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Tille E, Lorenz F, Beyer F, Schlüßler A, Biewener A, Nowotny J. Early functional improvements using continuous passive motion therapy after angular-stable plate osteosynthesis of proximal humerus fractures - results of a prospective, randomized trial. J Orthop Surg Res 2024; 19:313. [PMID: 38802866 PMCID: PMC11131183 DOI: 10.1186/s13018-024-04804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The use of continuous passive motion therapy (CPM) has led to promising results in the early phase of rehabilitation after surgical treatment of rotator cuff tears and arthrolysis of the elbow. However, its use has not been proven in other pathologies of the upper extremity. Therefore, the aim of the underlying study was to evaluate the use of CPM therapy after plate osteosynthesis of proximal humeral fractures. METHODS 95 patients with isolated proximal humerus fractures were enrolled in a prospective, randomized study. Patients were assigned to a treatment group with (n = 48, CPM) or without CPM therapy (n = 47, CG). Four patients (2 of each cohort) violated the study protocol and were excluded. CPM therapy was used for 6 weeks after surgery 2-3 times daily. Functional (range of motion) and patient reported outcomes (PROM, Constant Score [CSS], QuickDASH, subjective shoulder value [SSV], pain on visual analogue scale [VAS]) were evaluated at 6 weeks, 3 and 12months. 60 patients completed the 1-year follow-up. RESULTS The average patient age was 65.3 years (min: 27, max: 88, SD: ± 14.7). Seventy-two patients were female (79%). There was no difference regarding injury severity (2/3/4 part-fracture: 6/32/7 vs. 9/26/11, p = 0.867) and sex (p = 0.08). However, patients in the CPM group were significantly younger (CPM: 67 [min: 34, max: 82], CG: 74 [min: 27, max: 88], p = 0.032). After 6 weeks we observed a better range of motion for forward flexion (CPM: 90° [min: 50°, max: 180°] vs. CG: 80° [min: 20°, max: 170°] p = 0.035) and abduction (CPM: 80° [min: 40°, max: 180°] vs. CG: 70° [min: 20°, max: 180°], p = 0.048) in the CPM group. There was no difference regarding the further planes of motion or the assessed PROMs at 6 weeks. At 3 and 12 months the results between the treatment groups equalized with no further significant differences. CONCLUSION The treatment with CPM increases the range of motion after plate osteosynthesis of proximal humerus fractures in the first 6 weeks after surgery. This effect is not sustained after 3 and 12months. The evaluated PROMs are not being influenced by CPM therapy. Hence the results of this prospective randomized study suggest that CPM can be a beneficial asset in the early period of rehabilitation after proximal humerus plate osteosynthesis. TRIAL REGISTRATION The study protocol was registered in the US National Institutes of Health's database ( http://www. CLINICALTRIALS gov ) registry under NCT05952622.
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Affiliation(s)
- Eric Tille
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany.
