A Comparison Between Intensive and Conventional Therapies: A Systematic Review and Meta-Analysis Regarding the Pre-operative Outcomes After Total Knee Replacement
Bibliographic record
Abstract
Joint degeneration characterized by cartilage deterioration and bone wear is the hallmark of osteoarthritis (OA), a condition that worsens over time. Total knee arthroplasty (TKA) is the most common effective treatment for OA. Conventional therapy training (CTT) is the standard intervention; we are testing whether intensive therapy training (ITT) provides different results when used preoperatively. Our study compared intensive and standard preoperative physical therapy in randomized and non-randomized controlled trials, excluding various other study types. Two independent researchers assessed the risk of bias using appropriate tools (RoB 2 for RCTs (Cochrane Methods, London, UK) and ROBINS-I for non-randomized studies (Cochrane Methods, London, UK)). The analysis, conducted using ReviewManager 5.4 (Cochrane Methods, London, UK), presented results as mean differences (MD) with 95% CIs, employing fixed or random-effects models based on heterogeneity assessments. With a total number of 490 participants, ITT showed significant improvements in the six or 10-minute walk test (MD = 45.07m, P < 0.000001), quadriceps strength (MD = 0.07 Kg, P < 0.0001), range of motion (ROM) flexion (MD = 4.29, P = 0.03), isometric knee flexion (MD =2.32, P=0.04), SF-36 physical component (MD = 1.19, P <,0.0001), stair test (MD = -2.01, P = 0.01), timed up and go test (MD = -1.12, P = 0.02), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (MD = -8.43, P = 0.002). Conversely, CTT showed better results in isometric knee extension (MD = 3.45, P = 0.02). No significant differences were found in ROM extension or visual analog score (VAS) pain scores. Preoperative ITT demonstrates overall superior outcomes compared to CTT for total knee arthroplasty patients. ITT significantly improved various functional and patient-reported outcomes, including walking capacity, quadriceps strength, range of motion, and quality of life measures. However, CTT showed superiority in isometric knee extension. We recommend implementing preoperative ITT protocols for TKA patients while acknowledging the need for further research to optimize exercise specifics, frequency, and duration for optimal results.
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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 | 0.014 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.035 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| 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".