TKAとTHAの術前理学療法：系統的レビュー

人工膝関節置換術（TKA）と人工股関節置換術（THA）の術前の理学療法は術後のアウトカムを改善するか？という系統的レビューを紹介します。

Justina A. Gawel, Sarah E. Brown, Jenna C. Collins, Christine McCallum. Does pre-operative physical therapy improve post-surgical outcomes of patients undergoing a total knee and/or total hip arthroplasty? A systematic review. Physiotherapy Practice and Research, Volume 34, Number 1 / 2013, p9-20

10のRCT論文をレビューしています。結果ですが、TKA、THAとも術前理学療法群でリハ施設への転院が減少し、疼痛が減少し、患者満足度が向上しました。しかし機能予後に関しては一致した見解を認めませんでした。アウトカムの改善はまだ結論が出ていません。

プレハビリテーションは対象を選べば有用だと私は考えています。しかし、万人に行っても有意差を出すことはおそらく容易ではないと思います。プレハビリテーションを行うべき対象（患者と疾患・術式）を選定して、その中でRCTを行うのが望ましいのではと感じます。

Abstract
Background and purpose: Pre-operative physical therapy (PT) has been used in clinical practice to improve post-surgical outcomes after a total hip and/or knee replacement. The purpose of this systematic literature review was to investigate the ability of pre-operative physical therapy to improve post-surgical outcomes of patients undergoing a total knee and/or total hip arthroplasty. Methods: This review used the search engines PubMed, CINAHL, Cochrane library and the PEDro database and investigated all articles that studied the influence of pre-operative therapy on post-surgical results in patients that underwent a total knee and/or total hip arthroplasty. The studies included were randomized controlled trials (RCTs), English written, and compared pre-surgical outcomes to post-surgical outcomes in physical therapy interventions. Quality scoring was assessed using the PEDro scale for RCTs. Results: Ten articles met the inclusion criteria. The quality score ranged from 4–7 on the PEDro scale. Results found pre-operative PT in both total knee and total hip arthroplasty reduced the risk of discharge to a rehabilitation facility. Pain reduction (p < 0.05) was found with pool interventions versus land interventions immediately following an exercise session. Discussion: The results indicate there were benefits in the use of pre-operative PT on improving patient satisfaction, pain reduction, and discharge to a lower cost of care setting. The use of pre-operative physical therapy resulted in mixed findings in functional outcomes however. Conclusions: This updated systematic review suggests the current literature on pre-operative physical therapy is inconclusive regarding impact of improving post-surgical outcomes on patients receiving total knee and/or hip arthroplasty.