Comparison of Supervised and Unsupervised Models of Physical Therapy in Total Knee Arthroplasty: Systematic Review

Abstract

Background: Total knee arthroplasty (TKA) is an effective surgical treatment for advanced osteoarthritis. TKA must always be associated with postoperative physical rehabilitation provided by a physical therapist in order to restore functionality. As TKA-related health costs increase, an efficient rehabilitation program is needed. However, the physical therapy models for TKA patients are questionable. Objective: The objective of the systematic review is to analyze the evidences that deal with different models of physical rehabilitation and compare the effectiveness of the supervised treatment as well as the in home exercise programs without supervision. Methods/design: The databases Pubmed, Embase, Lilacs, The Cochrane Library, and Trip were searched for randomized clinical trials in any language and publication medium. The outcomes of interest were muscle strength, physical mobility and range of motion, atrophy, joint pain, and quality of life. The Cochrane Handbook for Systematic Reviews of Interventions was used for assessing the methodological quality of the studies. Results: The search returned 1133 studies. Of these, only five were included. Although the studies were heterogeneous, three studies investigated knee flexion range of motion, but this outcome did not differ statistically between groups after six months. Conclusion: In conclusion, the evidence for supervised and unsupervised models of physical therapy for TKA patients is inconclusive because important outcomes have not been investigated, and the pertinent studies have low methodological quality.