Prehabilitation before total knee arthroplasty: A systematic review on the use and efficacy of stratified care

Sophie Vervullens, Lotte Meert, Isabel Baert, Rob J E M Smeets, Peter Verdonk, Frank Rahusen, Mira Meeus*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

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Abstract

BACKGROUND: Preoperative rehabilitation (hereafter called "prehabilitation") has been proposed as a potentially effective treatment to target preoperative risk factors to prevent insufficient outcome after total knee arthroplasty (TKA).

PURPOSE: We aimed to assess whether previous clinical trials of non-surgical, non-pharmacological prehabilitation in individuals with knee osteoarthritis (KOA) awaiting TKA focused on specific clinical phenotypes or specific individual characteristics and whether the content of the prehabilitation was stratified accordingly. Second, we aimed to summarize and compare the long-term effects of stratified and non-stratified care on pain, satisfaction, function and quality of life.

METHODS: A systematic literature search of PubMed, Web of Science, Scopus and Embase was performed. All relevant articles published up to April 19, 2021 reporting "(randomized controlled) clinical trials or prospective cohort studies" (S) related to the key words "total knee arthroplasty" (P), "preoperative conservative interventions" (I), "pain, function, quality of life and/or satisfaction" (O) were included.

RESULTS: After screening 3498 potentially eligible records, 18 studies were assessed for risk of bias. Twelve studies had low, 2 moderate, 3 serious, and one high risk of bias. The latter study was excluded, resulting in 17 included studies. Five studies investigated a"stratified prehabilitation care" and 12 "non-stratified prehabilitation care". Stratified prehabilitation in 4 studies meant that the study sample was chosen considering a predefined intervention, and in the fifth study, the prehabilitation was stratified to individuals' needs. No direct comparison between the 2 approaches was possible. We found weak evidence for a positive effect of biopsychosocial prehabilitation compared to no prehabilitation on function (stratified studies) and pain neuroscience education prehabilitation compared to biomedical education on satisfaction (non-stratified studies) at 6 months post-TKA. We found strong evidence for positive effects of exercise prehabilitation compared to no prehabilitation on pain at 6 months and on function at 12 months post-TKA (non-stratified studies).

CONCLUSION: More research is needed of stratified prehabilitation care focusing on individual characteristics in people with KOA awaiting TKA.

REGISTRATION NUMBER: This systematic review was prospectively registered at PROSPERO on March 22, 2021 (no. CRD42021221098).

Original languageEnglish
Article number101705
Number of pages15
JournalAnnals of Physical and Rehabilitation Medicine
Volume66
Issue number4
Early online date14 Sept 2022
DOIs
Publication statusPublished - May 2023

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