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

https://doi.org/10.1016/j.apmr.2012.08.211Get rights and content

Abstract

Objective

To investigate the preoperative effects of exercise-based interventions on pain and physical function for people awaiting joint replacement surgery of the hip or knee.

Data Sources

Four computer databases (CINAHL, MEDLINE, Embase, and Cochrane Library) were searched until July 4, 2012. Search terms included knee, hip, joint replacement, arthroplasty, physiotherapy, physical therapy, exercise, hydrotherapy, rehabilitation, and preoperative. Reference lists of retrieved articles were also screened.

Study Selection

Randomized or quasi-randomized studies comparing an exercise-based intervention with a no-intervention group for people awaiting hip or knee joint replacement surgery were included. Outcomes were pain and physical function including self-reported function, walking speed, and muscle strength. One of 2 reviewers determined that 18 studies met the inclusion criteria.

Data Extraction

The methodologic quality of each study was independently assessed by 2 reviewers using the PEDro scale, and a final PEDro score was determined by discussion and consensus between the reviewers. Participants’ characteristics, content and design of the interventions, and data for quantitative synthesis were extracted by 1 reviewer.

Data Synthesis

For participants awaiting knee replacement surgery, quantitative data synthesis found no significant differences between the exercise and no-intervention groups for pain, self-reported function, walking speed, or muscle strength. For participants awaiting hip replacement surgery, quantitative data synthesis found a significant difference between the groups, with standardized mean differences (SMDs) indicating a medium-sized effect in favor of intervention for both pain (SMD=.45; 95% confidence interval .15–.75) and self-reported function (SMD=.46; 95% confidence interval .20–.72).

Conclusions

Exercise-based interventions can reduce pain and improve physical function for people awaiting hip replacement surgery but not knee replacement surgery.

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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