Prehabilitation in Patients at Risk of Poorer Outcomes Following Total Knee Arthroplasty: A Systematic Review
Bibliographic record
Abstract
BACKGROUND: While total knee arthroplasty (TKA) is a generally successful procedure, 10 to 30% of patients still report suboptimal outcomes after surgery. Prehabilitation may offer potential benefits to improve poorer outcomes, although its effectiveness remains uncertain. Our study aimed to assess the efficacy of prehabilitation interventions on patients at risk of poor outcomes following TKA. METHOD: There were six electronic databases searched up until December 2023. All randomized controlled trials comparing prehabilitation versus usual care in adult patients with osteoarthritis undergoing primary TKA and at risk of poorer outcomes were included. There were four reviewers who independently extracted data and assessed the risk of bias for each study. RESULTS: The 13 included studies assessed prehabilitation among patients at risk of poor outcomes, identified with various factors including range of motion deficit, functional limitations, high body mass index, psychological factors, frailty, older age, central sensitization, and high risk of discharge to inpatient rehabilitation. The interventions were initiated across a wide range, from 4 to 277 days before surgery. The efficacy of exercise therapy and multidisciplinary rehabilitation remains inconclusive due to limited, low-quality evidence. The results failed to indicate that various forms of nonexercise therapy, including education, psychological intervention, and weight loss therapy, were effective in improving outcomes after TKA. The included studies have major limitations such as small sample size, inappropriate comparators, substantial clinical heterogeneity in intervention characteristics, inadequate blinding for providers and participants, a lack of justification for identifying patients at risk of poor recovery, and a lack of appropriate interventions for managing modifiable factors. CONCLUSIONS: While our finding fails to show that nonexercise therapy is effective, results of exercise therapy and multidisciplinary rehabilitation remain inconclusive. Further high-quality research is warranted to establish evidence on modifiable factors predictive of poorer postoperative outcomes and investigate how they can be effectively managed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".