Table_1_Effects of Resistance Training Prior to Total Hip or Knee Replacement on Post-operative Recovery in Functional Performance: A Systematic Review and Meta-Analysis.DOCX

ObjectiveTo evaluate the effectiveness of pre-operative resistance training in patients allocated to TJR surgery on selected post-operative outcomes, via a meta-analysis of studies using exercise modalities and loading intensities objectively known to promote gains in muscle size and strength in adults of young-to-old age.
DesignA systematic review and meta-analysis.
Literature SearchCochrane Central, MEDLINE, EMBASE, and PEDro were searched on August 4th 2021.
Study SelectionRandomized Controlled Trials (RCTs) were included if (i) they compared pre-operative lower-limb-exercises before elective TJR with standard care, (ii) explicitly reported the exercise intensity, and (iii) reported data on functional performance.
Data SynthesisThis systematic review and meta-analysis is reported in accordance with the PRISMA reporting guidelines. A random effects model with an adjustment to the confidence interval was performed for pooling the data.
ResultsOne thousand studies were identified. After applying exclusion criteria, five RCTs were located including 256 participants (mean age ranged from 61 to 72 years, 54% women). Moderate-to-large improvements in functional performance and maximal knee extensor strength were observed at 3 months after surgery along with small-to-moderate effects 12 months post-operatively. For patient-reported outcomes, small-to-moderate improvements were observed at 3 months post-operatively with no-to-small improvements at 12 months.
ConclusionPrehabilitation efforts involving progressive resistance training provides an effective means to improve post-operative outcomes related to functional performance, knee extensor strength and patient-reported outcome in patients undergoing TJR. Due to large methodological diversity between studies, an optimal loading intensity remains unknown.
Systematic Review RegistrationProspero ID: CRD42021264796.

研究目的：通过对已知可促进青年至老年成年人群肌肉体积与力量增长的客观运动方式及负荷强度相关研究开展荟萃分析，评估接受全关节置换术（Total Joint Replacement, TJR）的患者实施术前阻力训练对其术后特定结局指标的改善效果。
研究设计：系统评价与荟萃分析。
文献检索：于2021年8月4日检索Cochrane中心对照试验注册库（Cochrane Central）、MEDLINE、EMBASE及PEDro数据库。
研究纳入标准：纳入随机对照试验（Randomized Controlled Trials, RCTs），需同时满足以下条件：(i) 对比择期全关节置换术前下肢运动干预与标准护理的干预效果；(ii) 明确报告运动强度；(iii) 报告功能性能相关数据。
数据合成：本系统评价与荟萃分析严格遵循PRISMA报告规范进行撰写。采用校正置信区间的随机效应模型完成数据合并。
研究结果：共检索出1000篇相关文献，经排除标准筛选后，最终纳入5项随机对照试验，共计256名受试者（平均年龄范围61~72岁，女性占比54%）。术后3个月时，受试者的功能性能及膝关节伸肌最大力量出现中至大幅改善；术后12个月时则呈现小至中等程度的改善效应。在患者报告结局指标方面，术后3个月可观察到小至中等程度的改善，术后12个月仅出现无到轻微程度的改善。
研究结论：针对接受全关节置换术的患者，采用渐进式阻力训练的术前预康复干预，可有效改善术后功能性能、膝关节伸肌力量及患者报告结局相关指标。但由于各项研究间方法学异质性较大，目前尚不明确最优负荷强度。
系统评价注册信息：系统评价注册平台Prospero注册编号：CRD42021264796。