Is physical rehabilitation superior to no physical rehabilitation following total knee arthroplasty? A systematic review and meta-analysis

Introduction: Physical rehabilitation is widely used following total knee arthroplasty (TKA), while no consensus has been reached regarding the optimal dosage, frequency and modality. Before a standardized protocol can be established, it is important to investigate the true efficacy for physical rehabilitation following TKA. Objective: To examine if physical rehabilitation is superior to no physical rehabilitation following total knee arthroplasty in terms of patient-reported outcomes for function and pain. Methods: The search strategy was conducted in five databases (MEDLINE, Embase, Cinahl, CENTRAL and SPORTDiscus) with eligibility criteria for inclusion being: Randomised controlled trials comparing patients receiving physical rehabilitation with a group receiving no physical rehabilitation following unilateral TKA. Potential sources of bias were assessed according to the Cochrane Risk of Bias Tool. The Consensus on Exercise Reporting Template (CERT) was used to extract and report exercise interventions from the included trials. Results: Only two of 3254 identified trials fulfilled the eligibility criteria and were included. The two trials were judged as being of moderate to good methodological quality, but lacking in the reporting of their exercise interventions. Difference in outcome measurements and interventions makes between-study comparison inconclusive. Conclusions: No conclusion regarding the superiority of physical rehabilitation to no-intervention following TKA can be drawn from the results of this systematic review. Further research is required to establish the true effectiveness of physical rehabilitation following TKA. Systematic review registration number: PROSPERO 2018 CRD42018094785.