The necessity of exercise intervention nursing before total knee arthroplasty is debatable
With great interest, we read the article entitled “A systematic review and meta-analysis of the effect of preoperative exercise intervention on rehabilitation after total knee arthroplasty” by Wang et al. (1). In this well-designed study, the authors conducted a systematic review and meta-analysis and concluded that “preoperative exercise intervention prior to total knee arthroplasty can improve knee flexion and flexibility, reduce inflammatory pain and stiffness, improve muscle strength, and improve joint function, thereby improving the quality of life of patients”. While the conclusions are of great importance, we would like to highlight some issues regarding study registration, search strategies, and data analysis that we believe should be considered when interpreting these findings.
In the Methods section, the authors did not provide study registry information. Registered studies can be effective in increasing transparency and avoiding potential bias. Therefore, an updated and unbiased review of the effectiveness of preoperative rehabilitation exercises on postoperative outcomes of total knee arthroplasty is warranted.
Regarding the search strategy in the text, there are three shortcomings that need to be pointed out: first, the author declared that only English articles were included, however, the English databases searched are limited, and other important databases such as CENTRAL, OpenGrey, ANZCTR and CINAHL should also be searched to maximize the inclusion of all available literature; second, the combination of search keywords provided in the text is too single, and different search combinations should be provided in each database, and the corresponding search details should be placed in the supplementary files of the text; third, we searched for eligible studies using our own search strategy and were surprised that some of the eligible studies were not included in the meta-analysis (2-5), thus we have a hard time believing the authors’ conclusions are correct.
Finally, we cannot find the quality level of the pooling outcomes in the text. It is necessary to realize that meta-analysis is an important reference in clinical decision-making, and it is particularly important to conduct a careful and accurate analysis of the existing data and to evaluate the quality level of the outcomes. In addition, the authors noted that the follow-up time for the outcomes ranged from 6–12 weeks, thus subgroup analyses based on follow-up or intervention time might make the conclusions more convincing.
Overall, Wang et al. (1) analyzed a valuable issue, however, the outcomes of this meta-analysis should be interpreted with caution due to the limitations described above.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-22-288/coif). The authors have no conflicts of interest to declare.
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References
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