Department of Rehabilitation, Ageing, Pain and Palliative Care, Peninsula Health, Frankston, Australia.
Epworth Monash Rehabilitation Medicine Research Unit, School of Clinical Sciences, Monash University, Clayton, Australia.
Musculoskeletal Care. 2024 Sep;22(3):e1945. doi: 10.1002/msc.1945.
Persistent high levels of knee pain after a total knee replacement have been estimated to affect 5%-10% of people and this is related to dissatisfaction with surgery, reduced function and reduced quality of life. This systematic review aims to evaluate the effectiveness of rehabilitation programs or strategies to reduce persistent pain and improve function and quality of life in people following a total knee replacement.
The systematic review was conducted following PRISMA guidelines with a search of relevant online databases up to 17 July 2024. The search criteria included English language randomised controlled trials of rehabilitation programs or strategies in any setting to treat people with persistent knee pain more than 3 months after a total knee replacement. Rehabilitation could include exercise, education, cognitive strategies and self-management programs and excluded medication trials, procedural techniques and complementary therapies.
After removal of duplicates, there were 468 abstracts screened for eligibility with 23 remaining for full-text screening and finally, one study meeting the eligibility criteria. This study's interventions were pain neuroscience education alone and pain neuroscience education plus neuromuscular exercise. There were no statistically significant between-group differences for pain reduction or functional improvement.
The evidence examining the value of rehabilitation programs or strategies for pain reduction and functional improvement in people with persistent pain following total knee replacement is deficient. Given the high number of people affected annually, further research concerning both prevention and management of persistent pain after knee replacement is warranted.
全膝关节置换术后持续存在的膝关节疼痛，据估计会影响 5%-10%的人，这与对手术的不满、功能下降和生活质量下降有关。本系统评价旨在评估康复方案或策略对减轻全膝关节置换术后持续疼痛、改善功能和生活质量的有效性。
本系统评价按照 PRISMA 指南进行，对截至 2024 年 7 月 17 日的相关在线数据库进行了检索。检索标准包括针对持续膝关节疼痛超过 3 个月的全膝关节置换术后人群的任何康复方案或策略的英语随机对照试验。康复可包括运动、教育、认知策略和自我管理方案，不包括药物试验、程序技术和补充疗法。
去除重复项后，有 468 篇摘要进行了资格筛选，有 23 篇进入全文筛选，最终有 1 项研究符合资格标准。该研究的干预措施是单纯的疼痛神经科学教育和疼痛神经科学教育加神经肌肉运动。在减轻疼痛或改善功能方面，组间无统计学差异。
关于康复方案或策略在减轻全膝关节置换术后持续疼痛人群的疼痛和改善功能方面的价值的证据不足。鉴于每年受影响的人数众多，有必要进一步研究膝关节置换术后持续性疼痛的预防和管理。
