Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: a systematic review and meta-analysis.

BACKGROUND: Continuous passive motion (CPM) is commonly used as a postoperative rehabilitation treatment, along with physical therapy, for postoperative knee rehabilitation. However, the comparison between the two in terms of efficacy in postoperative knee replacement recovery is unclear. PURPOSE: To compare efficacy and safety of combined CPM versus physical therapy alone in postoperative rehabilitation after knee arthroplasty. METHODS: PubMed, Embase, and Web of Science databases were used to retrieve and access clinical studies on the efficacy of CPM compared with physical therapy. Review Manager software was used for study publication bias assessment and data analysis based on inclusion criteria. RESULTS: A total of 6 articles covering 557 patients were included in the study. In terms of range of motion (ROM), passive knee flexion was similar between CPM and physical therapy (PT) (WMD, - 0.17; 95% CI, - 0.98-0.64; p = 0.68). At long-term follow-up, passive knee extension was similar between CPM and physical therapy (PT) (WMD, - 0.28; 95% CI, - 1.47 to - 0.92; I2 = 65%, p =0.65). In addition, CPM generates significantly higher in length of stay (WMD, 0.50; 95% CI, - 0.31 to 0.69; I2 = 3%, p < 0.001). CPM generates significantly higher treatment costs and incurs more care costs relative to physical therapy. CONCLUSION: Compared to PT, combined with CPM failed to significantly improve ROM of the knees and patient's satisfaction. In addition, CPM treatment significantly increased the cost of hospitalization.

Efecto de la movilización vertebral en rotación de la columna lumbar sobre la actividad electromiográfica del erector espinal / Effects of a rotational spinal mobilization of the lumbar spine on the erector spinae activation patterns

Introducción Este estudio investigó el efecto de la técnica de movilización rítmica lumbar en rotación de grado IV sobre la actividad electromiográfica del erector espinal, así como sobre el rango de movimiento lumbar durante la flexo-extensión de tronco. Metodología Doce participantes adultos asintomáticos realizaron 5movimientos de flexión-extensión antes y después de la intervención. Se registró de manera bilateral la actividad electromiográfica del erector espinal (longissimus thoracis) a nivel de L3 y L5, así como los datos cinemáticos para evaluar los patrones de movimiento de la región lumbo-pélvica. Se compararon las variables registradas antes y después de realizar la movilización rítmica oscilatoria de grado IV de Maitland sobre la región lumbar en el sentido de la rotación izquierda. La movilización fue aplicada en forma unilateral con el paciente en decúbito lateral derecho sobre la camilla. Resultados Hubo una disminución estadísticamente significativa (p<0,01) de la actividad EMG del erector espinal durante la fase de flexión máxima en el lado derecho a nivel de L3 tras la aplicación de la técnica estudiada. No se observó ninguna diferencia a nivel de L5, así como tampoco se observaron diferencias significativas en la cinemática lumbo-pélvica. Conclusión Este estudio demuestra que una movilización rítmica oscilatoria hacia el lado izquierdo en rotación lumbar de grado IV produce una disminución estadísticamente significativa de la actividad electromiográfica del erector espinal en la fase de flexión completa en el lado contralateral (el derecho), en el nivel vertebral de su aplicación (L3) y no en niveles inferiores (L5) (AU)

Introduction This study investigated the effect of the lumbar rotation rhythmic mobilization technique in grade IV on the electromyographic activity of the erector spinae as well as on the lumbar range of motion during trunk flexion-extension. Methodology Twelve asymptomatic adult participants performed 5flexion-extension movements before and after the intervention. The electromyographic activity of the erector spinae (longissimus thoracis) at the level of L3 and L5 was recorded bilaterally, as well as the kinematic data to evaluate the movement patterns of the lumbopelvic region. The variables recorded before and after performing the Maitland grade IV oscillatory rhythmic mobilization on the lumbar region in the direction of left rotation were compared. Mobilization was applied unilaterally with the patient in right lateral decubitus on the stretcher. Results There was a statistically significant decrease (p<0.01) in the EMG activity of the erector spinae during the maximum flexion phase on the right side at the L3 level after the application of the studied technique. No difference was observed at the L5 level, nor were significant differences in lumbopelvic kinematics. Conclusion This study demonstrates that a rhythmic oscillatory mobilization towards the left side in grade IV lumbar rotation produces a statistically significant decrease in the electromyographic activity of the erector spinae in the phase of full flexion on the contralateral (right) side, at the level vertebral column of its application (L3) and not at lower levels (L5) (AU)

