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84 APPENDICES Physiotherapy KCE reports vol. 40 stimulation for postoperative pain relief after total knee arthroplasty (96) The effect of a preoperative exercise and education program on functional recovery, health service utilization following primary total knee arthroplasty (97) Pre-arthroplasty rehabilitation is effective in reducing hospital stay (79) Effectiveness of electric stimulation of vastus medialis muscle in the rehabilitation of patients after total knee arthroplasty (83) RCT RCT RCT after total knee arthroplasty. Outcome variable: amount of opioids used during postoperative Patient Controlled Anaesthesia procedure. Interventions: patient-controlled anesthesia (PCA) alone, PCA plus TENS, or PCA plus sham TENS. Outcome variables: cumulative dose of morphine by PCA. RCT (131 patients) on the effectiveness of preoperative exercise/education on functional recovery after total knee replacement. Statistical analysis revealed that the study was underpowered to reach conclusive results Interventions: 4-week exercise/education program before surgery. Outcome variables: Western Ontario McMaster Osteoarthritis Index, the SF-36, and knee range of motion (ROM) and strength measures, length of stay, numbers of community rehabilitation or homecare visits following discharge from the surgical hospital, and costs associated with these services. RCT (133 patients with complex needs (co-morbid conditions or limited social support) on the effect on length of stay of individually-tailored rehabilitation after hip or knee arthroplasty. Interventions: pre-operative usual care without rehabilitation versus individual assessment followed by multi-disciplinary rehabilitation to optimize functional capacity, education about the in-hospital phase and early discharge planning Outcome variables: time to meet discharge criteria and length of stay RCT (30 patients) on the effect of electric muscle stimulation (EMS) after total knee arthroplasty. Interventions: EMS (40Hz, 300micros) of the vastus medialis muscle for 4 hours a day, starting on postoperative day 2, over the first 6 postoperative weeks. Outcome measures: Changes in walking speed, HSS knee score, and effort of walking as measured by the PCI. Answer possible and generally positive for 8 of the 9 first questions of the form. Recommendations seem applicable to Belgian situation Cochrane II form: Negative answer for 4 of the 9 first questions of the form. Hence, results and recommendations must be implemented with caution. Recommendations seem applicable to Belgian situation. Cochrane II form: Negative or no answer possible for 5 out of the 9 first questions of the form. Conclusions and recommendations of this study must be implemented with caution. Pedro 5/10
KCE reports vol. 40 APPENDICES Physiotherapy 85 Comparison of clinic-and home based rehabilitation programs after total knee arthroplasty (80) A randomized controlled trial of exercise to improve mobility and function after elective knee arthroplasty. Feasibility, results and methodological difficulties (98) Costs and effectiveness of pre-and postoperative home physiotherapy for total knee replacement : randomized controlled trial (99) Home continuous passive motion machine versus professional physical therapy following total knee replacement (100) RCT RCT RCT RCT (160 patients) evaluating clinic-based rehabilitation versus home-based rehabilitation. Interventions: clinic-based rehabilitation provided by outpatient physical therapists versus home-based rehabilitation monitored by periodic telephone calls from a physical therapist. Outcome variables: total score on the Knee Society clinical rating scale, total score on the Western Ontario and McMaster Universities Osteoarthritis Index, total score on the Medical Outcomes Study Short Form, score on the pain scale of the Knee Society clinical rating scale, score on the pain scale of the Western Ontario and McMaster Universities Osteoarthritis Index, score on the functional scale of the Western Ontario and McMaster Universities Osteoarthritis Index, distance walked in 6 minutes, number of stairs ascended and descended in 30 seconds, and knee flexion range of motion. RCT (47 patients) comparing the results of a homebased traditional exercise group to a home based functional exercise group. Interventions: Home-based traditional exercise group or home-based functional exercise group following discharge from hospital. Outcome variables: goniometry, a knee-specific pain score, leg extensor power and a walking test. RCT (160 patients) comparing the effectiveness of pre- and post-operative home-physiotherapy to hospital outpatient physiotherapy. Interventions: physiotherapy delivered at home or in an outpatient physiotherapy facility in a teaching hospital. Outcome variables: health-related quality of life (HRQoL), measured by the Western Ontario McMaster Osteoarthritis index (WOMAC) and the Short Form 36 health survey (SF-36) pre-operatively and at 12 weeks post-TKR operation; patient satisfaction; and NHS resource use. RCT RCT (103 total knee arthroplasties in 80 patients) studying the costs of self-continuous passive motion at home program versus traditional physical therapy delivered by a physiotherapist. Pedro 6/10 Cochrane II form: Well-conducted RCT (9 first answers to the Cochrane form are positive). Recommendations seem applicable to Belgian situation. However, the results of this study need to be replicated on a larger patients sample before definitive conclusions can be drawn. Cochrane II form: Negative or no answer possible for 3 out of the 9 first questions of the form. Conclusions and recommendations of this study must be implemented with caution. Cochrane II form: Negative or no answer possible for 4 out of the 9 first questions of the form. Critical appraisal not pursued
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