Summary

The Behavioural intervention based on Social Cognitive Theory and physical activity feedback interventions appear to be most effective in promoting physical activity in patients after Total Knee Replacement

Abstract

Background/Statement of Problem: The prevalence of knee osteoarthritis (KOA) is expected to rise significantly from the 2010 estimate of 4.7 million to 8.3 million by 2035. Furthermore, KOA is the topmost reason why people require total knee replacement (TKR). TKR has been found to be beneficial, leading to excellent outcomes. However, a challenge faced by patients after TKR is reduced mobility due to post-surgical pain consequently leading to reduced physical activity (PA) levels. There is overwhelming evidence to suggest that physical inactivity is associated with the development of chronic diseases and increased mortality. Although, there are indications of varying interventions for post TKR PA promotion, there is no reviews on the extent of research on the types of interventions used to promote post TKR PA. Thus, this study identified the different types of interventions used to improve PA in patients with TKR.

Methods

Six databases comprising Cumulative Index to Nursing and Allied Health Literature (CINAHL) via Ebscohost, Medline via OVID, Web of Science core collections, PEDro, Cochrane Library, African Journals Online (AJOL) and grey literature were searched for studies on interventions to improve PA in patients after TKR from inception to April 2024. We included any types of intervention design targeted at improving PA in the community or hospital, participants were aged 40 years and older, and undergone TKR. Findings were presented using narrative synthesis.

Result: A total of 14 studies were included in this review, 12 were randomized controlled trials, one quasi-experimental study and one prospective cohort study. The narrative synthesis identified pharmacological, standard rehabilitation exercise program, social cognitive theory (SCT) and counselling, self-efficacy telephone health coaching and incentives and physical activity feedback, as interventions for promoting PA post TKR. Physical activity feedback and physiotherapy exercise interventions were the most common interventions. However, majority of the studies on physical activity feedback and behavioural interventions such as SCT demonstrated significant effects on increasing PA post TKR.

Conclusion

Different interventions to improve PA in patients following TKR were identified. Behaviour intervention based on SCT and physical activity feedback interventions appear to be most effective in promoting PA.
Clinical Implications: Clinicians may consider the inclusion of PA feedback and behavioural change interventions in increasing PA post TKR. Future studies should continue investigating the components of these interventions on PA increments post TKR using larger multicentre Randomized Control Trials.

Registration: A review protocol was developed and registered with the OPEN SCIENCE FRAME WORK database, with the DOI https://doi.org/10.17605/OSF.IO/HGW2X

Keywords: Physical activity, total knee replacement, interventions, scoping review.

Funding Acknowledgement: This study was self-funded.

Ethical Approval: Ethical approval for this study was obtained (CMS/REC/2024/567) from the Research Ethics Committee of College of Medical Sciences, University of Benin, Edo State.