Effects of neural mobilization in the treatment of chronic low back pain: a systematic review / Efectos de la movilización neural en el tratamiento del dolor lumbar crónico: una revisión sistemática

Introduction: Low back pain appears in approximately two thirds of the population at some point in life and when it exceeds more than 12 weeks, it evolves to chronic low back pain. Chronic low back pain is considered one of the most common causes of disability and absence from work. A therapeutic technique that can be used as a treatment for chronic low back pain is neural mobilization, capable of restoring compromised neurological structures, restoring movement by improving the elasticity of neural tissue and adjacent tissues. Objective: To verify the effects of neural mobilization in patients with chronic low back pain. Material and methods: All articles were carefully evaluated in order to obtain concrete and reliable information. The databases used were Google Scholar, Scielo, Medline and PubMed due to the methodological quality and articles in the area of interest. The keywords “low back pain”, “chronic low back pain”, “neural mobilization” and “physiotherapeutic intervention” were combined in the most diverse possibilities, in English and Spanish translations. Results: 86 articles were found, nine of which were included in this review. They had a score ≥ 5 on the PEDro Scale, which methodologically qualifies the articles. After analyzing the results obtained through the selected articles, all the data collected, as well as their respective results, were described in a table that contains data from the articles. Conclusions: Neural mobilization reduces pain and improves the extensibility of tissues, causing a reduction in painful sensation and increased flexibility. Therefore, it is necessary to continue research in order to verify new results obtained through this type of intervention (AU)

Introducción: La lumbalgia aparece en aproximadamente dos tercios de la población en algún momento de la vida y cuando supera las 12 semanas evoluciona a lumbalgia crónica. El dolor lumbar crónico se considera una de las causas más comunes de incapacidad y ausencia laboral. Una técnica terapéutica que se puede utilizar como tratamiento para el dolor lumbar crónico es la movilización neural, capaz de restaurar las estructuras neurológicas comprometidas, restaurando el movimiento al mejorar la elasticidad del tejido neural y los tejidos adyacentes. Objetivo: Verificar los efectos de la movilización neural en pacientes con dolor lumbar crónico. Material y métodos: Todos los artículos fueron cuidadosamente evaluados para obtener información concreta y confiable. Las bases de datos utilizadas fueron Google Scholar, Scielo, Medline y PubMed debido a la calidad metodológica y artículos del área de interés. Las palabras clave “lumbalgia”, “lumbalgia crónica”, “movilización neural” e “intervención fisioterapéutica” se combinaron en las más diversas posibilidades, en las traducciones al inglés y al español. Resultados: Se encontraron 86 artículos, nueve de los cuales fueron incluidos en esta revisión. Tuvieron puntaje ≥ 5 en la Escala PEDro, que califica metodológicamente los artículos. Luego de analizar los resultados obtenidos a través de los artículos seleccionados, todos los datos recolectados, así como sus respectivos resultados, fueron descritos en una tabla que contiene los datos de los artículos. Conclusiones: La movilización neural reduce el dolor y mejora la extensibilidad de los tejidos, provocando una reducción de la sensación dolorosa y un aumento de la flexibilidad. Por lo tanto, es necesario continuar con la investigación para verificar nuevos resultados obtenidos a través de este tipo de intervención (AU)

PhysiCan - a device for automatic CPM exercises implementation over canines: Design and analysis.

