Abstract
PurposeOsteoarthritis is the single most common cause of pain and disability in older adults. This review addresses the question of the clinical effectiveness and cost-effectiveness of physiotherapy interventions following total knee replacement (TKR).MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, CINAHL, AMED, DARE, HTA and NHS EED databases were searched from inception to 02 May 2020. Search terms related to the clinical and cost-effectiveness of physiotherapy interventions were used. Studies meeting the inclusion criteria were identified and key data were extracted. Random effect meta-analysis was conducted for pain, physical function and range of motion (ROM).ResultsIn total, 1467 studies were identified. Of these, 26 studies were included; methodological quality of most studies was adequate. Physiotherapy interventions were more effective than control for function, SMD − 0.166 [95% Confidence Interval (CI) − 0.420 to 0.088.] and ROM, SMD − 0.219 [95% CI − 0.465 to 0.028] for a follow-up of 2 or 3 months. Patients in the intervention group showed improvement in pain at 12–13 weeks, SMD − 0.175 [95% CI − 0.416 to 0.067]. No evidence on the pooled estimate of cost-effectiveness of physiotherapy interventions was found.ConclusionsThis is the first systematic review and meta-analysis that has examined the clinical and cost-effectiveness of physiotherapy interventions following TKR. The findings of this review suggest that physiotherapy interventions were effective for improving physical function, ROM and pain in a short-term follow-up following TKR. Insufficient evidence exists to establish the benefit of physiotherapy in the long term for patient with TKR. Further study should examine the long-term effectiveness and cost-effectiveness of physiotherapy interventions.
Highlights
Osteoarthritis (OA) is a slowly progressive musculoskeletal disorder where the knee is the most common joint affected [1]
Physiotherapy interventions were more effective than control for function, standard mean difference (SMD) − 0.166 [95% Confidence Interval (CI) − 0.420 to 0.088.] and range of motion (ROM), SMD − 0.219 [95% CI − 0.465 to 0.028] for a follow-up of 2 or 3 months
The findings of this review suggest that physiotherapy interventions were effective for improving physical function, ROM and pain in a short-term follow-up following total knee replacement (TKR)
Summary
Osteoarthritis (OA) is a slowly progressive musculoskeletal disorder where the knee is the most common joint affected [1]. It is a major public health problem due to its prevalence, physical disability and high economic burden. The prevalence of knee OA was highest in high-income Asian Pacific regions such as Japan and South Korea [2]. University, Brooks Building, 53 Bonsall Street, Manchester M15 6GX, UK prevalence of knee OA in people aged ≥ 45 years was projected to increase from 13.8% in 2012 to 15.7% in 2032 [3]. Additional factors that contribute to the development of OA include knee injury, being overweight and obesity, old age, muscle weakness, repetitive use of joints, and bone density
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