The Effect of Early Post-Operative Outpatient Physiotherapy on Outcomes Following Lower Limb Arthroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND

Although joint arthroplasties are generally successful, many patients experience persistent impairments. It is unknown whether early outpatient physiotherapy can address these persistent impairments.

OBJECTIVE

To determine whether early outpatient physiotherapy, compared with delayed physiotherapy, improves pain, physical function and quality of life (QOL) in patients following lower limb arthroplasty.

METHOD: A systematic review and meta-analysis was conducted following the PRISMA guidelines. Searches were conducted across MEDLINE, Embase, CINAHL, Cochrane and PsycINFO. Eligible studies included randomised control trials (RCTs) comparing early and delayed physiotherapy in patients after lower limb arthroplasty. Data were pooled using a random-effects model. Risk of bias assessment was completed using the Physiotherapy Evidence Database scale. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence.

RESULTS

Three RCTs involving 224 participants undergoing joint arthroplasty (lateral uni-compartment knee replacement, total knee replacement and total hip replacement) were included. Meta-analyses demonstrated no significant differences in pain, physical function or QOL between early and delayed physiotherapy in short, medium or long term follow-ups. The certainty of evidence ranged from very low to low, with negligible to minimal effect sizes indicating minimal clinical relevance.

CONCLUSION

The systematic review and meta-analysis found low to very low quality evidence that early outpatient physiotherapy following knee or hip joint arthroplasty does not improve pain, physical function or QOL compared with delayed physiotherapy. Future research should aim to confirm modifiable risk factors contributing to poor outcomes post-operatively and evaluate the effectiveness of early targeted physiotherapy in these high-risk subgroups.