Continuous Passive Motion (CPM) devices have been used to assist physicians conducting human rehabilitation; however, similar machines specific for canine rehabilitation have not been found in the reviewed literature. This research performed a physical analysis of the hind limb of dogs to design a device for implementing automated CPM exercises. The device proved to comply with the guidelines to perform CPM exercises, allowing a proper setting of parameters to generate rehabilitation routines customized for different rehabilitation requirements. Also, an electromyography acquisition module was incorporated into the system, with surface electrodes to visualize and provide feedback to the user for muscle activation. Limitations were encountered with a range of motion of 80° and an error of approximately 2% for angular position accuracy.

Clinical evaluation of usefulness and effectiveness of sitting type continuous passive motion machines in patients with total knee arthroplasty: a study protocol for a single-blinded randomized controlled trial.

BACKGROUND: Total knee arthroplasty (TKA) is an important management strategy for patients with knee osteoarthritis (OA) refractory to conservative management. Postoperative range of motion (ROM) exercise is important to recover patients' activities of daily living. Continuous passive motion (CPM) is a machine that provides passive ROM exercises of the knee joint in a pre-defined arc of motion. The short- and long-term effects of CPM exercise are controversial. We hypothesized that the inconsistent results of the CPM exercise are due to poor fitting of CPM machines and measurement errors. This study aims to present a protocol for investigating a new type of CPM machine that could be applied in a sitting position in comparison with the conventional type of CPM machine for patients with unilateral TKAs. METHODS: This study presents the protocol of a prospective, multicenter, single-blinded, three-armed randomized controlled trial (RCT). One hundred and twenty-six patients receiving unilateral TKAs will be recruited at the physical medicine and rehabilitation clinics of two urban tertiary medical hospitals. The patients were randomly divided into three groups with a 1:1:1 allocation. The intervention group will receive two weeks of post-operative rehabilitation using a new type of CPM machine. The control group will receive 2 weeks of post-operative rehabilitation using conventional CPM machines. The third group will receive post-operative rehabilitation with both types of CPM machines. The primary outcome will be the change in the passive ROM of the affected knee joint from baseline to 2 weeks after baseline assessment. The secondary outcomes will be pain and functional measurements, and will include patient-reported outcomes and performance tests surveyed at multiple time points up to 3 months after TKA. DISCUSSION: This is the first RCT to investigate the effect of a new type of CPM machine. The results of this RCT will determine whether the position of the patients during CPM exercise is important in post-operative rehabilitation protocols after TKAs and will provide evidence for the development of proper rehabilitation guidelines after TKAs. TRIAL REGISTRATION: Clinical Research Information Service of Republic of Korea, KCT0005520, Registered on 21 October 2020, https://cris.nih.go.kr/cris/search/detailSearch.do/21750.

Prospective Randomized Trial of Continuous Passive Motion Versus Physical Therapy After Arthroscopic Release of Elbow Contracture.

BACKGROUND: Continuous passive motion (CPM) has been used for decades, but we are not aware of any randomized controlled trials (RCTs) in which CPM has been compared with physical therapy (PT) for rehabilitation following release of elbow contracture. METHODS: In this single-blinded, single-center RCT, we randomly assigned patients undergoing arthroscopic release of elbow contracture to a rehabilitation protocol involving either CPM or PT. The primary outcomes were the rate of recovery and the arc of elbow motion (range of motion) at 1 year. The rate of recovery was evaluated by measuring range of motion at 6 weeks and 3 months. The secondary outcomes included other range-of-motion-related outcomes, patient-reported outcome measures (PROMs), flexion strength and endurance, grip strength, and forearm circumference at multiple time points. RESULTS: A total of 24 patients were assigned to receive CPM, and 27 were assigned to receive PT. At 1 year, CPM was superior to PT with regard to the range of motion, with an estimated treatment difference of 9° (95% confidence interval [CI], 3° to 16°; p = 0.007). Similarly, the use of CPM led to a greater range of motion at 6 weeks and 3 months than PT. The percentage of lost motion recovered at 1 year was higher in the CPM group (51%) than in the PT group (36%) (p = 0.01). The probability of restoring a functional range of motion at 1 year was 62% higher in the CPM group than in the PT group (risk ratio for functional range of motion, 1.62; 95% CI, 1.01 to 2.61; p = 0.04). PROM scores were similar in the 2 groups at all time points, except for a difference in the American Shoulder and Elbow Surgeons (ASES) elbow function subscale, in favor of CPM, at 6 weeks. The use of CPM decreased swelling and reduced the loss of flexion strength, flexion endurance, and grip strength on day 3, with no between-group differences thereafter. CONCLUSIONS: Among patients undergoing arthroscopic release of elbow contracture, those who received CPM obtained a faster recovery and a greater range of motion at 1 year, with a higher chance of restoration of functional elbow motion than those who underwent routine PT. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Prolonged Application of Continuous Passive Movement Improves the Postoperative Recovery of Tibial Head Fractures: A Prospective Randomized Controlled Study.