| | - Franz Lorenz
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Antonia Schlüßler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Achim Biewener
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Jörg Nowotny
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
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Degenhardt H, Hirschmüller A, Minzlaff P. [Current approach in the follow-up treatment of joint-preserving operations on the knee joint in German-speaking countries]. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024; 38:40-47. [PMID: 38447941 DOI: 10.1055/a-2210-0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Postoperative follow-up after joint-preserving knee surgery involves conventional physiotherapy as well as other approaches and devices such as CPM and CAM splints, TENS devices, BFR exercise, prehabilitation, and digital health applications. The aim of this survey was to investigate current standards, trends and control methods in postoperative care to identify fields of concern and to compare them with the current literature. MATERIAL AND METHODS We conducted a structured anonymous online survey of specialists in orthopaedics and trauma surgery listed by the German-speaking Society for Arthroscopy and Joint Surgery (AGA). The questionnaire included 36 closed-ended questions on the follow-up of joint-preserving surgery of the knee joint. RESULTS Questionnaires from 528 participants with long-term professional experience (86.6% with more than 10 years) were analysed. Standardised post-treatment schemes are used by 97.2% and their evidence is estimated to be high (59.1%) / very high (14.8%). Problems of rehabilitation are seen in 10-20% of cases by 87.3% (persistent muscular atrophy 30.9%). After reconstructive surgery, CPM splints (70.1%), CAM splints (42.1%), orthoses (85.0%) and TENS devices (40.0%) are prescribed. More potent approaches for the treatment of postoperative muscle deficits are desired by 89.4%. BFR exercise is known by 41.7% and is used regularly by 8%. Communication with treating physiotherapists is infrequent (written: 27.5%). Digital rehabilitation management would be supported by 83.3%; 22.7% are not aware of digital health applications. 87.9% of participants believe that prehabilitation can affect postoperative outcomes. CONCLUSION Follow-up of knee joint-preserving surgeries is usually standardised and regularly reviewed for up-to-date evidence. The evidence for recommendations made is considered high. Orthoses are usually used after reconstructive surgery, persistent muscle atrophy is a major problem, BFR training is only known to a limited extent, and there is currently a lack of standardised training protocols. Communication with physiotherapists needs to be improved. Digital rehabilitation management is rarely used but would be supported by the majority of surgeons.
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Affiliation(s)
- Hannes Degenhardt
- Orthopädie und Unfallchirurgie, Klinikum Freising, Freising, Deutschland
- Sektion Sportorthopädie, Technische Universität München, München, Deutschland
| | - Anja Hirschmüller
- Altius Swiss Sportmed Center, Rheinfelden, Schweiz
- Universitätsklinikum Freiburg, Klinik für Orthopädie und Traumatologie, Freiburg, Deutschland
| | - Philipp Minzlaff
- Sektion Sportorthopädie, Technische Universität München, München, Deutschland
- Sportorthopädie Orthoclinic Agatharied, Krankenhaus Agatharied, Hausham, Deutschland
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Jia Z, Zhang Y, Zhang W, Xu C, Liu W. Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:68. [PMID: 38218933 PMCID: PMC10787984 DOI: 10.1186/s13018-024-04536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Continuous passive motion (CPM) is commonly used as a postoperative rehabilitation treatment, along with physical therapy, for postoperative knee rehabilitation. However, the comparison between the two in terms of efficacy in postoperative knee replacement recovery is unclear. PURPOSE To compare efficacy and safety of combined CPM versus physical therapy alone in postoperative rehabilitation after knee arthroplasty. METHODS PubMed, Embase, and Web of Science databases were used to retrieve and access clinical studies on the efficacy of CPM compared with physical therapy. Review Manager software was used for study publication bias assessment and data analysis based on inclusion criteria. RESULTS A total of 6 articles covering 557 patients were included in the study. In terms of range of motion (ROM), passive knee flexion was similar between CPM and physical therapy (PT) (WMD, - 0.17; 95% CI, - 0.98-0.64; p = 0.68). At long-term follow-up, passive knee extension was similar between CPM and physical therapy (PT) (WMD, - 0.28; 95% CI, - 1.47 to - 0.92; I2 = 65%, p =0.65). In addition, CPM generates significantly higher in length of stay (WMD, 0.50; 95% CI, - 0.31 to 0.69; I2 = 3%, p < 0.001). CPM generates significantly higher treatment costs and incurs more care costs relative to physical therapy. CONCLUSION Compared to PT, combined with CPM failed to significantly improve ROM of the knees and patient's satisfaction. In addition, CPM treatment significantly increased the cost of hospitalization.
