预康复对全膝关节置换术后患者的有效性：系统综述的系统综述

doi:10.3969/j.issn.1006-9771.2023.09.009

Abstract

Abstract:

Objective To conduct a systematic review of systematic reviews of the effect of preoperative prerehabilitation training on postoperative function of patients after total knee arthroplasty.

Methods The systematic reviews and meta-analysis about the application of preoperative prerehabilitation training after total knee arthroplasty were retrieved from Cochrane Library, Embase, PubMed, Web of Science, Wanfang Data, CNKI and VIP database, from establishment to March 10th, 2023. The methodological quality was evaluated using AMSTAR. The meta-analysis of the reseaches without repetitive content was performed using RevMan 5.3.

Results A total of ten systematic reviews/meta analyses were included. Compared with the routine rehabilitation, preoperative prerehabilitation training might decrease the scores of Western Ontario and McMaster Universities Osteoarthritis Index (MD = -1.34, 95%CI -1.94 to -0.74, P < 0.001), and Hospital for Special Surgery Knee Score (MD = -1.04, 95%CI -1.69 to -0.40, P = 0.001), shorten the length of hospital stay (MD = -1.01, 95%CI -1.66 to -0.36, P = 0.002), and enhance muscle strength three months after operation (SMD = 0.63, 95%CI 0.30 to 0.97, P < 0.001).

Conclusion Preoperative prerehabilitation training can improve postoperative knee function, enhance muscle strength three months after operation, and shorten length of hospital stay for the patients after total knee arthroplasty.

Key words: total knee arthroplasty, prerehabilitation, systematic review

CLC Number:

R687.4

SHI Jiawei, LI Lingyu, YANG Haojie, WANG Qinlu, ZOU Haiou. Effect of preoperative prerehabilitation training on total knee arthroplasty: a systematic review of systematic reviews[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1057-1064.

Figures/Tables 5

纳入文献	研究类型	国家	纳入文献数/n	样本量/n	质量评价方法	干预措施		干预周期及剂量	结局指标
纳入文献	研究类型	国家	纳入文献数/n	样本量/n	质量评价方法	实验组	对照组	干预周期及剂量	结局指标
罗欢等^[1](2022)	Meta分析	中国	10	788	Cochrane偏倚风险评估工具	本体感觉训练、躯体和上肢力量训练、抗阻训练、平衡定向训练	常规护理	每周1~3次，共6~12周	①②③④
Wang等^[8](2021)	系统综述+Meta分析	中国	12	889	Cochrane 偏倚风险评估工具	抗阻训练、股四头肌肌力训练、关节活动度训练、平衡训练	常规护理	每周1~3次，共2~6 周	①③④⑤⑥
Kwok等^[9](2015)	系统综述+Meta分析	英国	11	791	PEDro量表	股四头肌肌力训练、平衡训练、本体感觉训练	常规护理	每次20~30 min,每周2~3次，共2~4周	①②③④⑤⑦
Silkman等^[10](2012)	系统综述+Meta分析	美国	7	624	PEDro量表	下肢运动、股四头肌肌力训练、本体感觉训练、躯干和上肢力量训练	常规护理	每周3~4次，共3~6周	①②③④⑦⑧
张慧等^[11](2017)	系统综述+Meta分析	中国	13	745	Cochrane 偏倚风险评估工具	平衡运动、下肢运动、股四头肌肌力训练、关节活动范围训练、平衡训练	常规活动	每周1~3次，共4~8 周	①②③⑤⑥⑦⑨⑩
Chen等^[12](2018)	Meta分析	中国	16	1224	改良版Jadad量表	本体感觉训练、抗阻训练、平衡定向训练	常规护理	共4~8周	①②③④⑥⑦⑨
Wu等^[13](2022)	系统综述+Meta分析	中国	7	306	Cochrane 偏倚风险评估工具	下肢肌力训练、抗阻训练	常规护理	共3~20周	①②③④⑧
Ma等^[14](2018)	系统综述+Meta分析	中国	9	777	Cochrane 偏倚风险评估工具	本体感觉训练、渐进式抗阻训练、关节活动度训练	常规护理正常活动	每次5 min，每周4~6次，共4~8周	①②③④⑤⑥
Su等^[15](2022)	Meta分析	中国	19	1008	Cochrane 偏倚风险评估工具	伸展运动、等长肌力锻炼、活动锻炼、热疗	常规护理	每次10~30 min,每周3~7次，共4~8 周	①②③④⑥⑧⑨
李敏清等^[16](2018)	Meta分析	中国	6	356	Cochrane 偏倚风险评估工具	膝关节被动活动、术前功能锻炼指导、踝泵练习	常规护理	4周内完成	③⑩