METHODS: 60 patients with THFs were randomly and equally divided into the CPM group and non-CPM group. Both groups immediately received CPM and conventional physical therapies during hospitalization. After discharge, the non-CPM group was treated with conventional physical therapy alone, while the CPM group received conventional physical training in combination with CPM treatment. At 6 weeks and 6 months postoperatively, the primary outcome which was knee ROM and the secondary outcome which was knee functionality and quality of life were evaluated. RESULTS: The CPM group had a significantly increased ROM at both follow-up time points. The Knee Society Score, UCLA activity score, and the EuroQoL as well as the pain analysis showed significantly better results of the CPM group than the non-CPM group. CONCLUSIONS: The prolonged application of CPM therapy is an effective method to improve the postoperative rehabilitation of THFs.

Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty.

BACKGROUND: This study aimed to assess whether use of continuous passive motion (CPM) could improve range of motion in patients after total knee arthroplasty (TKA), if it could affect the surgical wound aspect (SWA) and if it could influence on pain management after TKA. METHODS: We randomized 210 patients in two groups, 102 patients in the CPM group, who received a standard rehabilitation protocol together with CPM application; and 108 patients in the no-CPM group, without CPM. Variables as knee motion (flexion, extension, range of motion) and pain were measured before surgery, on the 1st, 2nd and 3rd postoperative day, and in the 2nd, 6th, 12th and 24th postoperative weeks following TKA. The SWA was determined by the "surgical wound aspect score" (SWAS) in the next 48 h after surgery. This scale analyzes swelling, erythema, hematoma, blood drainage and blisters. RESULTS: There was an improvement in the knee motion over the course of follow-up in both groups, without significant difference in flexion parameter. We found no significant differences in the total score of SWA, except for hematoma, with less severity in the CPM group. Furthermore, we found no differences in the others SWAS parameters and pain. CONCLUSIONS: The application of CPM does not provide benefit to our patients undergoing TKA in terms of either improved flexion mobility or decreased pain. No relationship was found between the use of CPM and the global score of SWA following a TKA, except for a decrease in hematoma appearance.

Effect of continuous passive motion on the early recovery outcomes after total knee arthroplasty.

INTRODUCTION: Continuous passive motion (CPM) is a frequently used method in the early post-operative rehabilitation of patients after knee surgery. In this study, the effectiveness of the CPM method was evaluated after primary total knee arthroplasty during an early recovery period. METHODS: Eighty patients undergoing total knee arthroplasty were assigned into two groups. The experimental group received CPM and active exercises, while the control group active exercises only. All subjects were evaluated once before the surgery and at a discharge, in terms of mean active range of motion (AROM), mean Knee Society Score (KSS), and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). RESULTS: The mean AROM for the experimental group was 82.3° ± 14.3° and 76.1° ± 22.2° for the control. The mean KSS score was 136.4 ± 19.3 points for the experimental group, and 135.7 ± 15.1 for the control. There were no statistical differences between the two groups. The KSS functional score was 66.4 ± 8.1 points for the experimental group compared to 62.2 ± 7.3 points for the control, but there was a statistically significant difference between the groups at discharge from the hospital (p = 0.009). A subjective estimation of the pain level, joint stiffness and function also showed a statistically significant difference between the two groups (38.6 ± 14.3 points for the CPM group and 21.2 ± 15.7 for the control). CONCLUSION: These findings show that there is no significant effect of CPM in terms of improving clinical measurements. However, there was a significant beneficial effect on the subjective assessment of pain level, joint stiffness, and functional ability.

