Therapeutic validity and effectiveness of preoperative exercise on functional recovery after joint replacement: a systematic review and meta-analysis

Thomas J Hoogeboom, Ellen Oosting, Johanna E Vriezekolk, Cindy Veenhof, Petra C Siemonsma, Rob A de Bie, Cornelia H M van den Ende, Nico L U van Meeteren, Thomas J Hoogeboom, Ellen Oosting, Johanna E Vriezekolk, Cindy Veenhof, Petra C Siemonsma, Rob A de Bie, Cornelia H M van den Ende, Nico L U van Meeteren

Abstract

Background: Our aim was to develop a rating scale to assess the therapeutic validity of therapeutic exercise programmes. By use of this rating scale we investigated the therapeutic validity of therapeutic exercise in patients awaiting primary total joint replacement (TJR). Finally, we studied the association between therapeutic validity of preoperative therapeutic exercise and its effectiveness in terms of postoperative functional recovery.

Methods: (Quasi) randomised clinical trials on preoperative therapeutic exercise in adults awaiting TJR on postoperative recovery of functioning within three months after surgery were identified through database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Therapeutic validity of the interventions was assessed with a nine-itemed, expert-based rating scale (scores range from 0 to 9; score ≥6 reflecting therapeutic validity), developed in a four-round Delphi study. Effects were pooled using a random-effects model and meta-regression was used to study the influence of therapeutic validity.

Results: Of the 7,492 articles retrieved, 12 studies (737 patients) were included. None of the included studies demonstrated therapeutic validity and two demonstrated low risk of bias. Therapeutic exercise was not associated with 1) observed functional recovery during the hospital stay (Standardised Mean Difference [SMD]: -1.19; 95%-confidence interval [CI], -2.46 to 0.08); 2) observed recovery within three months of surgery (SMD: -0.15; 95%-CI, -0.42 to 0.12); and 3) self-reported recovery within three months of surgery (SMD -0.07; 95%-CI, -0.35 to 0.21) compared with control participants. Meta-regression showed no statistically significant relationship between therapeutic validity and pooled-effects.

Conclusion: Preoperative therapeutic exercise for TJR did not demonstrate beneficial effects on postoperative functional recovery. However, poor therapeutic validity of the therapeutic exercise programmes may have hampered potentially beneficial effects, since none of the studies met the predetermined quality criteria. Future review studies on therapeutic exercise should address therapeutic validity.

Conflict of interest statement

Competing Interests: The authors have the following interests. Petra C. Siemonsma and Nico L. U. van Meeteren are employed by TNO, Leiden. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1. Selection of trials investigating preoperative…
Figure 1. Selection of trials investigating preoperative exercise for total hip or knee replacement.
Figure 2. Functional recovery during hospital stay…
Figure 2. Functional recovery during hospital stay in individual studies of structured exercise training vs. control intervention.
Figure 3. Short-term recovery of observed functioning…
Figure 3. Short-term recovery of observed functioning in individual studies of structured exercise vs. control intervention.
Figure 4. Short-term recovery of self-reported functioning…
Figure 4. Short-term recovery of self-reported functioning in individual studies of structured exercise vs. control intervention.

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