Effects of home- based prehabilitation on pre- and postoperative outcomes following total hip and knee arthroplasty A SYSTEMATIC REVIEW AND META- ANALYSIS

Aims The aim of this study was to determine the effectiveness of home -based prehabilitation on pre-and postoperative outcomes in participants awaiting total knee (TKA) and hip arthro-plasty (THA). Methods A systematic review with meta-analysis of randomized controlled trials (RCTs) of prehabili-tation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, PubMed, Cochrane Li-brary, and Google Scholar databases were searched from inception to October 2022. Evi-dence was assessed by the PEDro scale and the Cochrane risk -of -bias (ROB2) tool.Results A total of 22 RCTs (1,601 patients) were identified with good overall quality and low risk of bias. Prehabilitation significantly improved pain prior to TKA (mean difference (MD)-1.02: p = 0.001), with non-significant improvements for function before (MD-0.48; p = 0.06) and after TKA (MD-0.69; p = 0.25). Small preoperative improvements were observed for pain (MD-0.02; p = 0.87) and function (MD-0.18; p = 0.16) prior to THA, but no post THA effect was found for pain (MD 0.19; p = 0.44) and function (MD 0.14; p = 0.68). A trend favouring usual care for improving quality of life (QoL) prior to TKA (MD 0.61; p = 0.34), but no effect on QoL prior (MD 0.03; p = 0.87) or post THA (MD-0.05; p = 0.83) was found. Prehabilitation significantly reduced hospital length of stay (LOS) for TKA (MD-0.43 days; p < 0.001) but not for THA (MD,-0.24; p = 0.12). Compliance was only reported in 11 studies and was excellent with a mean value of 90.5% (SD 6.82).Conclusion Prehabilitation interventions improve pain and function prior to TKA and THA and reduce hospital LOS, though it is unclear if these effects enhance outcomes postoperatively.