Evidence map›Paper›PMID 28061841›Full record

Trial reportBMC musculoskeletal disorders2017

Supervised neuromuscular exercise prior to hip and knee replacement: 12-month clinical effect and cost-utility analysis alongside a randomised controlled trial.

Linda Fernandes, Ewa M Roos, Søren Overgaard, Allan Villadsen, Rikke Søgaard

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC musculoskeletal disorders, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01003756 (Preoperative Exercise in Patients Undergoing Total Hip or Knee Replacement), which is not on this map. Cited by 30 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01003756 nacompletednot on this map

Preoperative Exercise in Patients Undergoing Total Hip or Knee Replacement

TypeinterventionalSponsorUniversity of Southern DenmarkRan2009 to 2011Enrolled165ConditionsOsteoarthritisArmsPreoperative neuromuscular exercise
3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Linda FernandesDepartment of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark. linda.fernandes1@gmail.com.
Ewa M RoosResearch Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Søren OvergaardDepartment of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Allan VilladsenDepartment of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Rikke SøgaardDepartment of Public Health, Aarhus University, Aarhus, Denmark.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere are indications of beneficial short-term effect of pre-operative exercise in reducing pain and improving activity of daily living after total hip replacement (THR) and total knee replacement (TKR) surgery. Though, information from studies conducting longer follow-ups and economic evaluations of exercise prior to THR and TKR is needed. The aim of the study was to analyse 12-month clinical effect and cost-utility of supervised neuromuscular exercise prior to THR and TKR surgery.

methodsThe study was conducted alongside a randomised controlled trial including 165 patients scheduled for standard THR or TKR at a hospital located in a rural area of Denmark. The patients were randomised to replacement surgery with or without an 8-week preoperative supervised neuromuscular exercise program (Clinical Trials registration no.: NCT01003756). Clinical effect was measured with Hip disability and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Quality adjusted life years (QALYs) were based on EQ-5D-3L and Danish preference weights. Resource use was extracted from national registries and valued using standard tariffs (2012-EUR). Incremental net benefit was analysed to estimate the probability for the intervention being cost effective for a range of threshold values. A health care sector perspective was applied.

resultsHOOS/KOOS quality of life [8.25 (95% CI, 0.42 to 16.10)] and QALYs [0.04 (95% CI, 0.01 to 0.07)] were statistically significantly improved. Effect-sizes ranged between 0.09-0.59 for HOOS/KOOS subscales. Despite including an intervention cost of €326 per patient, there was no difference in total cost between groups [€132 (95% CI -3942 to 3679)]. At a threshold of €40,000, preoperative exercise was found to be cost effective at 84% probability.

conclusionPreoperative supervised neuromuscular exercise for 8 weeks was found to be cost-effective in patients scheduled for THR and TKR surgery at conventional thresholds for willingness to pay. One-year clinical effects were small to moderate and favoured the intervention group, but only statistically significant for quality of life measures.

trial registrationClinicalTrials.gov ( NCT01003756 ) October 28, 2009.

Indexed as

Activities of Daily LivingAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeCost-Benefit AnalysisExercise TherapyFemaleHumansMaleMiddle AgedOsteoarthritis, HipOsteoarthritis, KneePreoperative CareTime FactorsTreatment OutcomeArthroplastyCost-benefit analysisExerciseOsteoarthritisReplacement

Identifiers

PMID28061841
PMCPMC5217578

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.