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162 APPENDICES Physiotherapy KCE reports vol.40 Table 10 Total knee replacement: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Muscle strengthening 96 ± 3% Type of evidence ? Evidence for ? (weak) Mobilizations 95 ± 3% ? Evidence available in the literature on physiotherapy of total knee replacement No information was available in the literature review about general muscle strengthening. There is weak evidence that low-velocity submaximal eccentric exercises of the hamstring muscles allow better recovery of full knee extension. No information was available in the literature review about general mobilizations. There is weak evidence that continuous passive mobilization (i.e., the use of the Kinetec) as an adjunct to physiotherapy is effective in improving short-term active knee flexion and reducing length of hospital stay and need for postoperative manipulation. However, its effects are clinically small. Gait rehabilitation 91 ± 4% ? No information was available in the literature review. Education of the patient 81 ± 6% Evidence for (weak) There is weak evidence that advices encouraging the patient to remain physically active (such as swimming, cycling, power walking) are beneficial to general health and quality of the bones. Massage 78 ± 6% ? No information was available in the literature review. Home exercises 72 ± 7% Evidence for (moderate) There is moderate evidence that patients who completed a home exercise program performed similarly to patients who completed regular outpatient clinic sessions in addition to the home exercises. However, this result should be interpreted with caution in our country where financing of hospital day duration is limited by national regulations. Stretching 55 ± 7% ? No information was available in the literature review. Contracted-relaxed techniques 49 ± 7% ? No information was available in the literature review. Cryotherapy 46 ± 7% Evidence for (weak) There is weak evidence that compression combined with cryotherapy is an effective, riskfree and well-tolerated physical therapy modality that allows pain reduction and decreases analgesics consumption after total knee replacement.
KCE reports vol. 40 APPENDICES Physiotherapy 163 Table 10 Total knee replacement: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Electrophysiotherapy 18 ± 6% Type of evidence Evidence for (weak) Evidence against (moderate) Evidence available in the literature on physiotherapy of total knee replacement The paucity of evidence that has been found in electrophysiotherapeutic modalities suggests that they should not be recommended on a routine basis as their effectiveness has not been sufficiently well established. Electric stimulation: there is weak evidence that electric stimulation results in a statistically significant improvement in patient s walking speed and in a reduction of extensor lag and length of hospital stay. TENS: there is moderate evidence that TENS is not effective in reducing pain in the postoperative management after total knee replacement. Manipulations 03 ± 3% ? No information was available in the literature review. EMG biofeedback 02 ± 2% ? No information was available in the literature review. Hydrotherapy 02 ± 2% ? No information was available in the literature review.
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