Introduction
Methods
Search strategy and study selection
Main outcome variables
Quality assessment
Data analysis
Results
Interventions
Type of intervention | Study | Description of intervention | When was the intervention applied? |
---|---|---|---|
Music | Allred [32] Prospective cohort | I: Easy-listening music with headphones for 20 min | Before and after their first ambulation at the first postoperative day |
C: 20-min quiet rest period | |||
Aris [33] RCT | I: Additional relaxing music therapy during recovery (< 60 beats per minute) | During recovery | |
C: Usual care | |||
Chen [34] RCT | I: Five compositions of 30 min soothing piano and Chinese violin music (60–80 beats per minute) | Ward before surgery, in the waiting area of the surgical room and twice during postoperative recovery | |
C: No music | |||
Hsu [35] Prospective cohort | I: Slow relaxing music with slow tempo, low tone and soft melody | Once a day at the 10 a.m. continuous passive motion (CPM) session on the first and second postoperative day | |
C: No music, required to rest in bed | |||
Hsu [36] Single-group QES | I: Music for 10 min before receiving CPM until the end of the CPM session | During CMP the first and second days after surgery | |
C: Rest in bed for 10 min before CPM began | |||
Keshmiri [37] RCT | I1: Isolation of noice by soundproof headphones in conjunction to disposable earplugs | During surgery, after the effect of sedative (Propofol) was applied | |
I2: Music of patients' choice with headphones | |||
C: No isolation of noise or music | |||
Leonard [38] RCT | I: Co-treatment session that used live music to support exercise | Postsurgery, after admission to the inpatient rehabilitation unit | |
C: Physiotherapy without music | |||
Santhna [39] QES | I: Music for five days post-operatively and analgesics | 5 days postoperatively | |
C: No music, only pharmacological intervention | |||
Simcock [40] RCT | I: Music of patients' choice with headphones | During surgery, after a spinal-epidural anaesthesia and sedation with propofol | |
C: White noise emanating from the headphones | |||
Education | Atabaki [41] RCT | I: Educational intervention presented as a combination of lecture, group discussion, individual education, questions and answers | Four perioperative stages (one day before surgery, 24 h and 48 h later, upon discharge from the hospital) |
C: Usual care | |||
Aytekin [42] Prospective cohort | I: Education (about OA, joint protection, home safety, and TKA) and home-based exercise | During 12 weeks before the operation | |
C: No additional training program, usual care | |||
Chen [43] QES | I: Cognitive-behavioural educational intervention (pamphlet, CD and oral instructions) | Before surgery after hospitalisation and 1 days postsurgery | |
C Routine care and usual instructions delivered orally | |||
Huang [44] RCT | I: 40-min preoperative home rehabilitation education program by a physiotherapist | 2–4 weeks prior to admission | |
C: No education program | |||
Huang [45] RCT | I: Traditional education, telephone education and mobile education | Following surgery | |
C: Traditional face-to-face and telephone education | |||
Lee [46] RCPS | I1: Psychoeducation on CPSP and prerecorded hypnotic intervention using audiotapes | One delivered before and another delivered at least 24 h after surgery | |
I2: Psychoeducation on CPSP and diaphragmatic breathing relaxation exercise | |||
C: Usual care | |||
Lin [47] QES | I: One-to-one less than 30 min preadmission preoperative teaching* | Preadmission preoperative | |
C: Postadmission preoperative teaching and no video | |||
