Article

Common clinical practice includes attempts to improve pain, function,
motion, and patient independence before total knee arthroplasty (TKA) surgery.
Although preoperative rehabilitation often is prescribed, it is unknown whether
this care improves patient outcomes after TKA surgery. OBJECTIVE: To focus on how
TKA preoperative rehabilitation affects quality of life, pain, and physical
outcomes after surgery.
A computerized search was performed in
February 2011. We searched PubMed, Ageline, CIHNAL, and SPORTDiscus from 1950
through February 2011 using combinations of the terms knee, rehabilitation,
arthroplasty, preoperative, and presurgical. Searches were limited to "human" and
"English" studies reported in peer-review journals. STUDY SELECTION: Seven
studies met the inclusion criteria. For all variables, none was consistently
favorable toward preoperative rehabilitation over alternative or control
treatment. DATA EXTRACTION: Means and standard deviations (SDs) for each category
of the Western Ontario and McMaster Osteoarthritis Index (WOMAC), range of
motion, and length of stay (LOS) were obtained and served to calculate point
measures and measures of variability. Specifically, bias-adjusted Hedges' g
effect sizes, along with 95% confidence intervals, were calculated to assess the
magnitude of the treatment effect for each outcome, with separate meta-analyses
performed as a summary of the treatment response for each outcome. DATA
SYNTHESIS: A total of 240 studies were identified in the search of the
literature. On the basis of the title, abstract, or study content, 203 studies
were excluded. Of the remaining 37 studies, 30 were excluded on the basis of
study design and choice of outcome measures. The results of this review indicate
that preoperative rehabilitation likely had no true treatment effect on WOMAC
scores, range of motion, and LOS because all effect sizes were weak (<0.4) and
confidence intervals crossed zero. CONCLUSION: For all outcomes, none was
consistently favorable toward preoperative rehabilitation over the alternative
for patients undergoing TKA with the exception of LOS in favor of the treatment group.
CI - Copyright (c) 2012 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS