Preoperative range of motion and applications of continuous passive motion predict outcomes after knee arthroplasty in patients with arthritis
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This study evaluated the clinical efficacy of continuous passive motion (CPM) following knee arthroplasty and determined the predictors of effect sizes of range of motion (ROM) and functional outcomes in patients with knee arthritis.
A comprehensive electronic database search was performed for randomized controlled trials (RCTs), without publication year or language restrictions. The included RCTs were analyzed through meta-analysis and risk of bias assessment. Study methodological quality (MQ) was assessed using the Physiotherapy Evidence Database (PEDro) scale. Inverse-variance weighted univariate and multivariate metaregression analyses were performed to determine the predictors of treatment outcomes.
A total of 77 RCTs with PEDro scores ranging from 6/10 to 8/10 were included. Meta-analyses revealed an overall significant favorable effect of CPM on treatment success rates [odds ratio: 3.64, 95% confidence interval (CI) 2.21–6.00]. Significant immediate [postoperative day 14; standard mean difference (SMD): 1.06; 95% CI 0.61–1.51] and short-term (3-month follow-up; SMD: 0.80; 95% CI 0.45–1.15) effects on knee ROM and a long-term effect on function (12-month follow-up; SMD: 1.08; 95% CI 0.28–1.89) were observed. The preoperative ROM, postoperative day of CPM initiation, daily ROM increment, and total application days were significant independent predictors of CPM efficacy.
Early CPM initiation with rapid progress over a long duration of CPM application predicts higher treatment effect on knee ROM and function. The results were based on a moderate level of evidence, with good MQ and potential blinding biases in the included RCTs. An aggressive protocol of CPM has clinically relevant beneficial short-term and long-term effects on postoperative outcomes.
Level of evidence
KeywordsKnee arthroplasty Arthritis Range of motion Continuous passive motion Functional outcome
This study was funded by grants from Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, Taiwan (grant no. W107HCP-04). The funding source had no role in the design, implementation, data analysis and interpretation, or reporting of the study. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the funding sources.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest related to the publication of this article.
This study dealt with published data only, no ethical approval has been necessary since sensitive information has not been provided or utilized in this review.
- 5.Briani RV, Ferreira AS, Pazzinatto MF, Pappas E, De Oliveira Silva D, Azevedo FM (2018) What interventions can improve quality of life or psychosocial factors of individuals with knee osteoarthritis? A systematic review with meta-analysis of primary outcomes from randomised controlled trials. Br J Sports Med 52(16):1031–1038CrossRefPubMedGoogle Scholar
- 7.Carifio J, Perla RJ (2007) Ten common misunderstandings, misconceptions, persistent myths and urban legends about likert. J Soc Sci 3(3):106–116Google Scholar
- 9.Cohen J (1988) The analysis of variance. In: Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale, pp 273–406Google Scholar
- 17.Harvey LA, Brosseau L, Herbert RD (2014) Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev 2:CD004260Google Scholar
- 19.Higgins JPT, Deeks JJ, Altman DG (2011) Chapter 16: special topics in statistics. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]: the cochrane collaboration. http://handbook.cochrane.org. Accessed Jun 04, 2018
- 20.Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The cochrane collaboration. http://handbook.cochrane.org. Accessed Jun 04, 2018
- 21.Hopkins WG (2002) A scale of magnitudes for effect statistics a new view of statistics. http://sportsci.org/resource/stats/effectmag.html. Accessed Jun 04, 2018
- 28.MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW, Kramer J, Vaz M (2000) Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty. Clin Orthop Relat Res (380):30–35Google Scholar
- 38.Salter RB (1989) The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop Relat Res (242):12–25Google Scholar
- 39.Sedgwick P, Marston L (2015) How to read a funnel plot in a meta-analysis. BMJ 351:1–3Google Scholar
- 40.Sterne JAC, Egger M, Moher D (2011) Chapter 10: addressing reporting biases. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The cochrane collaboration. http://www.handbook.cochrane.org. Accessed 12 Oct 2018
- 42.van Dijk HJD, Elvers JWH, Ruijter A, Oostendorp RAB (2007) Effect of continuous passive motion after total knee arthroplasty: a systematic review. Phys Singap 10(4):9–19Google Scholar
- 43.van Tulder M, Furlan A, Bombardier C, Bouter L (2003) Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976) 28(12):1290–1299Google Scholar
- 44.Viswanathan PKM (2010) Effect of continuous passive motion following total knee arthroplasty on knee range of motion and function: a systematic review. New Zeal J Physiother 38(3):14–22Google Scholar