Chesham Ross Alexander, Shanmugam Sivaramkumar
a Department of Psychology, Social Work and Allied Health Sciences , School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , UK.
Physiother Theory Pract. 2017 Jan;33(1):9-30. doi: 10.1080/09593985.2016.1230660. Epub 2016 Oct 13.
Knee osteoarthritis (OA) is a leading cause of disability in older adults (≥60) in the UK. If nonsurgical management fails and if OA severity becomes too great, knee arthroplasty is a preferred treatment choice. Preoperative physiotherapy is often offered as part of rehabilitation to improve postoperative patient-based outcomes.
Systematically review whether preoperative physiotherapy improves postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty (TKA) and compare study interventions to best-practice guidelines.
A literature search of Randomized Controlled Trials (RCTs), published April 2004-April 2014, was performed across six databases. Individual studies were evaluated for quality using the PEDro Scale.
Ten RCTs met the full inclusion/exclusion criteria. RCTs compared control groups versus: preoperative exercise (n = 5); combined exercise and education (n = 2); combined exercise and acupuncture (n = 1); neuromuscular electrical stimulation (NMES; n = 1); and acupuncture versus exercise (n = 1). RCTs recorded many patient-based outcomes including knee strength, ambulation, and pain. Minimal evidence is presented that preoperative physiotherapy is more effective than no physiotherapy or usual care. PEDro Scale and critical appraisal highlighted substantial methodological quality issues within the RCTs.
There is insufficient quality evidence to support the efficacy of preoperative physiotherapy in older adults who undergo total knee arthroplasty.
在英国，膝关节骨关节炎（OA）是导致60岁及以上老年人残疾的主要原因。如果非手术治疗失败且OA严重程度过高，膝关节置换术是首选的治疗选择。术前物理治疗通常作为康复治疗的一部分提供，以改善术后基于患者的治疗效果。
系统评价术前物理治疗是否能改善接受全膝关节置换术（TKA）的老年人术后基于患者的治疗效果，并将研究干预措施与最佳实践指南进行比较。
对2004年4月至2014年4月发表的随机对照试验（RCT）进行六个数据库的文献检索。使用PEDro量表对个体研究的质量进行评估。
10项RCT符合全部纳入/排除标准。RCT将对照组与以下进行比较：术前运动（n = 5）；运动与教育相结合（n = 2）；运动与针灸相结合（n = 1）；神经肌肉电刺激（NMES；n = 1）；以及针灸与运动对比（n = 1）。RCT记录了许多基于患者的治疗效果，包括膝关节力量、步行能力和疼痛。几乎没有证据表明术前物理治疗比不进行物理治疗或常规护理更有效。PEDro量表和批判性评价突出了RCT中存在的重大方法学质量问题。
没有足够的高质量证据支持术前物理治疗对接受全膝关节置换术的老年人的疗效。
