Tzu-Han Hung, Mei-Chun Liu, Ya-Wen Kuo, Jiann-Der Lee
Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Nursing, College of Nursing, Chang Gung University of Science and Technology (CGUST), No. 2, Sec. W., Jiapu Rd, Puzi, Chiayi, 61363, Taiwan.
Sports Med Open. 2025 Aug 6;11(1):91. doi: 10.1186/s40798-025-00899-6.
Knee osteoarthritis is a highly prevalent disease that affects 24-31.8% of patients who undergo total knee replacement (TKR); it impedes their rehabilitation and increases their risk of complications. The aim of this systematic review was to compare the effectiveness of multidisciplinary care intervention with that of conventional physical therapy in mitigating kinesiophobia in patients with knee osteoarthritis undergoing joint replacement.
This study was registered with the International Prospective Register of Systematic Reviews (registration no. CRD42022366356). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two Chinese databases (the National Digital Library of Theses and Dissertations and Airiti Library) and four English databases (CINAHL, Cochrane Library, PubMed, and Embase) were searched from their inception up to January 2023 for randomized controlled trials (RCTs) on multidisciplinary intervention for kinesiophobia following TKR.
Seven RCTs comprising 648 individuals (327 in the experimental group and 321 in the control group) were included in the analysis. Grading of Recommendations, Assessment, Development, and Evaluations revealed moderate evidence quality and strong recommendations for kinesiophobia, pain, and knee joint functional scales. Meta-analysis revealed that multidisciplinary care intervention significantly outperformed conventional physical therapy in terms of reducing kinesiophobia (P < 0.01), with this effect persisting for up to 6 months after the intervention. The overall effect size (standardized mean difference = -2.57, 95% confidence interval [-3.71, -1.44], P < 0.00001) was large, and no risk of publication bias was found.
Multidisciplinary care intervention reduces kinesiophobia in patients with knee osteoarthritis following TKR. It also reduces their pain scores and promotes early postoperative ambulation. Two studies of the seven included RCTs had small sample sizes (fewer than 100 individuals); this may have affected the robustness of the findings.
膝关节骨关节炎是一种高度流行的疾病，影响着24%至31.8%接受全膝关节置换术（TKR）的患者；它阻碍患者康复并增加并发症风险。本系统评价的目的是比较多学科护理干预与传统物理治疗在减轻接受关节置换的膝关节骨关节炎患者运动恐惧方面的效果。
本研究已在国际前瞻性系统评价注册库注册（注册号CRD42022366356）。按照系统评价和Meta分析优先报告项目指南，检索了两个中文数据库（国家学位论文全文数据库和华艺数位图书馆）和四个英文数据库（CINAHL、Cochrane图书馆、PubMed和Embase），从建库至2023年1月，查找关于TKR后运动恐惧多学科干预的随机对照试验（RCT）。
分析纳入了7项RCT，共648例个体（试验组327例，对照组321例）。推荐分级、评估、制定和评价显示，运动恐惧、疼痛和膝关节功能量表的证据质量为中等，推荐强度为强。Meta分析显示，多学科护理干预在减轻运动恐惧方面显著优于传统物理治疗（P<0.01），且该效果在干预后持续长达6个月。总体效应量较大（标准化均差=-2.57，95%置信区间[-3.71，-1.44]，P<0.00001），未发现发表偏倚风险。
多学科护理干预可减轻TKR后膝关节骨关节炎患者的运动恐惧。它还能降低患者的疼痛评分并促进术后早期活动。纳入的7项RCT中有两项样本量较小（少于100例个体）；这可能影响了研究结果的稳健性。
