Preoperative range of motion and applications of continuous passive motion predict outcomes after knee arthroplasty in patients with arthritis

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Abstract

Purpose: 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. Methods: 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. Results: 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. Conclusion: 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: II.

Original languageEnglish
JournalKnee Surgery, Sports Traumatology, Arthroscopy
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Knee Replacement Arthroplasties
Articular Range of Motion
Arthritis
Randomized Controlled Trials
Confidence Intervals
Knee
Meta-Analysis
Databases
Publications
Language
Multivariate Analysis
Odds Ratio
Therapeutics

Keywords

  • Arthritis
  • Continuous passive motion
  • Functional outcome
  • Knee arthroplasty
  • Range of motion

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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title = "Preoperative range of motion and applications of continuous passive motion predict outcomes after knee arthroplasty in patients with arthritis",
abstract = "Purpose: 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. Methods: 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. Results: 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. Conclusion: 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: II.",
keywords = "Arthritis, Continuous passive motion, Functional outcome, Knee arthroplasty, Range of motion, Arthritis, Continuous passive motion, Functional outcome, Knee arthroplasty, Range of motion",
author = "Liao, {Chun De} and Tsauo, {Jau Yih} and Huang, {Shih Wei} and Chen, {Hung Chou} and Chiu, {Yen Shuo} and Liou, {Tsan Hon}",
year = "2018",
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doi = "10.1007/s00167-018-5257-z",
language = "English",
journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
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T1 - Preoperative range of motion and applications of continuous passive motion predict outcomes after knee arthroplasty in patients with arthritis

AU - Liao, Chun De

AU - Tsauo, Jau Yih

AU - Huang, Shih Wei

AU - Chen, Hung Chou

AU - Chiu, Yen Shuo

AU - Liou, Tsan Hon

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: 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. Methods: 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. Results: 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. Conclusion: 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: II.

AB - Purpose: 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. Methods: 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. Results: 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. Conclusion: 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: II.

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KW - Functional outcome

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