Louw [48] CCTWAA | I: Education program and an additional 30-min group pain neuroscience education session | Before surgery | |
C: Only education program | |||
Malletschek [49] RCT | I: Additional pain psychoeducation over at least 45 min | 3–6 days after TKA | |
C: Usual care | |||
Moulton [50] Prospective cohort | I: Joint school by members of a multidisciplinary group explaining the process of the surgery | Preoperative for 2 h | |
C: No joint school | |||
Piva [51] RCT | I: Interactive education to promote physical activity and healthy eating | During 3 months postoperative: 2 lectures during the first postoperative week and mini-sessions of physical activity promotion in the subsequent weeks | |
C: No education | |||
Reslan [52] QES | I: One to one intervention (30–40 min) including education and exercise training by a nurse | Prior to surgery | |
C: Standard hospital care | |||
Timmers [53] RCT | I: Day-to-day postoperative care information related to topics such as pain, physiotherapy exercises, wound care, and daily self-care activities through an application | During the 28-day period after discharge | |
C: Only weekly, basic information | |||
Wilson [54] RCT | I: Usual teaching and preoperative educational intervention** | Teaching session and booklet within 4 weeks prior to surgery Phone call during a week before surgery | |
C: Usual teaching | |||
Yajnik [55] Retrospective cohort | I: Pain management educational card*** | Prior to peripheral nerve block placement on the day of surgery, at the time of ward admission by the bedside nurse and once daily during rounds | |
C: Before implementation of pain management educational card | |||
Psychotherapy | Birch [56] RCT | I: CBT based pain education of approximately 45 min delivered by 2 physiotherapists | 3 sessions preoperatively and 4 sessions postoperatively (2 weeks before surgery until 3 months after surgery) |
C: Usual care | |||
Cai [57] RCT | I: CBT | After TKA | |
C: No CBT | |||
Cai [58] RCT | I: Individually tailored CBT by a physiotherapist and a psychologist | During 4 weeks after surgery | |
C: No CBT | |||
Das Nair [59] RCT | I: 10 sessions of CBT during hour-long sessions by one or two psychologists | During waiting time for surgery | |
C: No CBT | |||
Harnirattisai [60] QES | I: 25-min sessions of nurse-patient interaction and discussion**** | At the fourth postoperative day and two weeks after surgery | |
C: No behavioural change intervention | |||
Jacobson [61] RCT | I: 19- to 21- minute audio recordings of guided imagery$ scripts designed for TKA patients | Every day for two weeks before surgery and three weeks after surgery | |
C: Commercially available 17- to 21-min audio recordings | |||
Riddle [62] QES | I: Intervention delivered by trained psychologists# | During 8 weekly sessions from approximately one month prior to surgery to one month after surgery | |
C: No intervention | |||
Riddle [63] RCT | I1: Eight 50-min sessions of 1-on-1 pain coping skills training | Approximately 2 weeks preoperatively to approximately 6 weeks postoperatively | |
I2: Eight 50-min sessions of 1-on-1 arthritis education by registered nurses | |||
C: Usual care | |||
Russo [64] RCT | I: Video according to the Videoinsight Methods^ principles | Three times a week during the first 3 months after surgery | |
C: No video | |||
Tristaino [23] Prospective cohort | I: Four psychologist-patient sessions of 30 min focusing on defining the psychological themes and concepts on which to focus the activity | One before surgery, two during postoperative hospital stay and one during rehabilitation | |
C: Standard of care | |||
Remaining | Baldwin [66] RCT | I1: Three or four 30-min Reiki treatments provided by three expert Reiki professionals | During the hospital stay |
