Effect of Physical Therapy Interventions in the Acute Care Setting on Function, Activity, and Participation After Total Knee Arthroplasty: A Systematic Review

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Despite seemingly routine use of physical therapy and its potential importance in reducing complications after total joint arthroplasty in the acute hospital setting, no agreed-upon approach to rehabilitation exists in this setting. In fact, rehabilitation practices and outcomes assessed are quite variable.


To determine the effects of physical therapy interventions in the acute care phase of total knee arthroplasty.

Data Sources:

Ovid Medline, Cochrane Database of Systematic Reviews, CINAHL.

Review Selection Criteria:

Peer-reviewed research from January 1996 to October 2016 of adults with primary total knee arthroplasty receiving any physical therapy intervention related to body systems/function impairments or activity/participation limitations measured within 7 days of surgery. All studies included a comparison group.

Data Extraction:

Two reviewers extracted data and determined study quality.

Data Synthesis:

Qualitative summary considering studies' risk of bias and number favoring interventions for outcomes.


Thirty-nine studies were included. Interventions included extra therapy, accelerated therapy, cryotherapy, Chinese medicine, lymphatic drainage, mechanical and manual passive motion, active-assistive motion, biofeedback, and electrical stimulation. Most studies included undefined “standard care.” Outcomes varied, with pain and knee motion commonly reported.


Evidence supports cryotherapy for reducing pain and accelerated therapy for improving range of motion and walking, but quality is low. High-quality studies in these areas are needed.

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