title: Enhanced education and physiotherapy before knee replacement; is it worth it? A systematic review.
abstract: BACKGROUND
  Around 20% of knee replacement have an unsatisfactory outcome. Pre-operative physiotherapy and education have been proposed to improve post-operative outcomes.
  
  
  OBJECTIVE
  This systematic review evaluated whether these factors improved length of stay and patient reported outcomes after knee replacement surgery.
  
  
  METHODS
  Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO and PEDro were searched on the 1st January 2013.
  
  
  METHODS
  Randomised or quasi-randomised studies assessing either pre-operative education or physiotherapy on patients undergoing a planned total or partial knee replacement were included in the review. Only studies with a control group receiving a defined standard of pre-operative care were included.
  
  
  RESULTS
  Eleven studies met the inclusion criteria set. Two studies analysed the effect of pre-operative education, seven pre-operative treatment by a physiotherapist and two studies used both factors. No study found significant differences in validated joint specific patient reported outcome measures. The education studies found a decrease in pre-operative expectation and an improvement in knowledge, flexion and regularity of exercise. Two studies found an improvement in muscle strength in the group treated by a physiotherapist at three months. The combination of education and physiotherapy was shown to reduce patient length of stay and cost in one study.
  
  
  CONCLUSIONS
  The evidence reviewed is insufficient to support the implementation of either pre-operative education or physiotherapy programmes. The combination of pre-operative education and treatment by a physiotherapist may reduce the medical costs associated with surgery.
authors.affiliation: University Hospitals Coventry and Warwickshire, United Kingdom. Electronic address: Robert.jordan@doctors.org.uk.
authors.forename: R W
authors.initials: RW
authors.lastname: Jordan
authors.affiliation: University of Warwick, United Kingdom. Electronic address: Nicholas.smith@warwick.ac.uk.
authors.forename: N A
authors.initials: NA
authors.lastname: Smith
authors.affiliation: University Hospitals Coventry and Warwickshire, United Kingdom. Electronic address: Gurdip.chahal@uhcw.nhs.uk.
authors.forename: G S
authors.initials: GS
authors.lastname: Chahal
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, United Kingdom. Electronic address: Clare.casson@nhct.nhs.uk.
authors.forename: C
authors.initials: C
authors.lastname: Casson
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, United Kingdom. Electronic address: Mike.reed@nhs.net.
authors.forename: M R
authors.initials: MR
authors.lastname: Reed
authors.affiliation: University of Warwick, United Kingdom. Electronic address: a.p.sprowson@warwick.ac.uk.
authors.forename: A P
authors.initials: AP
authors.lastname: Sprowson
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D026741:Physical Therapy Modalities; D011300:Preoperative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Education; Knee arthroplasty; Knee replacement; Physiotherapy; Pre-operative