Overview of study characteristics
| Publication location date of study number of centres | Randomised mean age % female | Intervention treatment | Control treatment | Pain assessment adherence to treatment Losses to follow-up |
| Bruun-Olsen et al
14 Norway 2008–2010 Two centres | n=57 (29:28) 68:69 years 62:50% | Group-based physiotherapist-led walking skills programme (2–6 patients per group). Commenced 6 weeks after surgery. Twelve sessions over 6–8 weeks. | 1:1 usual physiotherapy care consisting of 12 individual physiotherapy sessions. Commenced 6 weeks after surgery. Twice-weekly sessions until 12–14 weeks after surgery. | KOOS pain scale 28/29 completed intervention. 28/28 received control treatment. 6 (2:4) lost to follow-up. |
| Buhagiar et al
15 Australia 2012–2015 Two centres | n=165 (81:84) 67:67 years 69:68% | Inpatient rehabilitation at rehabilitation facility with twice daily supervised sessions of 1:1 and group-based exercises. Commenced after hospital discharge for 10 days. Home exercise programme after discharge from rehabilitation facility. | Home exercise programme comprising 2–3 group-based outpatient sessions to practice and progress exercises. Commenced 2 weeks after surgery. | KOOS pain scale 72/81 adhered to intervention. 74/84 adhered to control treatment. 6 (2:4) lost to follow-up. |
| Buker et al*30 Turkey 2009–2011 One centre | n=34 (18:16) 64:68 years 89:94% | 20 sessions of supervised physiotherapy and rehabilitation including range of motion and strengthening exercises, application of heat and TENS application. Five days a week for 4 weeks. | Home exercises including range of motion and strengthening exercise for 1 hour per day. Five days a week for 4 weeks. | Pain VAS Adherence not reported. Losses to follow-up not reported. |
| Chen et al
16 China 2013–2014 One centre | n=202 (101:101) 66:67 years 63:67% | Structured telephone follow-up by nurse at 1, 3 and 6 weeks after hospital discharge to improve adherence to home exercise routine. | No telephone follow-up | Pain VAS Adherence not reported. 15 (7:8) lost to follow-up. |
| Fransen et al
17 Australia 2009–2012 12 centres | n=422 (212:210) 64:65 years 54:52% | Group-based circuit exercise classes supervised by physiotherapist. Up to six patients per class. Commenced 6 weeks after surgery. Twice-weekly sessions for at least 8 weeks. | Usual physiotherapy care. Twenty-two per cent of participants reported six or more occasions of physiotherapy during the 6–12-week period after TKR. | WOMAC pain scale 140/212 participants attended≥12 classes 210/210 received control treatment 74 (43:31) lost to follow-up |
| Frost et al
18 UK 1995–1996 Not reported | n=47 (23:24) 72:71 years 48:50% | Home-based functional exercise. Commenced following discharge from hospital. Duration not reported. | Home-based traditional exercise. | OKS item (pain on walking) Adherence not reported. 20 (7:13) lost to follow-up. |
| Kauppila et al
19† Finland 2002–2005 One centre | n=86 (44:42) 71:71 years 76:79% | Group-based multidisciplinary rehabilitation programme. Up to eight patients per group. Commenced 2–4 months after surgery for 10 days. | Usual physiotherapy care. Supervised exercise programme at 2-month outpatient visit, with provision of further rehabilitation based on needs assessment. | WOMAC pain scale 44/44 attended intervention. 42:42 received control treatment. 11 (8:3) lost to follow-up. |
| Ko et al 20 Australia 2008–2010 Three-arm trial Four centres | n=249 (85:84:80) 67:68:67 years 68:60:61% | 1:1 physiotherapy with home-based sessions. Commenced 2 weeks after surgery. Twice-weekly 1:1 and home-based sessions over 6 weeks. | (1) Group-based circuit classes supervised by physiotherapist with home-based sessions. Up to eight patients per class. Commenced 2 weeks after surgery. Twice-weekly group and home-based sessions over 6 weeks. (2) Monitored home programme, two 1:1 physiotherapy sessions and one telephone follow-up call. Commenced 2 weeks after surgery. Four sessions per week for 6 weeks. | WOMAC pain scale 80% participants attended 9 or more 1:1 sessions, 77% attended nine or more group sessions, 83% attended both sessions in monitored home programme group. 16 (7:3:6) lost to follow-up. |
| Kramer et al
