Comparison of the effect of pre- and post-operative physical therapy versus post-operative physical therapy alone on pain and recovery of function after total knee arthroplasty.
Ahmad Alghadir, Zaheen Ahmed Iqbal, Shahnawaz Anwer
PMID 27821929WHAT IT FOUND
Adding pre-operative physical therapy to post-operative physical therapy, TENS, oral analgesics, and home exercise did not improve pain or function more than those treatments together in 50 knee replacement patients.
Both groups improved similarly over six weeks.
Key findings
01There were no significant between-group differences in pain or functional score at baseline, week 3, or week 6 post-operatively.
02Both groups showed statistically significant reduction in pain intensity and improved functional score at the end of the study.
03Mean pain reduction was 7 in the pre- and post-operative PT group and 6.3 in the post-operative PT group; mean functional improvement was 37 and 42.4, respectively.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only 50 patients at one hospital, so the result may not apply to other settings or patient groups. Pre-operative PT was given only during the average 5-day hospital stay, so it may have been too short or too low in dose to show a benefit. There was no follow-up after 6 weeks, so longer-term pain and function outcomes are unknown. All patients received post-operative PT, TENS, oral analgesics, and home exercise instructions, so the study cannot separate the contribution of any single component. The trial was rater-blinded, but the paper does not say participants or therapists were blinded.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that pre-operative physical therapy is ineffective for knee replacement recovery. The pre-operative group received only daily sessions during an average 5-day hospital stay, and both groups also received post-operative physical therapy, TENS, oral analgesics, and home exercise instructions, so the study cannot determine whether a longer or different pre-operative programme would help or which component produced the improvement.