I2: Standard of care and three or four sham Reiki session delivered by non-trained people | |||
C: Standard of care and sessions of “quiet time” | |||
Christiansen [67] RCT | I: Standard of care rehabilitation plus weight baring biofeedback training | On the morning before surgery (20 min) and after admission to the post anaesthesia care unit (30 min) and 20 min at the first, second and third postoperative day | |
C:Standard of care rehabilitation alone | |||
Hiraga [68] NRCT | I: Occupational therapy & self-monitoring using a diary | From 1 to 2 weeks postoperatively | |
C: Occupational therapy only | |||
Koo [69] RCT | I: Enhanced reality analgesia | Shortly after physiotherapy for 5 times a week, for 2 weeks | |
C: No enhanced reality analgesia | Shortly after physiotherapy for 5 times a week, for 1 week | ||
Notte [70] Prospective cohort | I: Weight bearing (WB) biofeedback-assisted progressive muscle relaxation training sessions using a Nintendo Wii fit Plus game and associated Wii balance board | Twice weekly at home for 6 weeks after surgery | |
C: Standard of care | |||
Wang [71] QES | I: CPM therapy and 30-min biofeedback relaxation training | One day before surgery and twice a day on the five first postoperative days, concurrent with CPM therapy | |
C: Only CPM therapy |
Music
Education
Psychotherapy
Other/remaining interventions
Outcomes
Pain
Type of intervention | Study | Nr TKA | Females (%) | Age mean ± SD | Follow-up | Outcome score (pain) | I score ± SD | C score ± SD | Statistically significance at latest follow-up | |
---|---|---|---|---|---|---|---|---|---|---|
Music | Allred 2010 | T | 56 | 31 (55.4) | 63.9 (64-84)* | 6 hours | VAS | 41.2 ± 25.8 | 45.1 ± 31.2 | P = 0.337 |
I | 28 | MPQ | 15.9 ± 10.6 | 14.9 ± 12.3 | P = na, no statistical analysis between groups | |||||
C | 28 | Opioid use (morphine or dilaudid) | na | na | P = 0.388 and P = 0.152 (regarding which oral medication) | |||||
Aris 2019 | T | 56 | 60 minutes | VAS | 0 (24.39 ** | 1.5 (32.61)** | P = 0.045 | |||
I | 28 | 19 (67.9) | 63.71±11.005 | |||||||
C | 28 | 19 (67.9) | 64.50±8.851 | |||||||
Chen 2015 | T | 30 | 20 (66.7) | 68 (53-85)* | Postoperative days | VAS (recovery) | 3.22 ± 0.22*** | 3.00 ± 0.25*** | P = 0.50 | |
I | 15 | VAS (ward) | 3.07 ± 0.26*** | 2.87 ± 0.18*** | P = 0.53 | |||||
C | 15 | Opioid use (parenteral morphine, meperidine, fentanyl in PO recovery) | 7.39 ± 2.66 | 6.86 ± 2.29 | P = 0.57 | |||||
Opioid use (parenteral morphine, meperidine, fentanyl in the ward) | 12.04 ± 14.43 | 12.90 ± 8.05 | P = 0.89 | |||||||
Hsu 2019 | T | 49 | 34 (69.4) | 73.9 ± 7.5 | 2 days | NRS | 0.06 ± 0.24 | 2.14 ± 1.10 | P < 0.01 | |
I | 49 | |||||||||
C | 49 | |||||||||
Keshmiri 2014 | T | 83 | 52 (62.7) | 68.7 ± 0.96 | 2-7 days | VAS (day 1-3) | 1.33 ± 0.11 (I1) & 1.44 ± 0.13 (I2) | 1.49 ± 0.13 | P = 0.718 | |
I1 | 28 | VAS (day 4-7) | 0.9 ± 0.15 (I1) & 0.81 ± 0.13 (I2) | 1.23 ± 0.19 | P = 0.330 | |||||
I2 | 27 | VAS (day 17) | 1.09 ± 0.12 (I1) & 1.08 ± 0.11 (I2) | 1.34 ± 0.14 | P = 0.435 | |||||
C | 28 | Days of pain catheter duration (type of pain medication na) | 3.43 ± 0.11 (I1) 7 3.48 ± 0.12 (I2) | 3.36 ± 0.19 | P = 0.452 | |||||
Leonard 2019 | T | 32 | Postoperative days | NRS | 5.44 ± 3.2 | 5.56 ± 2.52 | "No significant difference" | |||
I | 16 | 11 (68.8) | 67.9 (45-87)* | Observational coding for pain | 3.06 ± 3.13 | 2.31 ± 2.36 | P = 0.02 | |||
C | 16 | 12 (75) | 67.6 (53-80)* | |||||||
Santhna 2015 | T | 40 | 14 (70) 18 (90) | 63.80±5.64 64.90±6.94 | 5 (days) | PRI | 11.78^ | 29.23^ | P = 0.00 | |
I | 20 | |||||||||
C | 20 | VAS | 14.20^ | 26.80^ | P = 0.00 | |||||