The Impact of Continuous Passive Motion on Heterotopic Ossification Maturation.

ABSTRACT: Heterotopic ossification is the formation of pathological bone in soft tissues. It is postulated that continuous passive motion is a helpful adjuvant in the halt of the heterotopic ossification progression and the maintenance or increase of the joint mobility. The purpose of this clinical case study is to present the effectiveness of continuous passive motion. A 46-yr-old male patient experiencing right hemiparesis arrived in our rehabilitation department with limitation on passive flexion of the right hip. On x-ray of the pelvis, immature heterotopic bone formation was found. To halt this ongoing process of heterotopic bone formation, a program of continuous passive motion was implemented. In addition, risedronate was administrated. We started the continuous passive motion at 50 degrees of flexion for 30 mins that was increased to 100 degrees for 3 hrs daily. The final range of motion at the hip was: flexion 85 degrees, extension 0 degrees, internal rotation 10 degrees, external rotation 10 degrees, abduction 10 degrees, and adduction 10 degrees. Based on our results, continuous passive motion plays a role in heterotopic ossification maturation. The effectiveness of continuous passive motion implementation against HO should be further investigated for selected cases.

The Effect of Continuous Passive Motion in Patients Treated With Total Knee Arthroplasty for Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: The aim of the study was to identify the effectiveness of the continuous passive motion application on clinical outcomes after total knee arthroplasty, based on evidence from recently published high-quality randomized controlled trials. DESIGN: Two reviewers retrieved platforms of PubMed, Embase, and CENTRAL independently, for identifying eligible randomized controlled trials evaluating the effect of continuous passive motion applied after total knee arthroplasty for knee osteoarthritis. Subgroup meta-analyses were performed for all syntheses based on the follow-up intervals. RESULTS: A total of 10 randomized controlled trials, involving 841 patients, were finally included. Data were available for 15 different outcomes (including active/passive knee extension/flexion/full range of motion, Western Ontario and McMaster Universities Osteoarthritis Index-pain/physical function/stiffness/total score, visual analogue scale, time up and go, knee girth, Knee Society Scale-function/knee score), at several time points. In general, most of the pools demonstrated similar outcome between continuous passive motion and noncontinuous passive motion groups. Exclusively, the active knee extension at 1 wk (mean difference = 3.00, 95% confidence interval = 0.5-5.5, P = 0.019*), passive knee extension at 1 wk (mean difference = 3.00, 95% confidence interval = 0.28-5.72, P = 0.031*), and 3 mos (mean difference = 3.00, 95% confidence interval = 0.5-5.5, P = 0.019*) were shown to be significantly slightly different between two groups. CONCLUSIONS: This study demonstrated a limited role of continuous passive motion in patients operated with total knee arthroplasty. Thus, there is at this stage no indication for continuous passive motion procedures in patients operated with total knee arthroplasty as a standard postoperative care.

Active heel-slide exercise therapy facilitates the functional and proprioceptive enhancement following total knee arthroplasty compared to continuous passive motion.

