Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
完整摘要 · 中文译文
背景：影响21-35%的全膝关节置换术（TKA）后患者，运动恐惧症严重阻碍术后康复。基于运动的干预是否比常规术后康复更有效地减少运动恐惧症仍不清楚。 方法：我们系统检索了11个数据库，从建库至2026年7月11日，纳入比较基于运动的康复与常规术后康复在接受初次TKA的成人中的随机对照试验（RCT）。主要结局为运动恐惧症。次要结局包括膝关节功能、疼痛、平衡、下床活动时间和依从性。使用RevMan 5.4进行随机效应荟萃分析。证据确定性使用GRADE进行评估。 结果：共纳入11项RCT（N = 1,096）。基于运动的康复与运动恐惧症减轻相关（SMD = - 1.22，95% CI [- 1.72, - 0.72]；I2 = 93%；低确定性）以及膝关节功能改善相关（SMD = 1.19，95% CI [0.67, 1.71]；I2 = 93%；低确定性）。对于疼痛，≤ 4周的合并估计（SMD = - 1.09，95% CI [- 2.03, - 0.14]；I2 = 94%）因极端异质性而无法解释，且不稳健：排除唯一一项急性院内试验后，置信区间跨越零（SMD = - 1.09，95% CI [- 2.28, 0.09]）。除此以外，留一法敏感性分析支持运动恐惧症和膝关节功能的方向性结论，尽管效应量不稳定且确定性仍为低。 结论：低确定性证据提示，基于运动的康复可能与减少 恐动症在≤4周时以及全膝关节置换术（TKA）后12周膝关节功能出现可解释的改善；≤4周和≥24周的功能亚组估计值因存在极端异质性而无法解释，早期疼痛信号可能存在但不稳健。由于存在显著异质性、偏倚风险以及对离群研究的敏感性，效应量应谨慎解读。迫切需要设计良好、多中心、采用严格盲法和标准化方案的随机对照试验（RCT）。
完整摘要 · 英文原文
BACKGROUND: Affecting 21-35% of patients after total knee arthroplasty (TKA), kinesiophobia critically impedes postoperative rehabilitation. Whether exercise-based interventions reduce kinesiophobia more effectively than routine postoperative rehabilitation remains unclear. METHODS: We systematically searched 11 databases from inception to July 11, 2026, for RCTs comparing exercise-based rehabilitation with routine postoperative rehabilitation in adults undergoing primary TKA. The primary outcome was kinesiophobia. Secondary outcomes included knee function, pain, balance, mobilization time, and adherence. Random-effects meta-analyses were performed using RevMan 5.4. Certainty of evidence was assessed using GRADE. RESULTS: Eleven RCTs (N = 1,096) were included. Exercise-based rehabilitation was associated with a reduction in kinesiophobia (SMD = - 1.22, 95% CI [- 1.72, - 0.72]; I2 = 93%; low certainty) and improvements in knee function (SMD = 1.19, 95% CI [0.67, 1.71]; I2 = 93%; low certainty). For pain, the ≤ 4-week pooled estimate (SMD = - 1.09, 95% CI [- 2.03, - 0.14]; I2 = 94%) was not interpretable due to extreme heterogeneity and was not robust: after exclusion of the single acute in-hospital trial, the confidence interval crossed zero (SMD = - 1.09, 95% CI [- 2.28, 0.09]). Leave-one-out sensitivity analyses otherwise supported the directional conclusions for kinesiophobia and knee function, although effect sizes were unstable and certainty remained low. CONCLUSION: Low-certainty evidence suggests that exercise-based rehabilitation may be associated with reductions in kinesiophobia at ≤ 4 weeks and an interpretable 12-week improvement in knee function after TKA; the ≤ 4-week and ≥ 24-week functional subgroup estimates were not interpretable because of extreme heterogeneity, and the early pain signal was possible but non-robust. Effect sizes should be interpreted with caution due to substantial heterogeneity, risk of bias, and sensitivity to outlying studies. Well-designed, multicenter RCTs with rigorous blinding and standardized protocols are urgently needed.
摘要 待译
BACKGROUND: Affecting 21-35% of patients after total knee arthroplasty (TKA), kinesiophobia critically impedes postoperative rehabilitation. Whether exercise-based interventions reduce kinesiophobia more effectively than routine postoperative rehabilitation remains unclear. METHODS: We systematically searched 11 databases from inception to July 11, 2026, for RCTs comparing exercise-based rehabilitation with routine postoperative rehabilitation in adults undergoing primary TKA. The primary outcome was kinesiophobia.…