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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Background: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.Purpose: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.Results: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.Conclusions: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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