Two good quality multicomponent exercise and education prehabilitation studies were identified where the components consisted of both supervised and self-directed elements(4, 7). Both studies took place in patients awaiting total knee replacement.
One randomised controlled trial(4) compared the effects of a one-month preoperative knee joint mobilisation and pain neuroscience education intervention, with a control group receiving biomedical education and knee joint mobilisation. The intervention commenced 2 months prior to surgery and comprised of one session per week. The patients were instructed to perform knee mobilisation exercises and undertook both supervised and self-directed education on pain neuroscience topics such as the physiology of the nervous system, acute versus chronic pain, factors contributing to chronic pain, surgical experiences, and reconceptualization of postoperative pain after knee joint replacement.
The second randomised controlled trial(7) compared a three-month therapeutic education and functional readaptation (TERF) programme to usual care. Both groups received conventional pharmacological treatment comprising of paracetamol alone or with NSAIDS (dosage varied according to individual patient need). The intervention aimed to improve pain and functional disability and disease self-management in patients with musculoskeletal diseases affecting the lower limbs. It consisted of both supervised and self-directed exercises to improve knee strength & function, and education on consequences of osteoarthritis on daily life and treatments for management of knee osteoarthritis.
There is good or moderate quality evidence to suggest that multicomponent exercise & education prehabilitation interventions where components consist of both supervised and self-directed elements are likely to be ineffective for the following outcomes:
Pain:
Might not be effective (two good quality studies; one showed a significant improvement in the intervention group compared to control, for pain measured using conditioned pain modulation scores, but found no effect compared to control when pain was measured using temporal summation scores or central sensitisation(4). No effect for the intervention on pain scores was observed for the second study, when compared with control)(7).
Evidence of effectiveness of multicomponent exercise & education prehabilitation interventions where components consist of both supervised and self-directed elements is lacking for the following outcomes:
Kinesiophobia:
Might be effective (one good quality study showing a significant effect for the intervention compared to control)(4).
Function:
Might be effective (one good quality study showing a significant effect for the intervention compared to control)(7).
Pain catastrophising:
Might be effective (one good quality study showing intervention a significant effect for the intervention compared to control)(4).
Pressure pain threshold:
Might not be effective (one good quality showing no effect for the intervention compared to control)(4).
NSAID and analgesic drug use:
Might not be effective (one good quality study showing no effect for the intervention compared to control)(7).
Health status:
Might not be effective (one good quality study showing no effect for the intervention compared to control)(4).
Health-related QoL:
Might not be effective (one good quality study showing no effect for the intervention compared to control)(7).
Stiffness:
Might not be effective (One good quality study showing no effect for the intervention compared to control)(7).
Healthcare utilisation/costs:
Might not be effective (one good quality study showed no effect for reducing the number & costs of GP visits at 6 months post intervention, when compared to control(7). The study did find a significant reduction in costs/GP visits within the intervention group when compared to baseline).
Both studies were conducted in Spain(4, 7), so further consideration should be given to whether they would be generalisable to Wales.
The evidence for the outcomes listed above was derived from patients waiting for TKR and therefore may not be applicable to patients waiting for other elective surgeries.
It is suggested that further robust research and thorough evaluation of impact is needed