Efficacy and safety of lower-limb progressive resistance exercise for patients with total knee arthroplasty: a meta-analysis of randomized controlled trials.

Abstract Objective To evaluate the efficacy and safety of progressive resistance exercise (PRE) for patients with total knee arthroplasty (TKA) in a meta-analysis. Data Sources PubMed, MEDLINE, Cochrane’s Library, and EMBASE databases. Study selection Randomized controlled trials evaluating the effect of PRE on mobility and function in TKA patients. Data extraction A random-effect model was applied if significant heterogeneity was detected; otherwise, a fixed-effect model was applied. Data synthesis Seven RCTs. Compared to a rehabilitation program without PRE, physiotherapy including PRE was associated with improvements in the 6-minute walking test (weighed mean difference [WMD]: 19.22 m, p = 0.04) with a wide confidence interval (CI: 0.48∼37.95). However, sensitivity analysis by omitting one study with preoperative rehabilitation revealed non-significant results (WMD: 15.15m, p = 0.16). Moreover, PRE did not significantly improve the maximal walking speed (WMD: 0.05 m/s, 95% CI: 0.00∼0.11, p = 0.05). However, PRE was associated with improved knee strength of extension (standard mean difference [SMD]: 0.72, 95% CI: 0.47∼0.96, p Conclusions PRE may lead to improvements in physical function among patients receiving a TKA. PRE leads to higher ultimate strength in the surgical knee and is safe to perform.