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Table 1 Characteristics of included studies

From: Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis

Publication Operation Primary focus of intervention Follow up interval
Location Indication Study setting Outcomes
Date of study Number randomised (intervention:control) Intervention, health professional. Time commenced Adherence to intervention
Mean age (% female) Timing, duration and intensity Losses to follow up (intervention: control)
  Control group care  
Bruun-Olsen et al. 2013 [29] Norway 2008-2010 Primary TKA Walking skills On completion of intervention and 9 months after intervention
Osteoarthritis Outpatient physiotherapy department KOOS, 6 minute walk test, performance tests, ROM, self-efficacy in activities
N = 57 (29:28) Physiotherapist-led walking-skills programme with emphasis on weight-bearing exercises. Commenced 6 weeks after surgery 28/29 completed programme (97%)
6 (2:4) not followed up
69 (56.1%) 6–8 weeks  
  Usual physiotherapy  
Evgeniadis et al. 2008 [19] Greece 2006 Primary TKA Strengthening 6, 10 and 14 weeks after surgery
Osteoarthritis Home SF-36, Iowa Level of Assistance Scale, active ROM
N = 48 (24:24) Supervised exercise programme with emphasis on strengthening lower extremities 20/24 completed programme (83%)
69 (56.3%) Commenced after hospital discharge 13 (9:4) not followed up
  8 weeks  
  Control received standard preoperative and postoperative care  
Frost et al. 2002 [17] UK 1995-1996 Primary unilateral TKA Functional exercise 3, 6 and 12 months
Osteoarthritis Home VAS pain, ROM, leg extensor power, walking speed, gait speed
N = 47 (23:24) Warm up exercise, chair rise, walking, and leg lifts. Commenced after hospital discharge 16/23 completed programme (70%)
71.3 (48.9%) Number of visits and duration not specified 20 (7:13) not followed up
  Controls given instructions to continue exercises taught in hospital  
Fung et al. 2012 [27] Canada 2009-2010 TKA Balance and posture control additional to outpatient physiotherapy Discharge from physiotherapy, estimate about 3 months
Not specified Outpatient department in rehabilitation hospital ROM, 2-minute walk test, NRS pain, LEFS, Activity-specific Balance Confidence Scale, length of rehabilitation, satisfaction
N = 50 (27:23) Wii Fit gaming activities focused on multidirectional balance, and static and dynamic postural control 27/27 completed programme (100%)
68.1 (66%) Commenced a mean of 38–47 days after surgery 0 lost to follow up
  Twice weekly for mean of about 8 weeks  
  All patients received twice-weekly outpatient physiotherapy. Control patients also received 15 minutes of lower extremity strengthening and balance training exercises  
Harmer et al. 2009 [30] Australia 2005-2006 Primary TKA Hydrotherapy compared with gym-based therapy 8 and 26 weeks
Not specified Community pool WOMAC, VAS, 6 minute walk test, stair ascent, ROM, knee oedema
N = 102 (53:49) Supervised classes in pool with walking forward and backward, stepping sideways, step-ups, jogging, jumping, kicking, knee ROM exercises, lunges, and combined squats and upper extremity exercises. 81% of patients attended at least 8/12 sessions 3 (2:1) lost to 26 week follow up
68.3 (57%) Commenced 2 weeks after surgery  
  Twice a week, 60 min duration for 6 weeks  
  Control patients received gym-based rehabilitation with ergometer cycling; walking on a treadmill; stair climbing; standing isometric, balance and knee ROM exercises at a bar; and sit to stand exercises  
Kauppila et al. 2010 [13] Finland 2002-2005 Primary unilateral TKA Multidisciplinary rehabilitation programme 2 months, 6 months, 12 months
Osteoarthritis University hospital outpatient department WOMAC, 15 min walk test, stair ascent/ descent test, isometric strength, ROM
N = 86 (44:42) Week 1: physiotherapist assessment; 3 group sessions (45 minutes) with lower limb strengthening exercises; 2 pool gymnastic sessions (30 minutes) with lower limb stretching and mobility, and functional exercises focused on walking; lectures by social worker (60 minutes) and nutritionist (90 minutes) 44/44 attended multidisciplinary rehabilitation programme (100%)
70.6 (75.6%) Week 2: 2 lower limb strengthening exercise group sessions (45 minutes); 3 pool gymnastic sessions (45 minutes); orthopaedic surgeon lecture (45 minutes) and clinical assessment (15 minutes). 11 (8:3) lost to 6 and 12 month follow up
Included 60–80 years Daily supervised group stretching exercises (30 minutes)  
  Twice weekly supervised group Nordic walking (30 minutes)  
  4 group rehearsals of relaxation strategies (30 minutes)  
  Individualised exercise recommendations (40 minutes).  