PPI | 15.00^ | 26.00^ | P = 0.001 | |||||||
Paracetamol | 16000mg^^ | 17000 mg^^ | P > 0.05 | |||||||
Celecoxib | 600 mg^^ | 1600 mg^^ | P > 0.05 | |||||||
Tramadol | 125 mg^^ | 225 mg^^ | P > 0.05 | |||||||
Simcock 2008 | T | 30 | 18 (60) | 67.3±9.1 | 24 hours | VAS (3 hours PO) | 3.87 ± 3.44 | 1.47 ± 1.39 | P = 0.01 | |
I | 15 | VAS (6 hours PO) | 5.26 ± 3.04 | 3.38 ± 2.48 | P = 0.075 | |||||
C | 15 | VAS (24 hours PO) | 4.03 ± 2.89 | 2.41 ± 1.67 | P = 0.04 | |||||
Education | Atabaki 2019 | T | 56 | 6 (weeks) | WOMAC | 40.47 ± 10.47 | 57.29 ± 7.51 | P = 0.001 | ||
I | 48 | 46 (95.8) | 65.39 ± 5.08 | |||||||
C | 48 | 41 (85.4) | 63.83 ± 5.14 | |||||||
Aytekin 2019 | T | 44 | 6 months | VASpr | 0.4 ± 0.9 | 0.8 ± 1.1 | "no significant difference between groups" | |||
I | 23 | 18 (78.3) | 67.8 ± 6.3 | VASpa | 1.5 ± 1.5 | 2.3 ± 2.3 | "no significant difference between groups" | |||
C | 21 | 18(85.7) | 69.7 ± 6.4 | KOOSpain | 87.9 ± 15.4 | 92.7 ± 8.3 | "no significant difference between groups" | |||
Chen 2014 | T | 92 | 63 (68.5) | 69.26 ± 9.025 | 5 days | NRS (worst pain) | 4.89 ± 2.82 | 5.57 ± 2.84 | P = 0.308 | |
I | 42 | NRS (average pain) | 2.38 ± 1.97 | 2.43 ± 2.03 | P = 0.916 | |||||
C | 50 | NRS (current pain) | 2.46 ± 2.31 | 2.57 ± 2.26 | P = 0.836 | |||||
Huang 2011 | T | 242 | 174 (71.6) | 70.2 ± 7.3 | 5 days | VAS | 2.4 ± 0.7 | 2.5 ± 0.6 | P = 0.686 | |
I | 125 | |||||||||
C | 117 | |||||||||
Louw 2019 | T | 103 | 6 (months) | NRS | na | na | P = 0.386 | |||
I | 49 | 32 (65.3%) | 74.1 ± 9.5 | Morfine | 2601.62 ± 1103.90 | 2734.02 ± 1324.60 | P = 0.635 | |||
C | 54 | 23 (51.9) | 69.6 ± 10.6 | |||||||
Mallet-schek 2019 | T | 75 | 47 (62.7) | 59-78* | 3 months | KOOSpain | na | na | P = 0.01 | |
I | 37 | |||||||||
C | 38 | |||||||||
Lee 2019 | T | 24 | 6 months | NRS | 1.40 ± 0.89 (I1) & 1.73 ± 1.40 (I2) | 2.23 ± 1.41 | HYP vs. control: P = 0.134 and P = 0.038 (when controlled for covariates) MET vs. Control: PP = 0.975 | |||
I1 | 8 | 7 (87.5) | 65.63 ± 9.27 | |||||||
I2 | 8 | 7 (87.5) | 56.25 ± 11.22 | |||||||
C | 8 | 8 (100) | 67.88 ± 10.38 | |||||||
Moulton 2017 | T | 563 | na | 70.1 ± na | 2 years | OKS (6 months PO) | 28.71 ± na | 31.60 ± na | P = 0.251 | |
I | 503 | OKS (2 years PO) | 30.17 ± na | 33.26 ± na | P= 0.440 | |||||
C | 60 | |||||||||
Piva 2017 | T | 44 | 31 (70.5) | 6 months | WOMAC pain | min 1.7 (95% CI -3.0,-4.0) ^^^ | min 0.3 (95% CI - 1.5, 1.0) ^^^ | P = 0.035 | ||
I | 22 | 68.1 ± 7.5 | ||||||||
C | 22 | 68.3 ± 5.5 | ||||||||
Reslan 2018 | T | 60 | na | 4 weeks | HSSpain | 22.83 ± 4.78 | 19.18 ± 5.14 | PP = 0.001 | ||
I | 30 | 19 (63.6) | ||||||||
C | 30 | 17 (56.7) | ||||||||
Timmers 2019 | T | 213 | 4 weeks after discharge | NRS at rest | 3.45^ | 4.59^ | PP = 0.001 | |||
I | 114 | 74 (64.9) | 64.74 ± 7.57 | NRS activity | 3.99^ | 5.08^ | P < 0.001 | |||
C | 99 | 60 (60.6) | 65.63 ± 7.90 | NRS at night | 4.18^ | 5.21^ | P = 0.003 | |||
Wilson 2016 | T | 143 | 89 (62.6) | 3 days | BPI-I | 24.4 ± 14.4 | 22.4 ± 15.1 | PP = 0.45 | ||
I | 73 | 67 ± 8 | NRS (rest) | 2.8 ± 2.5 | 2.8 ± 2.7 | P = 0.70 | ||||
C | 70 | 66 ± 8 | NRS (moving) | 5.4 ± 3.0 | 6.1 ± 2.5 | P = 0.20 | ||||
NRS worst pain last 24 hours) | 7.0 ± 2.4 | 7.0 ± 2.3 | P = 0.87 | |||||||
Opioid use (morphine, hydroporphone, oxycodon, codeine) | 40 (45)*^ | 40 (42)*^ | "no difference between groups in daily 24-hours opioid administration" | |||||||
Yajnik 2018 | T | 40 | 3 (7.5) | 68 (46-80)* | 2 days | Opioid use (morphine, MME PO day 1 and 2) | 38 (1-117)* | 72 (32-285)* | P = 0.001 | |
I | 20 | Minimum pain (patients’ verbal rating 0–10) 1 day PO | 0 (0 - 3)* | 0 (0 - 6)* | P = 0.151 | |||||
