Five studies(1-5) examined the effectiveness of supervised strength-based training in patients awaiting total knee replacement.
The interventions commenced between eight and three weeks prior to the date of surgery and consisted of between 12 and 30 supervised exercise sessions. In one study (moderate quality)(4),patients were supervised via video-call. In one study (strong quality)(3) exercise sessions took place in the hospital. The remainder of the studies did not report the intervention setting. In one study (moderate quality) (2) patients also received postoperative rehabilitation as part of the intervention.
Control group comparisons consisted of usual care(3, 4), no intervention(5), postoperative rehabilitation only(2) and receiving print material, alongside one meeting with a physiotherapist(1). Four of the five studies(1, 3-5) were three-armed randomised controlled trials, which also included other intervention groups. Only outcomes for the supervised exercise group, compared to a control group have been reported in this summary.
There is good or moderate quality evidence to suggest that supervised strength-based prehabilitation interventions for patients on wait lists for total knee replacement are likely to be effective for the following outcomes:
Pain:
Might be effective (four studies; three moderate (1, 2, 4), one weak quality(5), all showing improvements in the intervention group compared to control [note: in two studies the statistical significance is not reported (1, 5)]).
Balance:
Might be effective (three studies; one strong(3), one moderate(4), one weak quality(5). All showing significant improvements in the intervention groups compared to control).
The evidence of effectiveness for supervised strength-based prehabilitation interventions for patients on wait lists for total knee replacement is inconsistent for the following outcomes:
Function:
Inconsistent (five studies; three [one strong(3), one moderate quality(4), one weak quality(5)] showing an improvement in the intervention group compared to control. Two moderate quality studies(1, 2) showing no improvement in the intervention group compared to control).
Quality of life:
Inconsistent (3 studies; 2 strong(3), 1 moderate(2), 1 weak quality(5). Inconsistent effects
across studies).
Mobility:
Inconsistent (3 studies; 2 strong(3), 1 moderate(2), 1 weak quality(5). Inconsistent effects across studies).
Strength:
Inconsistent (3 studies; 1 weak(5), 2 moderate quality(2, 4). Inconsistent effects across studies)
Range of motion:
Inconsistent (2 moderate quality studies(2, 4). Inconsistent effects across studies).
The evidence of effectiveness for supervised strength-based prehabilitation interventions for patients on wait lists for total knee replacement is lacking for the following outcomes:
Health status:
Might be effective (1 moderate quality study showing a significant improvement for intervention compared to control)(4).
Stiffness:
Might be effective (1 moderate quality study showing a significant improvement for intervention compared to control)(4).
Pain pressure threshold:
Might not be effective (1 moderate quality study showing no effect for the intervention compared to the control)(4).
Delay/cancellation of surgery:
In one strong quality study(3), 1 participant in the intervention group chose not to undergo surgery, compared to 2 in the control group.
Safety/feasibility:
One moderate quality study(2) reported no adverse events related to the intervention.
Two studies were undertaken in Spain(3, 5), and one each in South Korea(4), Denmark(2) and USA(1). Therefore, generalisability to the Welsh context should be considered.
The interventions all took place in patients awaiting total knee replacements 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