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Affiliation(s)
- Zhengfeng Jia
- Department of Orthopedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- Graduate School of Medical School of Chinese PLA Hospital, Beijing, China
| | - Yan Zhang
- Department of Quality Management, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Wupeng Zhang
- Department of Orthopedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Cheng Xu
- Department of Orthopedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Wanheng Liu
- Department of Orthopedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Bonnechère B, Timmermans A, Michiels S. Current Technology Developments Can Improve the Quality of Research and Level of Evidence for Rehabilitation Interventions: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23020875. [PMID: 36679672 PMCID: PMC9866361 DOI: 10.3390/s23020875] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 06/01/2023]
Abstract
The current important limitations to the implementation of Evidence-Based Practice (EBP) in the rehabilitation field are related to the validation process of interventions. Indeed, most of the strict guidelines that have been developed for the validation of new drugs (i.e., double or triple blinded, strict control of the doses and intensity) cannot-or can only partially-be applied in rehabilitation. Well-powered, high-quality randomized controlled trials are more difficult to organize in rehabilitation (e.g., longer duration of the intervention in rehabilitation, more difficult to standardize the intervention compared to drug validation studies, limited funding since not sponsored by big pharma companies), which reduces the possibility of conducting systematic reviews and meta-analyses, as currently high levels of evidence are sparse. The current limitations of EBP in rehabilitation are presented in this narrative review, and innovative solutions are suggested, such as technology-supported rehabilitation systems, continuous assessment, pragmatic trials, rehabilitation treatment specification systems, and advanced statistical methods, to tackle the current limitations. The development and implementation of new technologies can increase the quality of research and the level of evidence supporting rehabilitation, provided some adaptations are made to our research methodology.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Sarah Michiels
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Department of Otorhinolaryngology, Antwerp University Hospital, 2650 Edegem, Belgium
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Eymir M, Erduran M, Ünver B. Active heel-slide exercise therapy facilitates the functional and proprioceptive enhancement following total knee arthroplasty compared to continuous passive motion. Knee Surg Sports Traumatol Arthrosc 2021; 29:3352-3360. [PMID: 32778907 DOI: 10.1007/s00167-020-06181-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim was to compare active heel-slide exercise (AHSE) + standard physiotherapy (PT) to continuous passive motion (CPM) + standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of postoperative outcomes. METHODS Patients were randomly assigned into AHSE or CPM groups. Both groups received standard PT (range of motion and strengthening exercises, and ambulation) during hospital stay. Patients were evaluated regarding functional outcomes, knee proprioception, pain intensity, active range of motion, knee circumference, length of hospital stay, time for achieving straight leg raise actively, time for achieving 70° knee flexion. RESULTS Groups were similar at baseline (n.s.). At discharge, AHSE group was better in terms of pain intensity (p < 0.001), Hospital for Special Surgery knee score (p = 0.001), rise from sitting (p = 0.015), ascend/descend stairs (p = 0.038), and timed up and go test (p = 0.028) compared to CPM group. AHSE group was able to perform the straight leg raise earlier than CPM group during inpatient period (p = 0.001) and demonstrated improved proprioception at discharge and at 3-month follow-up (p < 0.05). No statistical differences were detected between groups in other evaluation parameters (n.s.). CONCLUSION Our findings support AHSE therapy offers a more functional rehabilitation and leads beneficial results for patients following TKA. Therefore, active exercise approach encouraging patients to participate in their rehabilitation should be first choice in acute postoperative rehabilitation following TKA rather than CPM. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Musa Eymir
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balcova, TR-35340, Izmir, Turkey.