C | 20 | Maximum pain (patients’ verbal rating 0–10) 1 day PO | 4 (2 - 9)* | 8 (1 - 10)* | P = 0.114 | |||||
Psycho-therapy | Birch 2019 | T | 60 | 1 (year) | VAS activity | 12 (5-18)^^^ | 9 (3-15) ^^^ | P = NS | ||
I | 31 | 22 (33) | 66 ± 9 | VAS rest | 7 (1–12)^^^ | 6 (1–12) ^^^ | P = NS | |||
C | 29 | 18 (27) | 66 ± 10 | |||||||
Cai 2017 | T | 108 | 6 months | KSS | 82.61 ± 6.38 | 73.30 ± 8.45 | P < 0.01 | |||
I | 54 | 31 (57.4) | 62.42 ± 6.59 | |||||||
C | 54 | 34 (63.0) | 63.94 ± 6.58 | |||||||
Cai 2018 | T | 100 | 62 (55.9) | 6 months | NRS | 5.63 ± 0.73 | 6.27 ± 0.86 | time effects: P < .001); group effects: P = 0.003); group-by-time interaction: P = 0.080 | ||
I | 50 | 65.26 ± 8.30 | ||||||||
C | 50 | 66.18 ± 7.04 | ||||||||
Das Nair 2018 | T | 50 | 23 (46) | WOMAC pain | 6.5 ± 3.6 | 7.5 ± 2.3 | P = 0.40 | |||
I | 25 | 65.7 ± 8.6 | ICOAP constant pain (item 1-5) | 6.4 ± 4.4 | 6.2 ± 3.2 | P = 0.99 | ||||
C | 25 | 66.7 ± 9.9 | ICOAP constant pain (item 1, 3, 4, 5) | 4.8 ± 3.7 | 5.1 ± 3.0 | P = 0.82 | ||||
ICOAP constant pain (converted rasch score item 1, 3, 4, 5) | 5.5 ± 4.1 | 6.0 ± 3.2 | P = 0.75 | |||||||
ICOAP intermittent pain (item 6-11) | 8.5 ± 5.6 | 10.2 ± 4.5 | P = 0.43 | |||||||
ICOAP intermittent pain (item 6, 7, 10, 11) | 5.7 ± 3.8 | 7.1 ± 3.3 | P = 0.33 | |||||||
ICOAP intermittent pain (converted rasch score item 6, 7, 10 11) | 5.5 ± 3.4 | 6.7 ± 3.0 | P = 0.34 | |||||||
Jacobson 2016 | T | 58 | 51 (62.2) | 65 (41-81)* | 6 months | WOMAC pain | 2.7 ± 3.1 | 3.5 ± 3.3 | P < 0.001 | |
I | 29 | VAS daily pain | na | na | P not available at 6 months postoperatively | |||||
C | 29 | |||||||||
Riddle 2011 | T | 63 | 45 (71.4) | 2 months | WOMAC pain | 6.0 ± 4.1 | 8.6 ± 3.7 | P = 0.017 | ||
I | 18 | 63.8 ± 11.5 | ||||||||
C | 45 | 60.8 ± 9.9 | ||||||||
Riddle 2019 | T | 402 | 12 months | WOMAC pain | 3.3 (95% CI 2.5, 4.2) (I1) & 3.0 (95% CI 2.1, 3.8) (I2)^^^ | 2.9 (95% CI 2.0, 3.8)^^^ | P= 0.60 | |||
I1 | 130 | 94 (72.3) | 62.6 ± 7.9 | NRS | 1.8 (95% CI 1.2, 2.4) (I1) & 2.0 (95% CI 1.3,2.6) (I2) ^^^ | 1.7 (95% CI 1.1, 2.2) ^^^ | P = na | |||
I2 | 135 | 85 (63.0) | 64.2 ± 8.5 | |||||||
C | 137 | 88 (64.2) | 62.7 ± 7.7 | |||||||
Tristaino 2015 | T | 64 | 44 (62.0) | 4 months | SF-36 bodily pain | 70.1 ± 21.5 | 67.8 ± 26.8 | P = 0.715 | ||
I | 33 | 64.2 ± 8.6 | ||||||||
C | 31 | 66.1 ± 6.6 | ||||||||
Remaining | Baldwin 2017 | T | 56 | na | na | 72 hours | VAS | na | na | "Reiki significant pain reduction (P = 0.003), Sham Reiki and SOC no significant reduction" |
I1 | 25 | Opioid use (oxycontin, oxycodone, morphine) | na | na | P = na, not mentioned in significant results) | |||||
I2 | 12 | |||||||||
C | 19 | |||||||||
Hiraga 2019 | T | 41 | 4 weeks | NRS rest | 1.3 ± 0.4 | 1.2 ± 0.4 | P = 0.965 | |||
I | 20 | 16 (80) | 76.4 ± 7.1 | NRS walk | 1.3 ± 0.2 | 3.2 ± 0.6 | P= 0.017 | |||
C | 21 | 19 (90.4) | 76.6 ± 5.5 | |||||||
Koo 2018 | T | 120 | 5 weeks | VAS | na (figure) | na (figure) | "No signicance was found in VAS analyses between the groups" | |||
I | 60 | 17 (28.3) | 65.00 ± 6.97 | |||||||
C | 60 | 15 (25) | 63.71 ± 5.09 | |||||||
Notte 2016 | T | 43 | na | na | 3 days postoperatively | NRS | na | na | P = 0.000 (1, 2, 3 days PO) | |
I | 23 | Opioid use (type of opioid na) | na | na | P = 0.92 | |||||
C | 20 | |||||||||
Wang 2015 | T | 66 | 23 (34.9) | 73.5 ± 9.5 | 5 days | NRS | 3.36 ± 1.47 | 4.23 ± 1.67 | P < 0.001 | |
I | 33 | Opioid use (pethidine PO day 5) | 1 (3.2) | 0 (0.0) | P = 0.49 | |||||
C | 33 | PMU (Acetaminophen or COX-2 inhibitor + pethidine or tramadol PO day 5) | 24 (77.4) | 21 (63.6) | P = 0.27 |
Function
