Review article (meta-analysis)Does Exercise Reduce Pain and Improve Physical Function Before Hip or Knee Replacement Surgery? A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Section snippets
Search strategy
Four computer databases (CINAHL, MEDLINE, Embase, and Cochrane Library) were searched until July 4, 2012. Comprehensive search strategies were individually constructed for each database using subject heading mapping (appendix 1). Typical search terms included knee, hip, joint replacement, arthroplasty, physiotherapy, physical therapy, exercise, hydrotherapy, rehabilitation, and preoperative. Titles and abstracts identified by the literature searches were screened by 1 reviewer (S.G.) utilizing
Included and excluded studies
Twenty-three trials were identified as highly relevant, of which 5 were subsequently excluded: 1 study32 investigated the effects of preoperative pool-based exercise in those awaiting knee replacement but did not involve a comparison group; 1 study33 did not complete a preoperative postintervention assessment of the no-intervention group; full text of another study34 was published in Dutch and communication with the corresponding author revealed that no English version was available; 1 study35
Discussion
Systematic reviews of randomized controlled trials are considered by some to be the best single source of information about the effectiveness of health care interventions.20, 51 Studies included in the current review typically had fair to good methodologic quality, and pooling of the studies’ data indicated that preoperative exercise-based interventions produced positive preoperative effects for people awaiting hip replacement surgery but not knee replacement surgery. People awaiting hip
Implications for practice
Although surgery is indicated when conservative treatment has failed,62, 63 reports suggest that the proportion of people who actually receive nonpharmacologic interventions before surgery might actually be small.64, 65 The results of the current review indicate that people awaiting hip replacement surgery can benefit from preoperative exercise programs. Because people can wait many months for surgery and might experience further deterioration in health-related quality of life during long waits,
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