Efficacy of Noninvasive Interventions for Reducing Postoperative Kinesiophobia in Patients Undergoing Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

Excessive fear of movement (kinesiophobia) hinders functional recovery after total knee arthroplasty. We evaluated the efficacy of noninvasive interventions in reducing postoperative kinesiophobia.

METHODS

We systematically searched PubMed, Embase, Scopus, and Web of Science for randomized controlled trials comparing noninvasive strategies with usual care, from inception to December 10, 2025. Risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. We pooled data using a random-effects meta-analysis to calculate mean differences (MD). The primary outcome was the Tampa Scale of Kinesiophobia (TSK). The certainty of evidence was appraised via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Sixteen randomized controlled trials (n = 1373) were included. Interventions were categorized into rehabilitation, cognitive-behavioral therapy (CBT), patient education, and adjunctive modalities. Meta-analysis indicated that rehabilitation and exercise programs significantly reduced TSK scores (MD = -7.95; 95% confidence interval: -13.15 to -2.74; P = .003) with moderate certainty. CBT interventions also produced significant reductions (MD = -6.12; 95% confidence interval: -10.79 to -1.45; P = .01) with low certainty. Both pooled effect sizes were close to the range of published anchor-based minimal clinically important difference estimates for the TSK (6.2-6.4 points). Educational and adjunctive approaches (eg, virtual reality, reflexology) consistently improved TSK and secondary outcomes, though heterogeneity precluded pooling.

CONCLUSIONS

Structured rehabilitation and exercise programs and CBT-based interventions were associated with significant reductions in kinesiophobia after total knee arthroplasty, although the certainty of evidence was moderate for rehabilitation and exercise and low for psychotherapy and CBT. Emerging modalities also showed favorable results, but the available evidence remains limited.

LEVEL OF EVIDENCE: I.