Clinical and cost‑effectiveness of physiotherapy interventions following total knee replacement: a systematic review and meta‑analysis

Fatoye, Francis ORCID: https://orcid.org/0000-0002-3502-3953, Yeowell, Gill ORCID: https://orcid.org/0000-0003-3872-9799, Wright, Julie ORCID: https://orcid.org/0000-0001-7761-093X and Gebrye, Tadesse ORCID: https://orcid.org/0000-0001-7976-2013 (2021) Clinical and cost‑effectiveness of physiotherapy interventions following total knee replacement: a systematic review and meta‑analysis. Archives of Orthopaedic and Trauma Surgery, 141 (10). pp. 1761-1778. ISSN 0344-8444

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Abstract

Purpose Osteoarthritis is the single most common cause of pain and disability in older adults. This review addresses the question of the clinical effectiveness and cost-effectiveness of physiotherapy interventions following total knee replacement (TKR). Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, CINAHL, AMED, DARE, HTA and NHS EED databases were searched from inception to 02 May 2020. Search terms related to the clinical and cost-effectiveness of physiotherapy interventions were used. Studies meeting the inclusion criteria were identified and key data were extracted. Random effect meta-analysis was conducted for pain, physical function and range of motion (ROM). Results In total, 1467 studies were identified. Of these, 26 studies were included; methodological quality of most studies was adequate. Physiotherapy interventions were more effective than control for function, SMD − 0.166 [95% Confidence Interval (CI) − 0.420 to 0.088.] and ROM, SMD − 0.219 [95% CI − 0.465 to 0.028] for a follow-up of 2 or 3 months. Patients in the intervention group showed improvement in pain at 12–13 weeks, SMD − 0.175 [95% CI − 0.416 to 0.067]. No evidence on the pooled estimate of cost-effectiveness of physiotherapy interventions was found. Conclusions This is the first systematic review and meta-analysis that has examined the clinical and cost-effectiveness of physiotherapy interventions following TKR. The findings of this review suggest that physiotherapy interventions were effective for improving physical function, ROM and pain in a short-term follow-up following TKR. Insufficient evidence exists to establish the benefit of physiotherapy in the long term for patient with TKR. Further study should examine the long-term effectiveness and cost-effectiveness of physiotherapy interventions.