Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials.
BMJ Open
; 10(1): e033248, 2020 01 20.
Article
em En
| MEDLINE
| ID: mdl-31964670
ABSTRACT
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 SECONDARYOUTCOMES:
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, I2=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.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Dor Pós-Operatória
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Cuidados Pré-Operatórios
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Ensaios Clínicos Controlados Aleatórios como Assunto
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Artroplastia do Joelho
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Dor Crônica
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article