One moderate(10) and one weak(11) quality study examined the effectiveness of neuromuscular exercise prehabilitation interventions for patients on wait lists for total knee replacement.
In the first study, (moderate quality)(10) the intervention group completed a neuromuscular exercise total joint replacement programme (NEMEX-TJR) consisting of aerobic and circuit training, alongside education on postoperative management. Participants attended for 4-12 weeks, depending on their position on the surgery waitlist. The control group completed education only.
In the second study (weak quality),(11) the intervention group completed an acute rehabilitative neuromuscular exercise-conditioning (APNEC) programme, consisting of nine exercise-conditioning sessions for the knee extensor of the surgical leg, accrued over one week (3 sessions per week, 3 x per day). This was compared to a usual care control group.
The evidence of effectiveness of neuromuscular prehabilitation interventions for patients on wait lists for total knee replacement is inconsistent for the following outcomes:
Strength:
Inconsistent (two studies; one moderate quality (10), one weak quality(11), inconsistent effects across studies).
The evidence of effectiveness of neuromuscular prehabilitation interventions for patients on wait lists for total knee replacement is lacking for the following outcomes:
Function:
Might not be effective (one moderate quality study; no effect for intervention when compared to control)(10)
Pain:
Might not be effective (one moderate quality study; no effect for intervention when compared to control) (10).
Range of motion:
Might not be effective (one moderate quality study; no effect for intervention when compared to control) (10).
Mobility:
Might not be effective (one moderate quality study; no effect for intervention when compared to control)(10).
Physical activity level:
Might not be effective (one moderate quality study; no effect for intervention when compared to control)(10).
Health-related quality of life:
Might not be effective (one moderate quality study; no effect for intervention when compared to control)(10).
The moderate quality study(10) took place in Switzerland, thus generalisability to the Welsh context needs to be considered. The weak quality(11) took place in Edinburgh UK, and therefore may be generalisable to Wales.
The intervention took place in patients waiting for total knee replacement 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.