Effect of Physical Therapy Interventions in the Acute Care Setting on Function, Activity, and Participation After Total Knee Arthroplasty: A Systematic Review

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.