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Exercise prehabilitation interventions of both supervised and self-directed

Exercise prehabilitation interventions consisting of both supervised and self-directed elements, for patients on wait lists for Orthopaedic surgery (13-16).

Intervention summary:

Three moderate quality RCTs published across five papers(13-17) examined prehabilitation exercise interventions consisting of both supervised and self-directedelements. One RCT each took place in patients awaiting TKR(16, 17), THR (14, 15) and high tibial osteotomy or prosthetic knee replacement (13).

The interventions lasted between five and eight weeks and all consisted of both clinic-based supervised sessions and home-based self-directed exercises. The control groups consisted of usual care (14-17) or no intervention (13). Exercises generally aimed to improve strength, flexibility, and range of motion.

The evidence of effectiveness for exercise prehabilitation interventions where components consist of both supervised and self-directed elements, for patients on orthopaedic surgical wait lists, is inconsistent for the following outcomes:

Function:

Inconsistent (three studies; moderate quality, inconsistent effects across studies) (13, 15, 16).

Muscle strength:

Inconsistent (three studies; moderate quality, inconsistent effects across studies) (13, 15, 16). 

Range of Motion outcomes:

Inconsistent (two studies; moderate quality, inconsistent effects across studies) (13, 15).

The evidence of effectiveness exercise prehabilitation interventions where components consist of supervised and self-directed elements, for patients on orthopaedic surgical wait lists, is lacking for the following outcomes:

Health status:

Might be effective (one moderate quality study showing significant effect for the intervention compared to control) (14).

Stiffness:

Might be effective (one moderate quality study showing significant effect for the intervention compared to control) (14).

Gait Speed:

Might not be effective (one moderate quality study showing no effect of the intervention on gait performance compared to control) (13).

Delay or cancellation of surgery:

One strong quality study showing two participants in the intervention group decided to delay/cancel surgery because of marked improvements in physical function and reduction in pain (14).