| | - Mehmet Erduran
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Dokuz Eylul University, Balcova, TR-35340, Izmir, Turkey
| | - Bayram Ünver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balcova, TR-35340, Izmir, Turkey
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Sun M, Yang L, Guo L, He R. [Effect of robotic-arm assisted total knee arthroplasty on femoral rotation alignment and its short-term effectiveness]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:807-812. [PMID: 34308585 DOI: 10.7507/1002-1892.202102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the improvement of femoral rotation alignment in total knee arthroplasty (TKA) by robotic-arm assisted positioning and osteotomy and its short-term effectiveness. Methods Between June 2020 and November 2020, 60 patients (60 knees) with advanced osteoarthritis of the knee, who met the selection criteria, were selected as the study subjects. Patients were randomly divided into two groups according to the random number table method, with 30 patients in each group. Patients were treated with robotic-arm assisted TKA (RATKA) in trial group, and with conventional TKA in control group. There was no significant difference in gender, age, side and course of osteoarthritis, body mass index, and the preoperative hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior condylar angle (PCA), knee society score-knee (KSS-K) and KSS-function (KSS-F) scores between the two groups ( P>0.05). The clinical (KSS-K, KSS-F scores) and imaging (HKA, LDFA, MPTA, PCA) evaluation indexes of the knee joints were compared between the two groups at 3 months after operation. Results All patients were successfully operated. The incisions in the two groups healed by first intention, with no complications related to the operation. Patients in the two groups were followed up 3-6 months, with an average of 3.9 months. KSS-K and KSS-F scores of the two groups at 3 months after operation were significantly higher than those before operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). X-ray re-examination showed that the prosthesis was in good position, and no prosthesis loosening or sinking occurred. HKA, MPTA, and PCA significantly improved in both groups at 3 months after operation ( P<0.05) except LDFA. There was no significant difference in HKA, LDFA, and MPTA between the two groups ( P>0.05). PCA in trial group was significantly smaller than that in control group ( t=2.635, P=0.010). Conclusion RATKA can not only correct knee deformity, relieve pain, improve the quality of life, but also achieve the goal of restoring accurate femoral rotation alignment. There was no adverse event after short-term follow-up and the effectiveness was satisfactory.
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Affiliation(s)
- Maolin Sun
- Center for Joint Surgery, the First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, 400038, P.R.China
| | - Liu Yang
- Center for Joint Surgery, the First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, 400038, P.R.China
| | - Lin Guo
- Center for Joint Surgery, the First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, 400038, P.R.China
| | - Rui He
- Center for Joint Surgery, the First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, 400038, P.R.China
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D'Amore T, Rao S, Corvi J, Jack RA, Tjoumakaris FP, Ciccotti MG, Freedman KB. The Utility of Continuous Passive Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies. Orthop J Sports Med 2021; 9:23259671211013841. [PMID: 34262979 PMCID: PMC8246506 DOI: 10.1177/23259671211013841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background The application of continuous passive motion (CPM) after anterior cruciate ligament reconstruction (ACLR) was popularized in the 1990s, but advancements in the understanding of ACLR rehabilitation have made the application of CPM controversial. Many sports medicine fellowship-trained surgeons report using CPM machines postoperatively. Purpose To determine the efficacy of CPM use for recovery after ACLR with respect to knee range of motion (ROM), knee swelling, postoperative pain, and postoperative complications. Study Design Systematic review; Level of evidence, 3. Methods The PubMed (MEDLINE), EMBASE, Cochrane, Cumulative Index of Nursing, and Allied Health Literature databases were searched from inception to January 1, 2020, for studies with evidence levels 1 to 3 on the use of CPM for ACLR rehabilitation. Included studies were those that comparatively evaluated postoperative outcomes after ACLR between at least 2 groups of patients, with 1 having received CPM rehabilitation and the other not having received CPM. Results A total of 12 studies from 1989 to 2019 met the inclusion criteria. These studies included 808 patients who underwent ACLR. There was no evidence of CPM improving knee stability, final postoperative ROM, or subjective pain scores. Additionally, CPM did not lead to decreased muscle atrophy or improved International Knee Documentation Committee scores. Regarding pain medication intake during postoperative hospitalization, 2 studies found that the CPM group used less pain medication, 1 study found the CPM group used more pain medication, and 1 study found that there was no difference between the 2 groups. Complications varied widely, with 2 of 12 studies reporting complications that required a return to the operating room. Conclusion A clinical benefit of postoperative CPM use after ACLR was not identified in this review. While our systematic review identified a number of studies that suggest CPM use may be associated with lower usage of pain medication in hospitalized patients, this cannot be confirmed without further investigation with standardized CPM protocols and larger sample sizes. Routine CPM use after ACLR was not supported by this systematic review.
