The conclusion appears appropriate based on the evidence presented, although the potential for selection bias and the omission of some data may weaken this conclusion.If you’re having a total or partial knee replacement – or considering one – you may have heard a lot of talk about “degrees of flexion”. Also, 2 studies omitted from the meta-analysis were also omitted from the narrative synthesis, therefore their results were not considered in the review. There was an inconsistency between the text and forest plot, as only four of the 5 studies stated in the text as being included in the meta-analysis were represented on the forest plot, with the fifth being a different study. The pooling of clinically and statistically heterogeneous data might not have been appropriate. The data extraction and quality assessment were conducted in duplicate, with study quality being assessed using suitable criteria.Īdequate study details were reported. A single author selected studies, therefore error and bias might have been introduced. The review was restricted to published articles in three languages, which might have resulted in publication or language bias. Several relevant databases were searched. The inclusion criteria were clear regarding the participants, interventions, outcomes and study design, and were relevant to the evaluation undertaken. Four studies reported no statistically significant difference in long-term effects on flexion range of motion.Ĭontinuous passive motion versus physiotherapy (two studies): one study reported better short-term effects of continuous passive motion in comparison with physiotherapy, while the other reported no difference between continuous passive motion and physiotherapy in either short- or long-term effects.Ĭontinuous passive motion versus immobilisation (one study): both short- and long-term results favoured continuous passive motion over seven days of cast immobilisation.Ĭontinuous passive motion versus slider board (two studies): there were no differences in short- or long-term effects between these treatments.Ĭontinuous passive motion plus physiotherapy versus physiotherapy plus 'drop and dangle' (one study): there were no differences in flexion range of motion after 5 days, but slightly better range of motion with continuous passive motion plus physiotherapy after six months. There was highly statistically significant heterogeneity between these studies (p<0.0001). Blinding of the patients and carers was not applicable because of the intervention being evaluated.Ĭontinuous passive motion plus physiotherapy versus physiotherapy: there was no statistically significant difference in short-term effects on flexion range of motion between continuous passive motion plus physiotherapy versus physiotherapy alone (WMD 8.27, 95% CI -1.60 to 18.15 five studies). All studies were scored positive for the method of randomisation, twelve for similarity at baseline, seven for blinding of the assessors, fourteen for length of follow-up, ten for drop-out rate, and three for the use of an intention-to-treat analysis. One author selected studies for the review.įifteen RCTs (n=990) were included in the review.įor quality, one RCT scored 8 out of a possible 10, three scored 6, three scored 5, five scored 4, two scored 3 and one scored 2. How were decisions on the relevance of primary studies made? Where reported, the studies assessed outcomes between 5 days and 12 months post-operatively. Three studies assessed active range of motion, three assessed passive range of motion, one assessed both active and passive range of motion, and it was unclear which type of outcome assessment was carried out in eight. The outcomes were classified as short term (5 to 14 days post-surgery) or long term (3 to 5 months post-surgery). The primary outcome was flexion range of motion. Studies reporting on range of motion were eligible for inclusion. No details of the participants in the included studies were provided. Studies of patients who had undergone a total knee arthroplasty were eligible for inclusion. The included studies evaluated continuous passive motion either alone or in conjunction with physiotherapy, compared with physiotherapy, passive knee flexion, immobilisation and slider board, or compared different continuous passive motion regimes. Studies evaluating post-operative continuous passive motion compared with no treatment or physiotherapy alone were eligible for inclusion. Specific interventions included in the review Randomised controlled trials (RCTs) were eligible for inclusion. Study designs of evaluations included in the review
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