  2 group sessions on coping strategies (90 minutes) and individual visit with psychologist  
  Total 10 days at 2–4 months after surgery  
  Control received an exercise programme to complete at home from 2 months after surgery.  
Kramer et al. 2003 [25] Canada Not specified Primary unilateral TKA Basic and advanced ROM and strengthening exercises. 12, 26 and 52 weeks
Osteoarthritis Home- and clinic- based groups WOMAC, SF-36, KSS, stair ascent and descent, 6 minute walk test
N = 160 (80:80) Attended outpatient physical therapy. Therapists able to modify or add exercises, use therapeutic modalities, joint mobilisations or other measures as appropriate 154/160 complete programmes (96%)
68.4 (56.9%) Between 2 to 12 weeks after surgery, two sessions per week for 1 hour per session 26 (11:15) medical issues, withdrawn consent
  Home-base group received a telephone call once in week 2 to 6 and once in weeks 7–12 reminding them of the importance of exercise and to give advice  
Liebs et al. 2010 [28] Germany 2005-2006 Primary unilateral TKA Ergometer cycling (additional to standard programme) 3, 6, 12 and 24 months
Osteoarthritis or osteonecrosis Multiple hospitals WOMAC, SF-36 PCS, patient satisfaction
N = 159 (85:74) Cycling with minimal resistance under guidance of a physical therapist. Aim was to improve muscle coordination, proprioception and ROM. No information on patient adherence reported
69.8 (71.7%) Three times a week for at least three weeks, starting after the second postoperative week 24 (10:14) lost to follow up at 3 months
  Controls received standard physiotherapy programme only  
Madsen et al. 2013 [24] Denmark 2010-2011 Fast-track primary TKA Group-based programme compared with home-based programme 3 and 6 months
Osteoarthritis Physiotherapist led strength endurance training, education, patient discussion. Home exercises twice weekly with strength training, endurance training on exercise bike, walking, balance, training and muscle strength training. OKS, SF-36 physical function, EQ-5D, ROM, peak Leg Extensor Power, balance test, 10 m walk test, sit-to-stand tests, VAS pain during Leg Extensor Power test.
N = 80 (40:40) 2 sessions per week for 6 weeks starting 4–8 weeks after surgery. Average 10.5 sessions (range 4–12) Patients in group-based programme attended mean 10.5 sessions (range 4–12). Adherence to home-based programme not reported
66.6 (41%) Home exercises with 1–2 planned visits by a local physiotherapist 10 (4:8) lost to follow up
Minns Lowe et al. 2012 [20] UK 2006-2009 Primary TKA Home-based functional rehabilitation 3, 6 and 12 months
Osteoarthritis Home OKS, KOOS, leg extensor power, timed sit to stand test, 10 metre timed walk
N = 107 (56:51) received surgery 2 physiotherapist home visits within 2 weeks and at 6–8 weeks after discharge. Assessment of function and rehabilitation progress on gait re-education, and use of walking aids. Twice daily exercise for 3 months: weight, partial knee bends/quarter squats, standing knee flexion and extension wall sits, heel and knee raises, step-overs, and stretches. Task training: getting in and out of a car, getting up from a chair at a table, walking outside and stairs. 46/47 home-based group received 2 visits (98%)
69.2 (58%) Controls received usual physiotherapy treatment provided at the hospital without additional home visits 1 (1:0) lost to follow up
Mitchell et al. 2005 [21] UK 1999-2000 Primary unilateral TKR Home physiotherapy compared with outpatient group provision 12 weeks
Osteoarthritis Up to 6 post-discharge home visits by community physiotherapist. Commenced 3–19 days after discharge. Patient assessment and individualised therapy relating to pain relief, knee flexion and extension, gait re-education, home and functional adaptations, reduction of swelling and mobilisation of soft tissues. Before surgery patients received 3 visits. WOMAC, SF-36, resource use and cost
N = 115 (57:58) Controls received exercises and individual treatment 1–2 times a week Home-based group had a mean of 8.4 sessions. Outpatient group had a mean of 3.5 sessions
70.3 (57.9%)   1 (0:1) lost to ITT analysis (45 patients withdrawn mainly pre-surgery)
Mockford et al. 2008 [14] Northern Ireland Not specified Primary TKA Outpatient physiotherapy 3 months and 1 year
Osteoarthritis, rheumatoid arthritis Outpatient department Oxford Knee Score, SF-12, Bartlett Patella Score, ROM, Walking distance
N = 143 (71:72) 6 weeks starting within 3 weeks of hospital discharge Intervention group attended mean 7.3 sessions (range 0–9). 43/71 attended all sessions (61%)
70.2 (61.5%) Control received no outpatient physiotherapy following discharge. All patients were given a home exercise regime to follow on discharge 7(4:3) not followed up
Moffet et al. 2004 [18] Canada 1997-1999 Primary TKA Intensive functional rehabilitation 4, 6, 12 months
Osteoarthritis Rehabilitation Institute WOMAC, SF-36, 6 minute walk test
N = 77 (38:39) 12 physiotherapist supervised sessions from 2 months after-discharge with individualised home exercises. 60-90mins per week for 6–8 weeks All intervention patients participated in the 12 sessions
67.7 (59.7%) Each session included: warm-up, specific strengthening exercises, functional task-oriented exercises, endurance exercises, and cool-down. ROM, pain and effusion monitored to optimise intervention. 6 (0:6) not followed up at 12 months
  Control group received usual care including possibility of supervised rehabilitation at home  
  All patients were taught a home exercise programme before hospital discharge.  