PURPOSE: The aim was to compare active heel-slide exercise (AHSE) + standard physiotherapy (PT) to continuous passive motion (CPM) + standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of postoperative outcomes. METHODS: Patients were randomly assigned into AHSE or CPM groups. Both groups received standard PT (range of motion and strengthening exercises, and ambulation) during hospital stay. Patients were evaluated regarding functional outcomes, knee proprioception, pain intensity, active range of motion, knee circumference, length of hospital stay, time for achieving straight leg raise actively, time for achieving 70° knee flexion. RESULTS: Groups were similar at baseline (n.s.). At discharge, AHSE group was better in terms of pain intensity (p < 0.001), Hospital for Special Surgery knee score (p = 0.001), rise from sitting (p = 0.015), ascend/descend stairs (p = 0.038), and timed up and go test (p = 0.028) compared to CPM group. AHSE group was able to perform the straight leg raise earlier than CPM group during inpatient period (p = 0.001) and demonstrated improved proprioception at discharge and at 3-month follow-up (p < 0.05). No statistical differences were detected between groups in other evaluation parameters (n.s.). CONCLUSION: Our findings support AHSE therapy offers a more functional rehabilitation and leads beneficial results for patients following TKA. Therefore, active exercise approach encouraging patients to participate in their rehabilitation should be first choice in acute postoperative rehabilitation following TKA rather than CPM. LEVEL OF EVIDENCE: II.

[Heterotopic ossifications after COVID-19 pneumonia]. / Heterotope ossificatie na een covid-19-pneumonie.

COVID-19 patients admitted to the Intensive Care Unit may develop painful range of motion restrictions of the large joints due to heterotopic ossifications. Here we describe two patients who developed restricted and painful passive and active mobility of the hips, shoulders and elbows after mechanical ventilation because of respiratory failure due to COVID-19 pneumonia. Conventional radiography showed extensive heterotopic ossifications. Retrospectively, alkaline phosphatase levels were elevated. It is likely that local and systemic factors contribute to the development of heterotopic ossifications. Early diagnosis is important to provide complementary non-pharmacological interventions (gentle passive mobilization) and medication (non-steroidal anti-inflammatory drugs, such as indomethacin). If pain and limited joint mobility remain present, surgical removal of ectopic bone could be considered. Future trials are needed to systematically map the prevalence of heterotopic ossifications in COVID-19 patients who were admitted to the Intensive Care Unit, andto evaluate whether prophylactic treatment with non-steroidal anti-inflammatory drug is of relevance.

Impact of continuous passive motion on rehabilitation following total knee arthroplasty.

BACKGROUND AND PURPOSE: There is an ongoing controversy in respect of the usage of continuous passive motion (CPM) following total knee arthroplasty (TKA). We analysed the impact of CPM on the early rehabilitation after TKA and the clinical outcome over the time. METHODS: Forty patients were prospectively randomized to postoperative protocols following TKA. Half of them (n = 20) received the standard manual therapy alone and the others (n = 20) were treated additionally with CPM. Identical implants were used in all patients. Passive range of movement (PROM) was noted. Patient satisfaction and knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the Knee Society Score (KSS) at time of discharge and 2 years postoperatively. RESULTS: The patients in the solitary manual therapy group (MT) showed preoperatively a 7.2° greater PROM (p = .03) with 5.4° higher flexion (p = .05). Analogously, the KSS presented with 42.7 points a higher score result compared to the CPM group with 35.9 points (p = .03). Although the preoperative ability with 105.2° for flexion and 97.2° for the PROM were in favour of the group without CPM (99.8° resp. 90.0°), at time of discharge the patients with CPM reached with 111.0° a significant higher flexion and with 109.0° a higher PROM (MT group: 107.0° resp. 103.5°) (p = .04/.02). At 2 years follow-up both scores (WOMAC/KSS) and function (extension, flexion and PROM) were balanced (p > .05). Patella resurfacing showed no impact on the clinical results at discharge or at time of last follow-up (p > .05). DISCUSSION: Although the addition of CPM did significantly improve knee flexion in the early postoperative stage, the difference might not represent a clinical relevance. Further, there were no notable effects on long-term clinical and functional results following TKA, so the routine application of CPM in the above stated setting might be ceased.