21 Canada Not reported Not reported | n=160 (80:80) 68:69 years 59:55% | 1:1 clinic-based rehabilitation programme with home exercise programme. Commenced 2 weeks after surgery. Up to two sessions a week for 10 weeks. | Home-based rehabilitation, monitored by telephone calls from physiotherapist. Commenced 2 weeks after surgery. At least one telephone call in weeks 2–6 and 1 call in weeks 7–12. | WOMAC pain scale 76/80 received intervention. 78/80 received control treatment. 26 (15:22) lost to follow-up. |
| Liebs et al*22 Germany 2005–2006 Five centres | n=159 (85:74) 70:70 years 73:70% | Ergometer cycling supervised by physiotherapist. Commenced 2 weeks after surgery. Three sessions a week for at least 3 weeks. | No ergometer cycling. | WOMAC pain scale Adherence not reported. 33 (15:18) lost to follow-up. |
| Liebs et al*23 Germany 2003–2004 Two centres | n=185 (87:98) 69:71 years 70:73% | Early aquatic therapy. Commenced 6 days after surgery. Three times a week up to fifth week postoperative. | Late aquatic therapy. Commenced 14 days after surgery. Three times a week up to fifth week postoperative. | WOMAC pain scale Adherence not reported. 41 (18:23) lost to follow-up. |
| Minns Lowe et al
24 UK 2006–2008 One centre | n=107 (56:51) 68:71 years 57:59% | Home-based functional rehabilitation with two visits from physiotherapist at 2 weeks and 6–8 weeks after hospital discharge. Twice daily exercises for at least 3 months. | Usual physiotherapy care involving provision of an exercise booklet, with outpatient physiotherapy on a needs-only basis. No additional home visits. | KOOS pain scale 46/56 patients received two visits. 47/51 received control treatment. 9 (7:2) lost to follow-up. |
| Moffet et al
25 Canada 1997–1999 Five centres | n=77 (38:39) 67:69 years 63:56% | Functional rehabilitation programme with individualised home exercises. Commenced at 2 months after surgery. Twelve supervised sessions over 6–8 weeks. | Usual physiotherapy care, which included supervised home rehabilitation visits for 26% of patients. | WOMAC pain scale 38/38 participated in 12 sessions. 39/39 received control treatment. 8 (0:8) lost to follow-up. |
| Monticone et al
26 Italy 2010–2013 One centre | n=110 (55:55) 67:68 years 65:62% | Home-based functional exercises aimed at managing kinesiophobia, with monthly phone calls to encourage adherence. Commenced after hospital discharge. Twice-weekly sessions for 6 months. | No physiotherapy, advice to stay active. | KOOS pain scale Adherence not reported. 0 lost to follow-up. |
| Petterson et al
27 USA 200–2005 One centre | n=200 (100:100) 65:65 years 47:45% | Combined neuromuscular electric stimulation (NMES) and volitional strength training programme. Commenced 3–4 weeks after surgery. Two or three sessions a week for 6 weeks. | Volitional strength training programme without NMES. | KOS ADL item (effect of pain on function) 84/100 completed intervention. 97/100 completed control treatment. 51 (32:19) lost to follow-up. |
| Szots et al
28 Denmark 2013 One centre | n=117 (59:58) 67:68 years 61:67% | Two nurse-led structured telephone follow-up calls. Telephone calls at 4 days and 14 days after hospital discharge. | No telephone follow-up. | WOMAC pain scale 54/59 patients had both telephone follow-up calls. 54/58 received control treatment. 9 (5:4) lost to follow-up. |
| Vuorenmaa et al
29‡ Finland 2008–2010 One centre | n=108 (53:55) 69:69 years 57:65% | Delayed monitored home exercises, with guidance from physiotherapist at 2, 3 and 6 months postoperative. Commenced at 2 months after surgery for 12 months. | Usual care, which involved no additional guidance from 2 months postoperative. | WOMAC pain scale Seventy-two per cent of patients performed the training sessions at least twice per week in the first 6 months. 53/53 received control treatment. 4 (2:2) lost to follow-up. |
*24-month follow-up also conducted but data from 12-month follow-up included in table to be consistent with follow-up period of other studies.
†Pain-specific outcome data were provided by the authors for a previous review6 and was used again in this review.
‡Follow-up at 14 months postoperatively.
KOOS, Knee Injury and Osteoarthritis Outcome Score; KOS ADL, Knee Outcome Survey - Activities of Daily Living; OKS, Oxford Knee Score; TENS, Transcutaneous Electrical Nerve Stimulation; VAS, Visual Analogue Scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.