Type of intervention | Study | Nr TKA | Females (%) | Age mean ± SD | Follow-up | Outcome score (function) | I score ± SD | C score ± SD | Statistically significance at latest follow-up | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Music | Hsu [35] | T | 91 | 67 (73.6) | 2 days | CPM angles 1 day PO | 24.29 ± 5.00 | 12.98 ± 4.43 | P < 0.01 | ||
I | 49 | 73.9 ± 7.5 | CPM angles 2 days PO | 21.22 ± 2.98 | 16.07 ± 4.49 | P < 0.01 | |||||
C | 42 | 71.33 ± 8.45 | Active knee flexion ROM 2 days PO | 106.22 ± 6.17 | 95.00 ± 6.80 | P < 0.01 | |||||
Hsu [36] | T | 49 | 2 days | Increased degree of knee flexion during CPM | 21.22 ± 2.98 | 10.02 ± 3.03 | P < 0.01 | ||||
I | 49 | 34 (69.4) | 73.9 ± 7.5 | ||||||||
C | 49 | 34 (69.4) | 73.9 ± 7.5 | ||||||||
Leonard [38] | T | 32 | Postoperative days | Observational coding for pedalling adherence | 7.81 ± 0.40 | 7.44 ± 1.21 | "No significant difference" | ||||
I | 16 | 11 (68.8) | 67.9 (45–87)* | ||||||||
C | 16 | 12 (75) | 67.6 (53–80)* | ||||||||
Education | Atabaki [41] | T | 96 | 6 weeks | WOMAC stiffness | 19.53 ± 12.34 | 41.66 ± 10.09 | P = 0.001 | |||
I | 48 | 46 (95.8) | 65.39 ± 5.08 | WOMAC performance difficulty | 43.48 ± 7.96 | 55.82 ± 4.30 | P = 0.001 | ||||
C | 48 | 41 (85.4) | 63.83 ± 5.14 | ||||||||
Aytekin [42] | T | 44 | 6 months | KOOS total | 82.2 ± 16.1 | 85.5 ± 9.5 | "No significant difference between groups" | ||||
I | 23 | 18 (78.3) | 67.8 ± 6.3 | KOOSdaily living activities | 87.2 ± 18.3 | 91.1 ± 9.2 | "No significant difference between groups" | ||||
C | 21 | 18(85.7) | 69.7 ± 6.4 | KOOSsports | 52.8 ± 24.4 | 56.1 ± 13.1 | "No significant difference between groups" | ||||
Chen [43] | T | 92 | 63 (68.5) | 69.26 ± 9.025 | 5 days | Overall rating of nine physical function items | 12.38 ± 2.806 | 12.05 ± 3.682 | P = 0.625 | ||
I | 42 | Ankle pumping | 1.55 ± 0.39 | 1.54 ± 0.44 | P = 0.927 | ||||||
C | 50 | Quadriceps setting | 0.17 ± 0.39 | 0.23 ± 0.43 | P = 0.518 | ||||||
Knee flexion/extension | 0.44 ± 0.53 | 0.69 ± 0.66 | P = 0.062 | ||||||||
Straight-leg raises | 1.22 ± 2.58 | 0.64 ± 0.56 | P = 0.000 | ||||||||
MPOAL | 3.71 ± 0.622 | 3.08 ± 1.090 | P = 0.004 | ||||||||
Huang 2011 | T | 242 | 174 (71.6) | 70.2 ± 7.3 | 5 days | Ability to walk during discharge | 85.7 ± na | 81.2 ± na | P = 0.343 | ||
I | 125 | ROM | 76 ± 22 | 74 ± 20 | P = 0.582 | ||||||
C | 117 | ||||||||||
Huang [45] | T | 150 | 102 (68.0) | 3 months | ROM ITT ROM PP | 110.6 ± 6.68 110.0 ± 6.33 | 105.00 ± 8.82 103.26 ± 7.57 | P < 0.001 P < 0.001 | |||
I | 75 | 62.42 ± 6.59 | |||||||||
C | 75 | 63.94 ± 6.58 | |||||||||
Lin [47] | T | 60 | 31 (51.7) | 68.6 ± na | EPC | 14.93 ± na | 8.87 ± na | P < 0.05 | |||
I | 30 | Knee flexion | 77.84 ± na | 70.16 ± na | P = 0.013 | ||||||
C | 30 | Ambulation ability | na | na | "The differences between groups were not significant" | ||||||
Louw [48] | T | 101 | 6 months | WOMAC | na | na | P = 0.222 | ||||
I | 49 | 32 (65.3) | 74.1 ± 9.5 | ||||||||
C | 54 | 23 (51.9) | 69.6 ± 10.6 | ||||||||
Malletschek 2019 | T | 75 | 47 (62.7) | 59 – 78** | 3 months | KSS | na | na | P = 0.08 | ||
I | 37 | ||||||||||
C | 38 | ||||||||||
Moulton [50] | T | 563 | na | 70.1 ± na | 2 years | OKS (6 months PO) | 28.71 ± na | 31.60 ± na | P = 0.251 (6 months) | ||
I | 503 | ||||||||||
C | 60 | ||||||||||
OKS (2 years PO) | 30.17 ± na | 33.26 ± na | P = 0.440 (2 years) | ||||||||
Piva [51] | T | 44 | 31 (70.5) | 6 months | SF-36 PF | 76.7 ± 16.1 | 70.3 ± 24.2 | P = 0.017 | |||
I | 22 | 68.1 ± 7.5 | Single-leg stance test | 16.1 ± 9.6 | 17.4 ± 9.8 | P = 0.037 | |||||
C | 22 | 68.3 ± 5.5 | WOMAC PF | 11.8 ± 6.7 | 12.8 ± 10.8 | P = 0.558 | |||||
Stair-climb | 14.3 ± 4.1 | 15.6 ± 7.4 | P = 0.054 | ||||||||
Chair-stand | 12.2 ± 2.8 | 13.7 ± 7.5 | P = 0.149 | ||||||||