The effects of immediate programmed cryotherapy and continuous passive motion in patients after computer-assisted total knee arthroplasty: a prospective, randomized controlled trial.

BACKGROUND: The postoperative nursing intervention with immediate cryotherapy and continuous passive motion (CPM) remains elusive regarding the postoperative pain and range of motion (ROM) for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA). METHODS: A prospective, randomized controlled trial with a purposive sampling method was utilized. Sixty patients scheduled for a unilateral CAS-TKA at a medical center were randomly assigned to the intervention group (n = 30) and control group (n = 30). The intervention group applied programed cryotherapy and CPM within 1 h while returning to the ward on the day of surgery, while the control group did not. Data were analyzed using mixed models to compare the numeric rating scale (NRS) for pain, ROM, and swelling at postoperative day (POD) 4. RESULTS: There was no significant difference in the NRS score between the groups (p = 0.168). The intervention group had significantly higher ROM than the control group (98° vs. 91°, p = 0.004) at POD 4. Although no significant difference in joint swelling was found between groups (p = 0.157), the intervention group had lower mean joint swelling (32.2 cm) than the control group (33.9 cm). CONCLUSIONS: Immediate programmed cryotherapy and continuous passive motion could help to improve ROM quickly after CAS-TKA. It should be incorporated into the daily nursing plan for patients undergoing CAS-TKA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04136431 . Registered 23 October 2019-retrospectively registered.

Application of continuous passive motion in patients with distal radius fractures: A randomized clinical trial.

The aim of this study was to know if applying continuous passive motion (CPM) in addition to routine exercises is more effective than routine exercises alone in pain reduction, range of motion (ROM) and function improvement after distal radius fractures (DRFs). In this randomized controlled trial, 21 patients with non-stabilized DRF after pin removal were randomly assigned to experimental and control groups. The experimental group received stretching exercises with CPM machine for 2×15min per session. Both groups received routine exercises for 1h, three times a week for 4 weeks. The primary outcome measure was pain evaluated on a visual analog scale (VAS), and the secondary outcome measures were disability evaluated by the patient-rated wrist/hand evaluation and ROM (goniometry) at 4, 6, and 12 weeks. Univariate analysis of covariance (ANCOVA) and a one-way repeated measure mixed model analysis of variance (ANOVA) were used for data analysis. Twenty-one participants completed the 12-week follow-up. Pain relief, ROM and functional improvement revealed that the treatment was successful in both groups. We detected no significant differences (p>0.05) between the two groups at the end of the follow-up period regarding pain, ROM, and function. Using a CPM machine had no additional effect on pain reduction, ROM and function improvement compared with routine exercises in patients with DRF.

Gravity-Assisted Passive Flexion in Total Knee Arthroplasty Recovery.

This study examined the use of gravity-assisted passive flexion (GAP-FLEX) for perioperative total knee arthroplasty (TKA) recovery. The main questions associated with this technique were: (1) Can GAP-FLEX improve patient recovery of range of motion after TKA? (2) Does GAP-FLEX reduce patient time and effort associated with therapy compared with continuous passive motion (CPM)? (3) Does GAP-FLEX reduce overall episodic care cost? A prospective, randomized multicenter study was conducted. Two senior surgeons used identical surgical approach, prosthesis, and postoperative management protocols. Patients consenting to the study were randomly assigned to either standard of care (CPM) or GAP-FLEX groups. Active flexion range of motion (ROM) was measured via goniometer with a primary endpoint established at 4 weeks after surgery. Secondary endpoints included pain and functional mobility. A total of 27 patients completed the study. Average ROM in the GAP-FLEX sample was 8.4° greater than the CPM sample (P=.009) at study endpoint. The GAP-FLEX patients achieved greater postoperative ROM within 2 days and maintained an improvement over CPM to study endpoint. Eighty-five percent (11 of 13) of GAP-FLEX patients achieved or surpassed their baseline ROM by study endpoint, compared with 50% (7 of 14) of CPM patients. These improvements occurred while requiring 90% less therapy time on device compared with the CPM patients. Patients did not report any statistically different pain levels but did exhibit higher functional mobility at endpoint (P=.026). [Orthopedics. 2020;43(5):e431-e437.].

