Prehabilitation Improves Knee Functioning Before and Within the First Year After Total Knee Arthroplasty: A Systematic Review With Meta-analysis.

Abstract

<b>OBJECTIVE:</b> To assess whether prehabilitation influenced knee functioning before and within the first year after total knee arthroplasty (TKA) surgery. <b>DESIGN:</b> Intervention systematic review with meta-analysis. <b>LITERATURE SEARCH:</b> The authors searched the MEDLINE/PubMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, Web of Science, and Scopus databases from their inception until March 2022. <b>STUDY SELECTION CITERIA:</b> The authors included peer-reviewed articles comparing preoperative, short-, mid- or long-term effects of exercise-based physical therapy before primary unilateral TKA with TKA without prehabilitation. <b>DATA SYNTHESIS:</b> We assessed bias using the Cochrane Risk-of-Bias tool (ROB 2.0) and therapeutic validity using the i-CONTENT tool. Standardized mean differences (Hedges' <i>g</i>) and 95% confidence intervals (CIs) were calculated for knee functioning. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. <b>RESULTS:</b> Sixteen trials (968 participants) were included; 14 qualified for meta-analysis. Low to very low certainty of evidence favored prehabilitation over no intervention for improving knee functioning before (<i>g</i> = 1.23; 95% CI: 0.49, 1.97) and up to 3 months after TKA (short-term: 1 day to 1 month, <i>g</i> = 0.90; 95% CI: 0.18, 1.61; mid-term: 6 weeks to 3 months, <i>g</i> = 0.45; 95% CI: 0.06, 0.84). There were no significant between-group differences at long-term follow-up (6-12 months, <i>g</i> = 0.07; 95% CI: -0.17, 0.30). <b>CONCLUSION:</b> There was low to very low certainty of evidence that prehabilitation promotes superior knee functioning before and up to 3 months after TKA, compared to TKA alone. The long-term postoperative effects were inconclusive. <i>J Orthop Sports Phys Ther 2022;52(11):709-725 Epub: 20 September 2022. doi:10.2519/jospt.2022.11160</i>.