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dc.contributor.authorSattler, Larissa Nicole
dc.contributor.authorHing, Wayne Anthony
dc.contributor.authorVertullo, Christopher
dc.date.accessioned2020-02-25T23:23:17Z
dc.date.available2020-02-25T23:23:17Z
dc.date.issued2019
dc.identifier.issn1471-2474
dc.identifier.doi10.1186/s12891-019-2415-5
dc.identifier.urihttp://hdl.handle.net/10072/391893
dc.description.abstractBackground: Total knee replacement (TKR) patients participate in early supervised exercise therapy programs, despite a lack of evidence for such programs or the optimal type, duration or frequency to provide the best clinical outcomes. As hospital stay rates decrease worldwide, the first days after joint replacement surgery are of increasing clinical importance. The purpose of this study was to investigate any reported effects of published early exercise therapy following TKR surgery. Methods: Databases PubMed, CINAHL, Embase, Cochrane, and Pedro were searched up to August 2018 for trials which investigated an early supervised exercise therapy, commencing within 48 h of surgery. Risk of bias was evaluated using a Modified Downs and Black Checklist and meta-analysis of results was conducted using Review Manager (RevMan). Standardised Mean Differences (SMD) or Mean Differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses. Results: Four studies (323 patients) that used four different interventions were identified, including Modified Quadriceps Setting, Flexion Splinting, Passive Flexion Ranging and a Drop and Dangle Flexion regime. Patients receiving the Drop and Dangle flexion protocol had superior flexion in the first 2 days after TKR and at discharge, the Flexion Splint patients were discharged earlier and had greater flexion at 6-weeks postoperatively, and the Modified Quadriceps Setting group showed greater hamstring and gluteal muscle strength. Results of the methodological quality assessment showed included studies were of moderate quality. The meta-analysis included 3 of the 4 trials and found no significant differences between groups in maximum knee flexion (MD = 1.34; 95% CI, - 5.55-8.24) or knee society scores (MD = - 1.17; 95% CI, - 4.32-1.98) assessed at 6 weeks post-operatively. Conclusion: The paucity and heterogeneity of existing studies that examine early supervised exercise therapy following TKR surgery makes it challenging for clinicians to deliver high-quality evidence-based exercise programs in the early postoperative period. Although superior knee flexion range was found across differing regimes, the meta-analysis showed no significant difference in this outcome between groups at 6 weeks. The results of this review show high quality randomized clinical trials are urgently needed to evaluate the impact of early exercise following TKR surgery. Trial Registration: This review was registered with PROSPERO (CRD42017081016).
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherBioMed Central Ltd.
dc.relation.ispartofpagefrom42:1
dc.relation.ispartofpageto42:11
dc.relation.ispartofissue1
dc.relation.ispartofjournalBMC Musculoskeletal Disorders
dc.relation.ispartofvolume20
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchcode1103
dc.subject.keywordsScience & Technology
dc.subject.keywordsLife Sciences & Biomedicine
dc.subject.keywordsOrthopedics
dc.subject.keywordsRheumatology
dc.subject.keywordsTotal knee replacement
dc.titleWhat is the evidence to support early supervised exercise therapy after primary total knee replacement? A systematic review and meta-analysis
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationSattler, LN; Hing, WA; Vertullo, CJ, What is the evidence to support early supervised exercise therapy after primary total knee replacement? A systematic review and meta-analysis, BMC Musculoskeletal Disorders, 2019, 20 (1), pp. 42:1-42:11
dcterms.dateAccepted2019-01-09
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/
dc.date.updated2020-02-25T22:55:04Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© The Author(s). 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
gro.hasfulltextFull Text
gro.griffith.authorVertullo, Christopher J.


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