Two good quality randomised controlled trials explored the effectiveness of multicomponent interventions incorporating supervised exercise and education amongst patients waiting for total knee replacement(1) and total hip replacement(2).
The first randomised controlled trial(1) compared a 4-week preoperative exercise and education programme at a community physical therapy clinic amongst patients awaiting total knee replacement, to a no intervention control group. The intervention commenced 6 weeks before the surgery and comprised of 12 sessions delivered thrice/ week consisting of strengthening exercises and advice on everyday functional activities.
The second randomised controlled trial(2) compared a 1-month pre-operative physiotherapy programme amongst patients waiting for total hip replacement, against a no intervention control group, undertaken in the month prior to surgery. The intervention included strength, flexibility,cardiovascular training, postural alignment, and advice on everyday functional activities.
There is good or moderate quality evidence to suggest that multicomponent interventions incorporating supervised exercise and education are likely to be ineffective for the following outcomes:
Function:
Might not be effective (Two good quality studies, both showing no effect for intervention when compared to control) (1, 2).
Health status:
Might not be effective (Two good quality studies, both showing no effect for intervention when compared to control) (1, 2).
Pain:
Might not be effective (Two good quality studies; one showed a significant improvement in the intervention group for pain measured using the visual analogue scale (VAS), when compared to control(2). However, both studies showed no effect of the intervention on pain score when measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, when compared to control) (1, 2).
Stiffness:
Might not be effective (Two good quality studies, both showing no effect for intervention when compared to control)(1, 2).
The evidence of effectiveness of multicomponent interventions incorporating supervised exercise and education is inconsistent for the following outcomes:
Health-related Quality of life (QoL):
Inconsistent (two studies; good quality, inconsistent effects across studies)(1, 2).
Muscle strength:
Inconsistent (two studies; good quality, inconsistent effects across and within studies)(1, 2).
Range of motion (ROM):
Inconsistent (two studies; good quality, inconsistent effects across and within studies)(1, 2).
The evidence of effectiveness of multicomponent interventions incorporating supervised exercise and education is lacking for the following outcomes:
Delay or cancellation of surgery:
Might not be effective (One good quality study showing no effect for the intervention)(1).
One study was conducted in Canada(1) and one in Italy(2), so further consideration should be given to whether they would be generalisable to Wales.
Most of the evidence for the outcomes listed above were derived from patients waiting for TKR or THR, 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