Zahed Mohamed, Alesawy Alzahraa Faris, Zahed Ziad Samir, Mohamed Ahmed, Samir Rahafat, Eleisawy Mahmoud
Orthopedics, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, GBR.
Ophthalmology, Faculty of Medicine, Benha University, Qalubiya, EGY.
Cureus. 2024 Dec 5;16(12):e75141. doi: 10.7759/cureus.75141. eCollection 2024 Dec.
Joint degeneration characterized by cartilage deterioration and bone wear is the hallmark of osteoarthritis (OA), a condition that worsens over time. Total knee arthroplasty (TKA) is the most common effective treatment for OA. Conventional therapy training (CTT) is the standard intervention; we are testing whether intensive therapy training (ITT) provides different results when used preoperatively. Our study compared intensive and standard preoperative physical therapy in randomized and non-randomized controlled trials, excluding various other study types. Two independent researchers assessed the risk of bias using appropriate tools (RoB 2 for RCTs (Cochrane Methods, London, UK) and ROBINS-I for non-randomized studies (Cochrane Methods, London, UK)). The analysis, conducted using ReviewManager 5.4 (Cochrane Methods, London, UK), presented results as mean differences (MD) with 95% CIs, employing fixed or random-effects models based on heterogeneity assessments. With a total number of 490 participants, ITT showed significant improvements in the six or 10-minute walk test (MD = 45.07m, P < 0.000001), quadriceps strength (MD = 0.07 Kg, P < 0.0001), range of motion (ROM) flexion (MD = 4.29, P = 0.03), isometric knee flexion (MD =2.32, P=0.04), SF-36 physical component (MD = 1.19, P <,0.0001), stair test (MD = -2.01, P = 0.01), timed up and go test (MD = -1.12, P = 0.02), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (MD = -8.43, P = 0.002). Conversely, CTT showed better results in isometric knee extension (MD = 3.45, P = 0.02). No significant differences were found in ROM extension or visual analog score (VAS) pain scores. Preoperative ITT demonstrates overall superior outcomes compared to CTT for total knee arthroplasty patients. ITT significantly improved various functional and patient-reported outcomes, including walking capacity, quadriceps strength, range of motion, and quality of life measures. However, CTT showed superiority in isometric knee extension. We recommend implementing preoperative ITT protocols for TKA patients while acknowledging the need for further research to optimize exercise specifics, frequency, and duration for optimal results.
以软骨退化和骨磨损为特征的关节退变是骨关节炎（OA）的标志，这种疾病会随着时间的推移而恶化。全膝关节置换术（TKA）是治疗OA最常见的有效方法。传统治疗训练（CTT）是标准干预措施；我们正在测试术前使用强化治疗训练（ITT）是否会产生不同的结果。我们的研究在随机和非随机对照试验中比较了强化和标准术前物理治疗，排除了各种其他研究类型。两名独立研究人员使用适当的工具评估偏倚风险（随机对照试验使用RoB 2（英国伦敦Cochrane方法），非随机研究使用ROBINS-I（英国伦敦Cochrane方法））。使用ReviewManager 5.4（英国伦敦Cochrane方法）进行分析，结果以平均差（MD）和95%置信区间表示，根据异质性评估采用固定或随机效应模型。在总共490名参与者中，ITT在6分钟或10分钟步行测试（MD = 45.07m，P < 0.000001）、股四头肌力量（MD = 0.07 Kg，P < 0.0001）、活动范围（ROM）屈曲（MD = 4.29，P = 0.03）、等长膝关节屈曲（MD = 2.32，P = 0.04）、SF-36身体成分（MD = 1.19，P < 0.0001）、楼梯测试（MD = -2.01，P = 0.01）、计时起立行走测试（MD = -1.12，P = 0.02）以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分（MD = -8.43，P = 0.002）方面显示出显著改善。相反，CTT在等长膝关节伸展方面显示出更好的结果。在ROM伸展或视觉模拟评分（VAS）疼痛评分方面未发现显著差异。对于全膝关节置换术患者，术前ITT总体上显示出优于CTT的结果。ITT显著改善了各种功能和患者报告的结果，包括步行能力、股四头肌力量、活动范围和生活质量指标。然而，CTT在等长膝关节伸展方面表现出优势。我们建议为TKA患者实施术前ITT方案，同时认识到需要进一步研究以优化运动细节、频率和持续时间以获得最佳效果。