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纳入文献	①	②	③	④	⑤	⑥	⑦	⑧	⑨	⑩	⑪	评分
罗欢等^[1](2022)	否	是	是	否	是	是	是	是	是	不清楚	否	7.5
Wang等^[8](2021)	否	是	是	否	是	是	是	是	是	是	是	9
Kwok等^[9](2015)	否	是	是	否	是	是	是	是	是	否	否	7
Silkman等^[10](2012)	否	是	是	否	是	是	是	是	是	是	否	8
张慧等^[11](2017)	否	是	是	否	是	是	是	是	是	不清楚	否	7.5
Chen等^[12](2018)	否	是	是	否	是	是	是	是	是	是	是	9
Wu等^[13](2022)	是	是	是	否	是	是	是	是	是	是	是	10
Ma等^[14](2018)	否	是	是	否	是	是	是	是	是	是	是	9
Su等^[15](2022)	是	是	是	否	是	是	是	是	是	是	是	10
李敏清等^[16](2018)	否	是	是	是	是	是	是	是	是	不清楚	否	8.5

结局指标	纳入研究数/n	异质性		效应模型	Meta分析
结局指标	纳入研究数/n	P值	I²值	效应模型	MD/SMD	95%CI	P值
膝关节功能
WOMAC	8	< 0.01	87%	随机	-1.34	-1.94~-0.74	< 0.001
HSS	3	< 0.01	76%	随机	-1.04	-1.69~-0.40	0.001
ROM
主动伸展	8	0.16	33%	固定	-0.02	-0.20~-0.16	0.830
主动屈曲	11	< 0.01	85%	随机	2.99	-0.70~6.69	0.110
疼痛
VAS	5	0.06	57%	随机	-0.50	-0.93~-0.17	0.005
KOOS	5	0.20	34%	固定	0.25	-0.07~0.57	0.130
WOMAC	8	< 0.01	81%	随机	-0.29	-0.75~0.17	0.220
住院时间	5	< 0.01	72%	随机	-1.01	-1.66~-0.36	0.002
股四头肌肌力
术后2个月	6	0.15	38%	固定	0.09	-0.21~0.38	0.560
术后3个月	5	0.21	32%	固定	0.63	0.30~0.97	< 0.001
生活质量	5	0.13	44%	固定	-2.36	-7.03~2.32	0.320
运动功能
TUGT	7	< 0.01	82%	随机	-0.61	-1.14~-0.09	0.020
6MWT	3	0.20	38%	固定	-0.22	-0.60~0.16	0.260

Effect of preoperative prerehabilitation training on total knee arthroplasty: a systematic review of systematic reviews

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纳入文献	膝关节功能	ROM	疼痛	住院时间	股四头肌肌力	生活质量	运动功能
罗欢等^[1](2022)	中	中	中	-	低	-	中
Wang等^[8](2021)	高	低	-	-	中	中	中
Kwok等^[9](2015)	低	中	低	中	中	中	-
Silkman等^[10](2012)	低	中	低	中	低	-	-
张慧等^[11](2017)	中	低	中	高	-	极低	低
Chen等^[12](2018)	中	中	低	中	低	-	低
Wu等^[13](2022)	极低	中	极低	-	低	-	低
Ma等^[14](2018)	中	低	中	高	-	中	低
Su等^[15](2022)	高	中	中	中	-	-	中
李敏清等^[16](2018)	中	中	-	-	-	-	-