A Comparison Between Intensive and Conventional Therapies: A Systematic Review and Meta-Analysis Regarding the Pre-operative Outcomes After Total Knee Replacement

Abstract

Joint degeneration characterized by cartilage deterioration and bone wear is the hallmark of osteoarthritis (OA), a condition that worsens over time. Total knee arthroplasty (TKA) is the most common effective treatment for OA. Conventional therapy training (CTT) is the standard intervention; we are testing whether intensive therapy training (ITT) provides different results when used preoperatively. Our study compared intensive and standard preoperative physical therapy in randomized and non-randomized controlled trials, excluding various other study types. Two independent researchers assessed the risk of bias using appropriate tools (RoB 2 for RCTs (Cochrane Methods, London, UK) and ROBINS-I for non-randomized studies (Cochrane Methods, London, UK)). The analysis, conducted using ReviewManager 5.4 (Cochrane Methods, London, UK), presented results as mean differences (MD) with 95% CIs, employing fixed or random-effects models based on heterogeneity assessments. With a total number of 490 participants, ITT showed significant improvements in the six or 10-minute walk test (MD = 45.07m, P < 0.000001), quadriceps strength (MD = 0.07 Kg, P < 0.0001), range of motion (ROM) flexion (MD = 4.29, P = 0.03), isometric knee flexion (MD =2.32, P=0.04), SF-36 physical component (MD = 1.19, P