Sattler Larissa Nicole, Hing Wayne Anthony, Vertullo Christopher John
Bond University, 14 University Drive, Robina, QLD, 4226, Australia.
, PO Box 8711, Gold Coast, MC, QLD, 9726, Australia.
BMC Musculoskelet Disord. 2019 Jan 29;20(1):42. doi: 10.1186/s12891-019-2415-5.
Total knee replacement (TKR) patients participate in early supervised exercise therapy programs, despite a lack of evidence for such programs or the optimal type, duration or frequency to provide the best clinical outcomes. As hospital stay rates decrease worldwide, the first days after joint replacement surgery are of increasing clinical importance. The purpose of this study was to investigate any reported effects of published early exercise therapy following TKR surgery.
Databases PubMed, CINAHL, Embase, Cochrane, and Pedro were searched up to August 2018 for trials which investigated an early supervised exercise therapy, commencing within 48 h of surgery. Risk of bias was evaluated using a Modified Downs and Black Checklist and meta-analysis of results was conducted using Review Manager (RevMan). Standardised Mean Differences (SMD) or Mean Differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses.
Four studies (323 patients) that used four different interventions were identified, including Modified Quadriceps Setting, Flexion Splinting, Passive Flexion Ranging and a Drop and Dangle Flexion regime. Patients receiving the Drop and Dangle flexion protocol had superior flexion in the first 2 days after TKR and at discharge, the Flexion Splint patients were discharged earlier and had greater flexion at 6-weeks postoperatively, and the Modified Quadriceps Setting group showed greater hamstring and gluteal muscle strength. Results of the methodological quality assessment showed included studies were of moderate quality. The meta-analysis included 3 of the 4 trials and found no significant differences between groups in maximum knee flexion (MD = 1.34; 95% CI, - 5.55-8.24) or knee society scores (MD = - 1.17; 95% CI, - 4.32-1.98) assessed at 6 weeks post-operatively.
The paucity and heterogeneity of existing studies that examine early supervised exercise therapy following TKR surgery makes it challenging for clinicians to deliver high-quality evidence-based exercise programs in the early postoperative period. Although superior knee flexion range was found across differing regimes, the meta-analysis showed no significant difference in this outcome between groups at 6 weeks. The results of this review show high quality randomized clinical trials are urgently needed to evaluate the impact of early exercise following TKR surgery.
This review was registered with PROSPERO ( CRD42017081016 ).
尽管缺乏关于全膝关节置换术（TKR）患者参与早期监督运动治疗计划的证据，也不清楚提供最佳临床结果的最佳类型、持续时间或频率，但他们仍参与此类计划。随着全球住院率的下降，关节置换手术后的头几天在临床上的重要性日益增加。本研究的目的是调查TKR手术后已发表的早期运动治疗的任何报道效果。
截至2018年8月，对PubMed、CINAHL、Embase、Cochrane和Pedro数据库进行检索，以查找调查在手术48小时内开始的早期监督运动治疗的试验。使用改良的唐斯和布莱克清单评估偏倚风险，并使用Review Manager（RevMan）对结果进行荟萃分析。计算标准化均数差（SMD）或均数差（MD）以及95%置信区间，并在荟萃分析中进行合并。
确定了四项研究（323名患者），采用了四种不同的干预措施，包括改良股四头肌设置、屈曲夹板固定、被动屈曲范围训练和垂吊屈曲训练。接受垂吊屈曲训练方案的患者在TKR后的头2天和出院时屈曲度更佳，屈曲夹板固定组患者出院更早，术后6周屈曲度更大，改良股四头肌设置组的腘绳肌和臀肌力量更强。方法学质量评估结果显示纳入的研究质量中等。荟萃分析纳入了4项试验中的3项，发现术后6周评估的最大膝关节屈曲度（MD = 1.34；95% CI，-5.5至8.24）或膝关节协会评分（MD = -1.17；95% CI，-4.32至1.98）在组间无显著差异。
现有研究中关于TKR手术后早期监督运动治疗的研究数量稀少且存在异质性，这使得临床医生在术后早期提供高质量的循证运动计划具有挑战性。尽管在不同训练方案中发现了更好的膝关节屈曲范围，但荟萃分析显示6周时组间在该结果上无显著差异。本综述结果表明迫切需要高质量的随机临床试验来评估TKR手术后早期运动的影响。
本综述已在PROSPERO（CRD42017081016）注册。
