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Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE: Nearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic...

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Autores principales: Dennis, Jane, Wylde, Vikki, Gooberman-Hill, Rachael, Blom, AW, Beswick, Andrew David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045074/
https://www.ncbi.nlm.nih.gov/pubmed/31964670
http://dx.doi.org/10.1136/bmjopen-2019-033248
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author Dennis, Jane
Wylde, Vikki
Gooberman-Hill, Rachael
Blom, AW
Beswick, Andrew David
author_facet Dennis, Jane
Wylde, Vikki
Gooberman-Hill, Rachael
Blom, AW
Beswick, Andrew David
author_sort Dennis, Jane
collection PubMed
description OBJECTIVE: Nearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR. DESIGN: MEDLINE, Embase, CINAHL, The Cochrane Library and PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation. PRIMARY AND SECONDARY OUTCOMES: Pain at 6 months or longer; adverse events. INTERVENTIONS: Presurgical interventions aimed at improving TKR outcomes. RESULTS: Eight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I(2)=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions. CONCLUSIONS: We found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR. PROSPERO REGISTRATION NUMBER: CRD42017041382.
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spelling pubmed-70450742020-03-09 Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials Dennis, Jane Wylde, Vikki Gooberman-Hill, Rachael Blom, AW Beswick, Andrew David BMJ Open Surgery OBJECTIVE: Nearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR. DESIGN: MEDLINE, Embase, CINAHL, The Cochrane Library and PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation. PRIMARY AND SECONDARY OUTCOMES: Pain at 6 months or longer; adverse events. INTERVENTIONS: Presurgical interventions aimed at improving TKR outcomes. RESULTS: Eight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I(2)=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions. CONCLUSIONS: We found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR. PROSPERO REGISTRATION NUMBER: CRD42017041382. BMJ Publishing Group 2020-01-20 /pmc/articles/PMC7045074/ /pubmed/31964670 http://dx.doi.org/10.1136/bmjopen-2019-033248 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Surgery
Dennis, Jane
Wylde, Vikki
Gooberman-Hill, Rachael
Blom, AW
Beswick, Andrew David
Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials
title Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials
title_full Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials
title_fullStr Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials
title_full_unstemmed Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials
title_short Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials
title_sort effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045074/
https://www.ncbi.nlm.nih.gov/pubmed/31964670
http://dx.doi.org/10.1136/bmjopen-2019-033248
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