The relationship between prescribed pre-operative knee-extensor exercise dosage and effect on knee-extensor strength prior to and following total knee arthroplasty: a systematic review and meta-regression analysis of randomized controlled trials. Issue 11 (November 2020)

• Record Type: Journal Article
• Authors: Husted, R.S.; Juhl, C.; Troelsen, A.; Thorborg, K.; Kallemose, T.; Rathleff, M.S.; Bandholm, T.
• Is Part Of: Osteoarthritis and cartilage. Volume 28:Issue 11(2020)
• Page Start: 1412
• Page End: 1426
• Publication Date: 2020-11
• Subjects: Knee osteoarthritis -- Dose-response -- Exercise therapy -- Knee-extensor muscle strength -- Total knee arthroplasty; Osteoarthritis -- Periodicals; Cartilage -- Periodicals; Osteoarthritis -- Periodicals; Cartilage -- Periodicals; Arthrose -- Périodiques; Articulations -- Maladies -- Périodiques; 616.7223005
• DOI: 10.1016/j.joca.2020.08.011
• Languages: English
• ISSNs: 1063-4584

Abstract

Summary: Objective: The aim of this systematic review was to evaluate the relationship between prescribed knee-extensor strength exercise dosage in pre-operative exercise intervention and the effect on knee-extensor muscle strength prior to and following TKA. Additional meta-analyses report the effect of pre-habilitation on outcomes prior to and following TKA. Design: A systematic literature search was performed including RCT's evaluating the effect of pre-operative exercise prior to and following TKA. Meta-regression analysis was performed to evaluate the dose-response relationship between prescribed exercise dose and the pooled effect, measured as standardized mean difference (SMD). The prescribed exercise dose was quantified using a formula accounting for as many exercise descriptors as possible. Risk of bias in the included trials was assessed using the Cochrane Risk of Bias Tool . Results: Twelve trials with 616 patients were included. Meta-regression analysis showed no relationship between prescribed pre-operative knee-extensor exercise dosage and change in knee-extensor strength neither prior to (slope 0.0005 [95%CI -0.007 to 0.008]) or 3 months following TKA (slope 0.0014 [95%CI -0.006 to 0.009]). Prior to TKA, a moderate effect favoring pre-operative exercise for increase in knee-extensor strength was found (SMD 0.50 [95%CI 0.12 to 0.88]), but not at 3 months following TKA (SMD -0.01 [95%CI -0.45 to 0.43]). Risk of bias was generally assessed as unclear. Conclusion: Meta-regression analysis of existing trials suggests no relationship between the prescribed pre-operative knee-extensor exercise dosage and the change in knee-extensor strength observed prior to and following TKA. Pre-operative exercise including knee-extensor muscle strength exercise increased knee-extensor strength moderately prior to but not 3 months following TKA. Protocol registration: PROSPERO ID (CRD42018076308) (http://www.crd.york.ac.uk/PROSPERO/ ).