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Meta-Analysis
. 2016 Feb 2;6(2):e009857.
doi: 10.1136/bmjopen-2015-009857.

Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials

Li Wang  1 , Myeongjong Lee  2 , Zhe Zhang  3 , Jessica Moodie  4 , Davy Cheng  5 , Janet Martin  6
Affiliations
Meta-Analysis

Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials

Li Wang et al. BMJ Open. .

Abstract

Objectives: The clinical impact of preoperative physiotherapy on recovery after joint replacement remains controversial. This systematic review aimed to assess the clinical impact of prehabilitation before joint replacement.

Design: We searched PubMed, Embase and Cochrane CENTRAL up to November 2015 for randomised controlled trials comparing prehabilitation versus no prehabilitation before joint replacement surgery. Postoperative pain and function scores were converted to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales (0-100, high scores indicate worse outcome). Random effects meta-analysis was performed to calculate weighted mean differences (WMD, 95% CI), subgrouped by hip and knee surgery.

Primary and secondary outcomes: Postoperative pain and function scores, time to resume activities of daily living, quality of life, length of hospital stay, total cost, patient satisfaction, postoperative complications, any adverse events and discontinuations.

Results: Of 22 studies (1492 patients), 18 had high risk of bias. Prehabilitation slightly reduced pain scores within 4 weeks postoperatively (WMD -6.1 points, 95% CI -10.6 to -1.6 points, on a scale of 0-100), but differences did not remain beyond 4 weeks. Prehabilitation slightly improved WOMAC function score at 6-8 and 12 weeks (WMD -4.0, 95% CI -7.5 to -0.5), and time to climbing stairs (WMD -1.4 days, 95% CI -1.9 to -0.8 days), toilet use (-0.9 days, 95% CI -1.3 to -0.5 days) and chair use (WMD -1.2 days, 95% CI -1.7 to -0.8 days). Effects were similar for knee and hip surgery. Differences were not found for SF-36 scores, length of stay and total cost. Other outcomes of interest were inadequately reported.

Conclusions: Existing evidence suggests that prehabilitation may slightly improve early postoperative pain and function among patients undergoing joint replacement; however, effects remain too small and short-term to be considered clinically-important, and did not affect key outcomes of interest (ie, length of stay, quality of life, costs).

Keywords: JOINT REPLACEMENT; META-ANALYSIS; ORTHOPAEDIC & TRAUMA SURGERY; PAIN MANAGEMENT; REHABILITATION MEDICINE.

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Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection.
Figure 2
Figure 2
Pain score at 4 weeks or less (converted to WOMAC pain subscale 0–100) for prehabilitation versus no prehabilitation in joint replacement surgery. WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.
Figure 3
Figure 3
Function score at 6–8 weeks (converted to WOMAC function subscale 0–100) for prehabilitation versus no prehabilitation in joint replacement surgery. WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.
Figure 4
Figure 4
Function score at 12 weeks (converted to WOMAC function subscale 0–100) for prehabilitation versus no prehabilitation in joint replacement surgery. ADL, activities of daily living; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index. KOOS, Knee injury and Osteoarthritis Outcome Score; HOOS, Hip disability and Osteoarthritis Outcome Score.
Figure 5
Figure 5
Hospital length of stay (days) for prehabilitation versus no prehabilitation in joint replacement surgery.
See this image and copyright information in PMC

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