6-Min walk | 472.6 ± 86.5 | 518.0 ± 103.3 | P = 0.638 | ||||||||
Gait speed | 1.14 ± 0.16 | 1.18 ± 0.24 | P = 0.790 | ||||||||
Daily activity | 152.5 ± 93.3 | 174.9 ± 126.1 | P = 0.279 | ||||||||
Reslan [52] | T | 60 | 4 weeks | HSSfunction | 15.73 ± 3.49 | 13.92 ± 3.35 | P = 0.026 | ||||
I | 30 | 19 (63.6) | na | HSSrom | 17.04 ± 2.55 | 16.53 ± 4.20 | P = NS | ||||
C | 30 | 17 (56.7) | na | HSSquadriceps muscle strength | 9.13 ± 3.81 | 8.47 ± 2.93 | P = NS | ||||
HSSflexion deformity | 10.02 ± 1.21 | 8.47 ± 1.93 | P = 0.007 | ||||||||
HSSinstability | 9.89 ± 3.41 | 8.27 ± 2.89 | P = 0.049 | ||||||||
LEFS | 60.35 ± 11.22 | 53.83 ± 12.98 | P = 0.048 | ||||||||
Timmers [53] | T | 213 | 4 weeks after discharge | KOOS | 37.61 ± 10.17 | 43.08 ± 12.96 | P < 0.001 | ||||
I | 114 | 74 (64.9) | 64.74 (7.57) | Ability to perform physiotherapy | 7.50*** | 6.88*** | P = 0.03 | ||||
C | 99 | 60 (60.6) | 65.63 (7.90) | Ability to perform self-care activities | 8.32*** | 7.64*** | P = 0.004 | ||||
Yajnik 2018 | T | 40 | 3 (7.5) | 68 (46–80)* | 2 days | Maximum ambulation 1 day PO | 20 (0–59)^ | 12 (0–30) ^ | P = 0.069 (POD 1) | ||
I | 20 | Maximum ambulation 2 days PO | 46 (6–67)^ | 38 (0–61) ^ | P = 0.141 (POD 2) | ||||||
C | 20 | ||||||||||
Psycho-herapy | Birch 2019 | T | 60 | 1 year | OKS | 33 (29, 27)^^ | 37 (33, 41)^^ | P = NS | |||
I | 31 | 22 (33) | 66 (9) | 6-Min walk | 441 (402,480)^^ | 406 (367, 446)^^ | P = NS | ||||
C | 29 | 18 (27) | 66 (10) | Sit to stand | 12 (11, 14) ^^ | 11 (95% CI 10,13) ^^ | P = NS | ||||
Cai [57] | T | 108 | 6 months | KSS | 82.61 ± 6.38 | 73.30 ± 8.45 | P < 0.01 | ||||
I | 54 | 31 (57.4) | 62.42 ± 6.59 | First time out of bed (hours) | 22.13 ± 4.18 | 36.41 ± 7.31 | P = < 0.001 | ||||
C | 54 | 34 (63.0) | 63.94 ± 6.58 | ||||||||
Cai [58] | T | 100 | 62 (55.9) | 6 months | HSS function | 80.68 ± 8.02 | 68.98 ± 8.64 | P < 0.001 (time interaction), P < 0.001 (group interaction), P = 0.003 (group-by-time interaction) | |||
I | 50 | 65.26 ± 8.30 | |||||||||
C | 50 | 66.18 ± 7.04 | |||||||||
Das Nair [59] | T | 50 | 23 (46.0) | 6 months | WOMAC function | 20.9 ± 12.7 | 32.0 ± 4.8 | P = 0.009 | |||
I | 25 | 65.7 ± 8.6 | WOMAC stiffness | 3.2 ± 1.9 | 4.2 ± 0.9 | P = 0.11 | |||||
C | 25 | 66.7 ± 9.9 | |||||||||
Harnirattisai [60] | T | 63 | 59 (93.7) | 67.88 (60–85)* | 6 weeks | PTT total | 8.86 ± 1.89 | 6.43 ± 1.66 | P = na | ||
I | 42 | PPT standing balance | Δ 2.00 ± 1.22^^^ | Δ 1.09 ± 1.22^^^ | P = 0.016 | ||||||
C | 21 | PPT walking speed | Δ 1.55 ± 1.02^^^ | Δ 0.76 ± 0.83^^^ | P = 0.004 | ||||||
PPT chair-stand | Δ 2.36 ± 1.05^^^ | Δ 1.33 ± 1.02^^^ | P < 0.001 | ||||||||
ADL and daily requirements exercise activity | na | na | "There were no significant differences in ADL participation" | ||||||||
Jacobson [61] | T | 58 | 51 (62.2) | 65 (41–81)* | 6 months | SF-36 physical | 50.4 ± 6.0 | 47.3 ± 7.5 | P = na | ||
I | 29 | WOMAC stiffness | 1.9 ± 1.4 | 2.1 ± 1.9 | P = na | ||||||
C | 29 | WOMAC function | 7.2 ± 7.1 | 10.2 ± 10.5 | P = na | ||||||
Gait velocity | na | na | P = 0.0154 (group-by-imaging ability interaction) | ||||||||
Timed walk in seconds | 7.4 ± 2.2 | 8,5 ± 2.3 | P = na | ||||||||
Riddle [62] | T | 63 | 45 (71.4) | 2 months | WOMAC disability | 18.3 ± 12.2 | 24.1 ± 10.9 | P = 0.023 (for differences among discharge scores for the 2 groups after adjusting for baseline differences) | |||
I | 18 | 63.8 ± 11.5 | |||||||||
C | 45 | 60.8 ± 9.9 | |||||||||
Riddle [63] | T | 402 | 12 months | WOMACfunction | 11.7 (8.6, 14.9) (I1) & 12.2 (9.0, 15.4) (I2)^^ | 10.5 (7.4, 13.6)^^ | P > 0.05 | ||||
I1 | 130 | 94 (72.3) | 62.6 ± 7.9 | SPPB | 8.0 (7.2, 8.7) (I1) & 8.4 (7.6, 9.1) (I2)^^ | 8.6 (95% CI 7.8, 9.4)^^ | P > 0.05 | ||||
