Preoperative High-Intensity Strength Training and Outcomes After Total Knee Arthroplasty: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
CONTEXT: Preoperative and postoperative strength training is beneficial for outcomes of total knee arthroplasty (TKA). However, the effect of high-intensity strength training is not well understood. OBJECTIVE: This systematic review and meta-analysis aimed to determine the effects of preoperative high-intensity strength training on TKA outcomes. DATA SOURCES: PubMed, EMBASE, and Cochrane CENTRAL were searched up to December 18, 2023. STUDY SELECTION: Randomized controlled trials and cohort studies evaluating the effect of preoperative high-intensity strength training after TKA were eligible. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level II, systematic review and meta-analysis of randomized controlled trials and cohort studies. DATA EXTRACTION: Evaluated outcomes consisted of Timed Up and Go (TUG) test, the 6-minute walk test (6MWT), stair test, range of motion (ROM) flexion, Short Form Health Survey (SF-36) scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and the Knee Injury and Osteoarthritis Outcome Score for Activities of Daily Living (KOOS-ADL). These were compared between the intervention and control groups using pooled standardized mean differences. The quality of the studies was appraised using the Risk of Bias in Nonrandomized Studies by Interventions (ROBINS-I) and the Cochrane Collaboration tool. RESULTS: Seven studies, comprising 419 patients in total, were included. The meta-analysis showed that the preoperative high-intensity strength training group (intervention group) exhibited statistically significant improvements compared with the control group in 6MWT (pooled standardized mean difference [pSMD] = 0.73; 95% CI, 0.04 to 1.41), ROM flexion (pSMD = 0.40; 95% CI, 0.08 to 0.72), SF-36 (pSMD = 1.54; 95% CI, 0.32 to 2.75), and WOMAC (pSMD = -0.78, 95% CI, -1.22 to -0.34). CONCLUSION: Preoperative high-intensity strength training as the prehabilitation programs for patients scheduled for TKA lead to better postoperative recovery, enhanced physical function, and improved quality of life.
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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 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.037 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 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".