may reduce the medical costs associated with surgery.
Authors: Christopher P Childers; Anaar E Siletz; Emily S Singer; Claire Faltermeier; Q Lina Hu; Clifford Y Ko; Gregory J Golladay; Stephen L Kates; Elizabeth C Wick; Melinda Maggard-Gibbons Journal: Geriatr Orthop Surg Rehabil Date: 2018-02-12
Authors: Thomas W Wainwright; Mike Gill; David A McDonald; Robert G Middleton; Mike Reed; Opinder Sahota; Piers Yates; Olle Ljungqvist Journal: Acta Orthop Date: 2019-10-30 Impact factor: 3.717