Monticone et al. 2013 [16] Italy 2010 Primary TKR, osteoarthritis Home-based functional exercise programme 6 and 12 months
N = 110 (55:55) Home Knee injury and Osteoarthritis Outcome Score (KOOS), Tampa Scale for Kinesiophobia, NRS pain, SF-36
67 (64%) Continuation of functional exercises provided in hospital. Cognitive behavioural intervention with home exercise book about the fear-avoidance model and management of kinesiophobia. Monthly phone calls to reinforce adherence. No patients dropped out of study but no information collected on patient adherence
  Commenced after discharge from rehabilitation unit 0 losses to follow up
  Twice-weekly 60-minute sessions for 6 months  
  No physiotherapy. Advice to stay active  
Piqueras et al. 2013 [22] Spain 2008-2010 Primary TKR, able to walk and with no contra-indications for rehabilitation Outpatient and home-based telerehabilitation 2 weeks after intervention and 3 months
Osteoarthritis 5 sessions under therapist supervision at rehabilitation department and 5 sessions at home ROM, isometric hamstring and quadriceps strength, pain, WOMAC, timed up and go test
N = 142 (72:70). 181 randomised but 142 completed baseline measures Commenced after 2 week rehabilitation programme after hospital discharge 18/72 home-based (25%) and 21/70 outpatient (30%) dropped out during first 5 sessions.
73.5 (72.4%) Interactive virtual telerehabilitation. Patients received information needed to perform exercises and remote therapist monitoring. Therapy modified as rehabilitation evolved. System used wireless movement sensors, interactive software and a touch-screen computer, and a web-portal. 9 (4:5) lost to follow up
  Daily 1 hour sessions for 10 days  
  Conventional out-patient physical therapy. All randomised patients received a 2 week rehabilitation programme immediately after hospital discharge  
Piva et al. 2010 [26] USA 2007-2008 Unilateral TKR in the last 2-6months Balance exercises (additional to supervised functional training programme) 2 months and 6 months
Not specified Outpatient physical therapy department WOMAC, Lower Extremity Functional Scale, timed chair rise test, self-selected gait speed over 4 m
N = 43 (21:22) Additional balance exercises (agility and perturbation) 84% completed programmes. 64-67% of prescribed exercises completed
68.5 (71.4%) Control group received a supervised functional training program without additional balance exercises 8 (3:5) not followed up
  Commenced 2–6 months after surgery  
  All patients received 12 sessions of functional training over 6 weeks  
  Home exercises given to both groups at the end of the supervised programme  
Rajan et al. 2004 et al. [15] UK 1998-1999 Primary TKA Outpatient physiotherapy 3 months, 6 months and 1 year
Monoarticular arthrosis Outpatient ROM
N = 120 (59:61) Average 4–6 physiotherapy sessions No information on patient adherence
68.5 (62.9%) Commenced after discharge from hospital 4 (3:1) not followed up
  Control group did not receive outpatient physiotherapy  
  All patients given a home exercise regime on discharge  
Tousignant et al. 2011 [23] Canada Not specified TKA Functional rehabilitation 4 months
Not specified Home Knee range of motion, Berg balance scale, 30 second chair-stand test, WOMAC, Timed up and go, Tinetti test, functional autonomy measu(SMAF), SF-36
N = 48 (24:24) Intervention group received tele-rehabilitation through high speed internet. Progressive exercises to reduce disability and improve function in ADL. Family member or friend present to ensure safety No information on adherence
66 (unreported) 2 sessions per week for 8 weeks 7 (3:4) not followed up
  Commenced within 5 days of hospital discharge  
  Approx 1 hour duration  
  Control group received usual home care services and outpatient rehabilitation over 2 month period