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Affiliation(s)
- Taylor D'Amore
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Somnath Rao
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - John Corvi
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.,Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Fotios P Tjoumakaris
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Michael G Ciccotti
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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Xie YJ, Wang S, Gong QJ, Wang JX, Sun FH, Miyamoto A, Ou X, Wang L, Wang SQ, Zhang C. Effects of electromyography biofeedback for patients after knee surgery: A systematic review and meta-analysis. J Biomech 2021; 120:110386. [PMID: 33794414 DOI: 10.1016/j.jbiomech.2021.110386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/10/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
There has been no systematic review evaluating the efficacy of electromyography (EMG) biofeedback after knee surgery recently. This meta-analysis aimed to determine whether EMG-biofeedback is effective for improving the range of motion (ROM), physical function, and pain relief in patients after knee. Randomized controlled trials (RCTs) assessing the effect of EMG-biofeedback after any knee surgery were retrieved from EMBASE, PubMed, Cochrane Library, Physiotherapy Evidence Database, ClinicalTrials.gov, ProQuest. This review identified 773 unique studies, and six RCTs were in the final meta-analysis. EMG-Biofeedback treatment has a significant difference compared to other rehabilitation therapy in knee ROM improving (SMD = -0.48, 95% CI = -0.82 to -0.14, p = 0.006, I2 = 37%). Moreover, there was no significant difference in pain (SMD = -0.33, 95% CI = -0.67 to0.02, p = 0.07, I2 = 41%) and physical function scores (MD = 1.83, 95% CI = -3.48 to7.14, p = 0.50, I2 = 0%). The results illustrate that EMG-biofeedback can improve knee ROM in patients after knee surgery. However, it is not superior to other rehabilitation methods for pain relief and physical function improvement.
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Affiliation(s)
- Yu-Jie Xie
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Shuang Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Qun-Jie Gong
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Jian-Xiong Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Fu-Hua Sun
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Akira Miyamoto
- Department of Physical Therapy Faculty of Rehabilitation of Kobe International University, Japan
| | - Xia Ou
- Nuclear Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Li Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Shi-Qi Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Chi Zhang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.
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Wirries N, Ezechieli M, Stimpel K, Skutek M. Impact of continuous passive motion on rehabilitation following total knee arthroplasty. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1869. [PMID: 32985036 DOI: 10.1002/pri.1869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/30/2020] [Accepted: 07/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is an ongoing controversy in respect of the usage of continuous passive motion (CPM) following total knee arthroplasty (TKA). We analysed the impact of CPM on the early rehabilitation after TKA and the clinical outcome over the time. METHODS Forty patients were prospectively randomized to postoperative protocols following TKA. Half of them (n = 20) received the standard manual therapy alone and the others (n = 20) were treated additionally with CPM. Identical implants were used in all patients. Passive range of movement (PROM) was noted. Patient satisfaction and knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the Knee Society Score (KSS) at time of discharge and 2 years postoperatively. RESULTS The patients in the solitary manual therapy group (MT) showed preoperatively a 7.2° greater PROM (p = .03) with 5.4° higher flexion (p = .05). Analogously, the KSS presented with 42.7 points a higher score result compared to the CPM group with 35.9 points (p = .03). Although the preoperative ability with 105.2° for flexion and 97.2° for the PROM were in favour of the group without CPM (99.8° resp. 90.0°), at time of discharge the patients with CPM reached with 111.0° a significant higher flexion and with 109.0° a higher PROM (MT group: 107.0° resp. 103.5°) (p = .04/.02). At 2 years follow-up both scores (WOMAC/KSS) and function (extension, flexion and PROM) were balanced (p > .05). Patella resurfacing showed no impact on the clinical results at discharge or at time of last follow-up (p > .05). DISCUSSION Although the addition of CPM did significantly improve knee flexion in the early postoperative stage, the difference might not represent a clinical relevance. Further, there were no notable effects on long-term clinical and functional results following TKA, so the routine application of CPM in the above stated setting might be ceased.
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Affiliation(s)
- Nils Wirries
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Marco Ezechieli
- Department of Orthopedic Surgery, St. Josefs Hospital, Salzkotten, Germany
| | - Kai Stimpel
- Therapiezentrum Langenhagen, Hannover, Germany
| | - Michael Skutek
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
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