I2 | 135 | 85 (63.0) | 64.2 ± 8.5 | ||||||||
C | 137 | 88 (64.2) | 62.7 ± 7.7 | ||||||||
Russo 2016 | T | 110 | na | 69.1 ± na | 3 months | SF-36 physical | 45.6 ± 8.3 | 46.2 ± 9.9 | P > 0.01 | ||
I | 55 | KSS | 87.8 ± 9.6 | 78.3 ± 8.2 | P = < 0.005 | ||||||
C | 55 | WOMAC | 79.9 ± 13.0 | 69.7 ± 9.5 | P = < 0.005 | ||||||
VAS functional score | 2.8 ± 1.6 | 4.0 ± 1.5 | P = < 0.005 | ||||||||
Tristaino 2015 | T | 44 | 44 (62.0) | 4 months | SF-36 PCS | 49.5 ± 6.6 | 50.9 ± 9.8 | P = 0.5114 | |||
I | 33 | 64.2 ± 8.6 | Days until physiotherapy objective reached | 8.1 ± 2.4 | 8.8 ± 2.3 | P = 0.2424 | |||||
C | 31 | 66.1 ± 6.6 | |||||||||
Remaining | Chistriansen 2015 | T | 26 | 13 (50) | 26 weeks | FTSST | 9.5 ± 2.4 | 9.6 ± 1.6 | P = 0.21 | ||
I | 13 | 68.2 ± 8.6 | Hip moment (Nm/kg) during FTSST | 0.65 ± 0.24 | 0.63 ± 0.20 | P = 0.686 | |||||
C | 13 | 66.6 ± 8.1 | Knee moment (Nm/kg) during FTSST | 1.03 ± 0.22 | 0.97 ± 0.11 | P = 0.434 | |||||
Ankle moment (Nm/kg) during FTSST | 0.17 ± 0.16 | 0.24 ± 0.14 | P = 0.227 | ||||||||
Walking speed (m/s) | 1.29 ± 0.25 | 1.24 ± 0.13 | P = 0.68 | ||||||||
Hip moment during walking | 0.28 ± 0.19 | 0.36 ± 0.22 | P = 0.160 | ||||||||
Knee extension moment during walking | 0.61 ± 0.25 | 0.42 ± 0.44 | P = 0.008 | ||||||||
Ankle moment during walking | 0.09 ± 0.29 | 0.01 ± 0.19 | P = 0.877 | ||||||||
Hiraga [68] | T | 41 | 4 weeks | Daily step count | 3580.5 ± 1545.2 | 2088.4 ± 2008.3 | P = 0.041 | ||||
I | 20 | 16 (80) | 76.4 ± 7.1 | Psychical activity time | 1741.4 ± 551.3 | 731.8 ± 321.1 | P = 0.000 | ||||
C | 21 | 19 (90.4) | 76.6 ± 5.5 | ||||||||
Koo [69] | T | 120 | 5 weeks | WOMAC | 14.59 ± 9.14 | 10.86 ± 10.84 | P = 0.398 | ||||
I | 60 | 17 (28.3) | 65.00 ± 6.97 | Graded ambulation distance | na | na | P = na | ||||
C | 60 | 15 (25) | 63.71 ± 5.09 | 6-Min walk test | 407.00 ± 83.62 | 353.35 ± 82.35 | P = 0.163 | ||||
Timed-stand test | 19.29 ± 2.80 | 19.00 ± 6.16 | P = 0.967 |
QoL
Type of intervention | Study | Nr TKA | Females (%) | Age mean ± SD | Follow-up | Outcome score (QoL) | I score ± SD I score ± SD | C score ± SD | Statistically significance at latest follow-up | |
---|---|---|---|---|---|---|---|---|---|---|
Education | Malletscheck 2019 | T | 75 | 47 (62.7) | 59–78* | 3 months | KOOS QoL | na | na | P = NS |
I | 37 | |||||||||
C | 38 | |||||||||
Timmers 2019 | T | 213 | 4 weeks after discharge | EQ-5D | 0.76 ± 0.16 | 0.67 ± 0.25 | P < 0.001 | |||
I | 114 | 74 (64.9) | 64.74 ± 7.57 | |||||||
C | 99 | 60 (60.6) | 65.63 ± 7.90 |
Quality assessment
Certainty assessment | No of patients | Certainty | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | ITPD | No ITPD | |||||||
Pain (follow up: range 60 min to 6 months; assessed with: Various outcome measures) | |||||||||||||||
34 | 19 randomised trials and 15 remaining* | Serious | Serious | Serious | Not serious | all plausible residual confounding would suggest spurious effect, while no effect was observed | 1618 | 996 | ⨁⨁◯◯ low | ||||||
Function (follow up: range 2 days to 2 years; assessed with: Various outcome measures) | |||||||||||||||
29 | 16 randomised trials and 13 remaining** | Serious | Serious | Serious | Not serious | all plausible residual confounding would suggest spurious effect, while no effect was observed | 1580 | 1003 | ⨁⨁◯◯ low | ||||||
QoL (follow up: range 24 weeks to 3 months; assessed with: Various outcome measures) | |||||||||||||||
2 | 1 randomised trial and one non-randomised trial | Serious | Serious | Not serious | Not serious | all plausible residual confounding would suggest spurious effect, while no effect was observed | 151 | 137 | ⨁⨁⨁◯ moderate |