Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systemic review

School of Physiotherapy, University of Melbourne, Carlton, VIC, 3010, Australia.
The Australian journal of physiotherapy (Impact Factor: 3.48). 02/2004; 50(1):25-30. DOI: 10.1016/S0004-9514(14)60245-2
Source: PubMed


A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

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    • "The authors concluded that there was low to moderate quality evidence for the benefit of pre-operative exercise for Total Knee Replacement (TKR). These data are consistent with three earlier systematic reviews [16] [17] [18]. Little attention has been placed on the potential role exercise might play in preparation for surgery. "

    Full-text · Article · Oct 2015 · International Journal of Physiotherapy and Research
    • "While recent reviews have described a net benefit of prehabilitation [3] [4] [5], they have not conducted a meta-analysis nor have they focused specifically on total-body prehabilitation strategies across surgical populations. Therefore, the purpose of this study was to systematically review and meta-analyse the current literature examining the effect of total-body prehabilitation interventions on peri-and postoperative outcomes in adults undergoing surgical intervention. "
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    ABSTRACT: Objective To systematically review the evidence of pre-operative exercise, known as ‘prehabilitation’, on peri- and postoperative outcomes in adult surgical populations. Design Systematic review and meta-analysis. Data sources CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011. Methods Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-body exercise with peri- and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Risk of bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysis due to the heterogeneity of measures and methodologies for assessing other outcomes. Results In total, 4597 citations were identified by the search strategy, of which 21 studies were included. Trials were generally small (median = 54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found that total-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improving health-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitation reduced postoperative length of stay with a small to moderate effect size (Hedges’ g = -0.39, P = 0.033). Intervention-related adverse events were reported in two of 669 exercising participants. Conclusion The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physical benefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias.
    No preview · Article · Jan 2013 · Physiotherapy
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    • "Joint replacement is the end-stage surgical procedure for severe osteoarthritis of the hip or knee, and is considered to be an effective intervention for pain relief and restoration of functional ability [1] [2]. Integral to the care pathway for joint replacement patients is the provision of physiotherapy, which aims to improve both short-and long-term functional outcomes , although research has found that neither pre-operative or inpatient physiotherapy improve functional outcomes after joint replacement effectively [3] [4]. There is evidence that physiotherapy after discharge facilitates more rapid recovery of range of motion, but provides no long-term benefits [5–7]. "

    Full-text · Article · Dec 2008 · Physiotherapy
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