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  • Study: More Evidence for Early Post-TKR Exercise Interventions 'Urgently Needed'

    With the number of total knee replacements (TKRs) on the rise and average hospital lengths-of-stay (LOS) for the procedure dropping, you might naturally assume that the most effective early postoperative exercise interventions for TKR have been pretty well established by now.

    You'd be wrong, say authors of a new systematic review.

    They write that their review, which scoured more than 1,200 potentially useful studies, reveals a "paucity" of research that "makes it challenging for clinicians to deliver high-quality evidence-based exercise programs in the early postoperative period." They add that the prevalence of TKR and ever-decreasing hospital stays underscore the fact that more high-quality randomized clinical trials are "urgently needed."

    Authors of the review, published in BMC Musculoskeletal Disorders, had an inkling of what they were up against: they were aware that there were "limited studies" that demonstrated the effectiveness or best approach to early postoperative interventions, and they recognized that "large variations between institutions and individual clinicians exist as to what active inpatient therapy is prescribed." Still, they wanted to evaluate existing research to see if some of those gaps could be filled in.

    Focusing on studies that investigated supervised exercise therapy after TKR in the acute hospital setting, the researchers were able to find 1,296 possibly useful articles, of which 77 were reviewed in full text. Of those, only 4 articles were considered eligible for systematic review, and just 3 of the 4 met the criteria for meta-analysis. Reviewers excluded studies that used electrical stimulation, acupuncture, cryotherapy, and "electrical modalities" such as continuous passive motion, "as these were considered...an adjunct to physiotherapist-led exercise-based interventions."

    In the end, the 4 studies included in the review involved 323 participants and 373 individual knees (1 study with 50 participants studied both knees of each individual). Total study-versus-control group sizes were roughly equal, and, overall, most participants (78.5%) were female. The review focused on outcomes from 4 interventions: modified quadriceps setting, flexion splinting, passive flexion ranging, and a drop-and-dangle flexion protocol. As for assessment of outcomes, those varied depending on the study—not only did baselines differ, but follow-up times ranged from 4 weeks postsurgery to as much as 1 year afterward.

    Though not conclusive, researchers noted a few characteristics related to the various interventions: patients receiving the drop-and-dangle protocol had better flexion in the first 2 days after TKR and at discharge; flexion splint patients tended to be discharged earlier and had greater flexion at 6 weeks after TKR; and the modified quadriceps-setting patients tended to have greater hamstring and gluteal muscle strength. However, a meta-analysis of 3 of the 4 studies found no differences in flexion or knee society scores at 6 weeks' post-TKR.

    The real bottom line to be gleaned from the analysis, according to authors, is that the lack of solid evidence "precludes the formulation of clinical guidelines as to the optimum type, frequency, or duration of early exercise therapy after TKR."

    "Given the cost of providing these inpatient services, it is surprising that such a large deficit exists in the literature," authors write. "There is a need for further studies of high-quality design into supervised exercise therapy programs to provide greater functional outcomes and patient-reported satisfaction following TKR surgery, particularly in the early post-operative period."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    APTA Volunteer Opportunities Now Available

    There are new volunteer opportunities available with APTA—and a new way of letting the association know you're interested.

    Calls are now open for several APTA Board of Directors-appointed groups, including the Reference, Ethics and Judicial, Finance and Audit, Public Policy and Advocacy, and Scientific and Practice Affairs committees; as well as APTA awards subcommittees on advocacy, education, lectures, practice and service, publications, research, scholarships, and Catherine Worthingham Fellows. Deadline for making your interest known is February 28, 2019, for all groups except the Reference Committee, which has a March 1 deadline. More information on the opportunities can be found on APTA's volunteer groups webpage.

    But that's not all of what's new when it comes to volunteering with APTA. The most recent call for volunteers coincides with the debut of APTA Engage, a new volunteer portal designed to make it easier to serve the association and its components. The new system allows users to build a volunteer profile that can help identify the right volunteer fit, and features a dynamic list of opportunities ranging from 1-time, low time-commitment, locally based options to long-term volunteer positions at the national level.

    Members interested in volunteer positions currently open should use APTA Engage to notify the association of their willingness to serve, but even those who aren't hoping to participate in 1 of the currently available roles should consider creating an APTA Engage profile soon to make the process that much easier when other opportunities present themselves. Questions? Contact denakilgore@apta.org.