Effectiveness of Strategies to Promote Adherence to Rehabilitation in Total Knee Arthroplasty

Objective(s): To synthesize the effectiveness of interventions to promote adherence to rehabilitation in adherence (primary) and clinical outcome in patients undergoing total knee arthroplasty (TKA)

Data Sources: MEDLINE, Cochrane and PEDro were searched from inception to February 2022. Search terms were based on PICO strategy, including the terms knee arthroplasty, rehabilitation, adherence and compliance (and derivations).

Study Selection: Interventional studies with patients undergoing TKA, in which experimental interventions were designed to improve adherence to rehabilitation were eligible. Nine studies (6% of initially identified), involving 756 participants, were analyzed. Two reviewers independently searched and selected studies; a third reviewer was involved when necessary

Data Extraction: Two reviewers extracted data independently, including id, author's name, publication year, design, intervention(s) characteristics, and measures of 1)adherence and 2)clinical outcome (pain and functionality). Sample size, mean and standard deviations, significance levels, confidence intervals, and hazard ratios or odds ratios as appropriate, were extracted for further analysis

Data Synthesis: The interventions to promote adherence included phone calls (4 studies), activity goals (4 studies), motivational strategies (n=2), financial incentives and music. Qualitatively, adherence-related results, such as activity level, compliance and retention rates were inconsistent, suggesting from positive to non-existent benefits. The quantitative synthesis with meta-analysis suggested a positive impact on reliefing postoperative pain, SMD 95%CI=[0.31 (0.09 to 0.54),p < 0.01] but no superior benefits of adherence interventions on functional outcome than standard care (p>0.05).

Conclusions: Overall, the effectiveness of current interventions to improve adherence to TKA rehabilitation is still inconclusive, with benefits ranging from positive to non-existent. Yet, these strategies may contribute to improve clinical outcome, especially in terms of pain relief. The diversity of results from individual studies and the heterogeneity in the interventions designs suggested that further studies are needed.

Author(s) Disclosures: Project PID2020-115825RA-I00, funded by MCIN/ AEI/10.13039/501100011033, convocatoria Proyectos I+D+i 2020 - Modalidades “Retos Investigación” y “Generación de Conocimiento”