Movilización pasiva continua en pacientes con artroplastia de rodilla / Continuous passive motion in knee arthroplasty patients

Introducción: La artroplastia total de rodilla es el recurso terapéutico para pacientes con artrosis severa y gran incapacidad física. Sin embargo, muchos evolucionan con dolor y déficit funcional. En este estudio, se utiliza un tratamiento con movilización pasiva continua a partir de los 10 días de la cirugía. Materiales y Métodos: Se incluyó a 60 pacientes que fueron asignados, en forma aleatoria, a 2 grupos (30 en cada grupo). Al grupo 1 (G1, 23 mujeres) se le aplicó un protocolo de tratamiento convencional y, al grupo 2 (G2, 17 mujeres), el mismo programa y la adicción de un equipo de movimiento pasivo continuo a los 10 días de la intervención. Se evaluaron el dolor, la movilidad articular, la fuerza muscular y la función (WOMAC y prueba TUG). Resultados: No se observaron diferencias estadísticamente significativas en los parámetros estudiados, aunque sí una tendencia a la mejoría en el G2. En este grupo, la fuerza de extensión de la rodilla fue mayor y también hubo una correlación basal entre la fuerza y la prueba TUG. Conclusiones: El uso diferido de la movilización pasiva continua mejoró la fuerza de extensión de la rodilla y el rendimiento en la prueba TUG, aunque sin diferencias significativas entre ambos grupos. No se observaron efectos adversos. Nivel de Evidencia: I

Introduction: Total knee arthroplasty (TKA) is a valid therapeutic option for patients with severe arthritis and physical disability. However, many TKA patients develop pain and functional impairment. In our study, we used a continuous passive motion (CPM) device for exercise starting 10 days after surgery. Materials and Methods: The study population consisted of 60 patients, who were randomized into 2 groups. Group I (GI: 30 patients, 23 females) underwent the standard treatment and group II (GII, 30 patients, 17 females) underwent the standard treatment plus CPM starting 10 days after surgery. We evaluated pain, range of motion (ROM), extension muscle strength, and function (WOMAC and TUG tests). Results: All compared parameters yielded no statistically significant differences. A greater trend toward improvement was observed in GII regarding some parameters: greater extension muscle strength and a baseline correlation between flexion strength and the TUG test. Conclusions: The use of CPM starting 10 days after of surgery improved the extension muscle strength and produced better TUG test results, although without any statistically significant difference with the standard procedure. No adverse effects were observed. Level of Evidence: I

Physical Therapist Management of Total Knee Arthroplasty.

A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.

Tenolysis rate after zone 2 flexor tendon repairs.

OBJECTIVES: This study aims to evaluate the tenolysis rates of zone 2 flexor digitorum profundus (FDP) with flexor digitorum superficialis (FDS) tendon repairs using four-strand technique and early passive motion exercises. PATIENTS AND METHODS: In this retrospective study, we performed zone 2 flexor tendon repairs in 149 patients (117 males, 32 females, mean age 33.3±12.9 years; range, 13 to 72 years) (82 right and 67 left hands) between November 2014 and January 2019. A total of 194 FDP and FDS tendons were repaired primarily by using modified Kessler and Bunnell methods. Patients underwent pure passive motion protocols after surgery according to modified Duran's protocol. No active flexion components were added until postoperative fourth week. RESULTS: Twenty-three out of 149 patients and 28 out of 194 fingers (14.43%) had tenolysis. There was no significant relationship between the number of operated fingers, gender, and tenolysis rate (p=0.836, p=0.584, respectively). CONCLUSION: The repair of the FDP with FDS tendon increases the tenolysis rate in zone 2. The tenolysis rate does not change according to the number or distribution of injured fingers and gender of the patient.