Exercise- and education-based prehabilitation before total knee arthroplasty: a pilot study.
Pascale Gränicher, Loes Mulder, Ton Lenssen and 4 others
PMID 38192160WHAT IT FOUND
For patients awaiting knee replacement, prehabilitation combining exercise and education was safe but patient consent was low.
It did not show better physical performance tests or shorter stay than usual care, though self-reported sport and activity scores differed over time between groups.
Key findings
01Nine intervention patients completed all scheduled sessions, and there were no adverse or serious adverse events.
02Physical performance tests and length of stay did not differ significantly between groups over time.
03Self-reported sport function and activity level changed differently between groups over time, but the study was too small to confirm an effect.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The trial randomized only 20 patients and was designed to test feasibility, not to prove effectiveness. Only 20 of 76 eligible patients consented, which was below the pre-set feasibility threshold. Patients, physical therapists and investigators were not blinded to assignment, which can affect self-reported outcomes and behaviour. The intervention combined exercise and education, so the study cannot separate the effect of either component. Physical performance tests and length of stay did not differ significantly, so the positive self-reported findings were not matched by objective outcomes. Postoperative rehabilitation was not standardized, and hospital routines influenced length of stay. Baseline groups were not identical, with higher BMI and more pain under load in the control group. Missing data were imputed, and one intervention patient missed final physical testing.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the significant self-reported sport and activity findings as proof that exercise alone improves knee function. The programme included education as well, so the contribution of any single component cannot be separated. The study was also too small, and physical performance tests and length of stay did not differ significantly.