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Background: Persistent high levels of knee pain after a total knee replacement have been estimated to affect 5%–10% of people and this is related to dissatisfaction with surgery, reduced function and reduced quality of life. This systematic review aims to evaluate the effectiveness of rehabilitation programs or strategies to reduce persistent pain and improve function and quality of life in people following a total knee replacement. Methods: The systematic review was conducted following PRISMA guidelines with a search of relevant online databases up to 17 July 2024. The search criteria included English language randomised controlled trials of rehabilitation programs or strategies in any setting to treat people with persistent knee pain more than 3 months after a total knee replacement. Rehabilitation could include exercise, education, cognitive strategies and self‐management programs and excluded medication trials, procedural techniques and complementary therapies. Results: After removal of duplicates, there were 468 abstracts screened for eligibility with 23 remaining for full‐text screening and finally, one study meeting the eligibility criteria. This study's interventions were pain neuroscience education alone and pain neuroscience education plus neuromuscular exercise. There were no statistically significant between‐group differences for pain reduction or functional improvement. Conclusion: The evidence examining the value of rehabilitation programs or strategies for pain reduction and functional improvement in people with persistent pain following total knee replacement is deficient. Given the high number of people affected annually, further research concerning both prevention and management of persistent pain after knee replacement is warranted. [ABSTRACT FROM AUTHOR]

Background: Weight loss is recommended for people with obesity prior to undergoing total knee or hip arthroplasty. This study aimed to determine the feasibility of implementing a dietitian‐led low‐inflammatory weight‐loss diet for people with obesity awaiting arthroplasty. Secondary aims were to report weight change, patient‐reported outcomes, diet compliance, surgery deferment and diet acceptability. Methods: Eligible participants were enrolled across two sequential periods; Usual Care (UC) was recruited, followed by an intervention period with a dietitian‐led weight‐loss programme (DT). Assessments occurred at baseline, 6‐month and pre‐surgery (11–12 months from baseline). Predefined diet feasibility outcomes included: (i) recruitment rate ≥60%, (ii) ≥60% of DT group reporting ≥10% improved compliance with low‐inflammatory diet by pre‐surgery, (iii) all DT participants attending ≥60% of dietitian consultations, (iv) proportion of DT group losing ≥5% weight double that of UC by pre‐surgery. Results: Ninety‐seven people participated (UC, n = 47, DT, n = 50). Baseline variables were similar between groups. None of the diet feasibility criteria were fulfilled: 52% of eligible people consented; 57% of DT group improved diet compliance; 72% of DT Group attended ≥60% of dietitian appointments; 31.4% of DT group lost ≥5% weight (compared to 20.6% of UC). Compared to UC group at pre‐surgery, DT group demonstrated modest weight loss (−1.7 kg (95%CI ‐3.5,0.2) versus −0.4 kg (−2.5,1.6)), and decreased waist circumference (−4.8 cm (−6.9,‐2.8) versus −2.2 cm (−5.2,0.7)). Three DT participants declined surgery due to improved symptoms. Conclusion: Utilisation of a dietitian‐led low‐inflammatory weight‐loss diet was not feasible in this cohort. Suboptimal diet compliance likely explains the modest weight loss results. [ABSTRACT FROM AUTHOR]

Systematic implementation of evidence-based, clinical practice guidelines for management of knee osteoarthritis (OA) in primary care physiotherapy in Australia is embryonic. Clinical practice guidelines have been implemented in the public healthcare sector at a State-level for physiotherapists in the form of multidisciplinary programs, but the reach of physiotherapy-led OA management programs is grossly inadequate in the private sector. To provide a snapshot of the management of people with knee OA in private physiotherapy practice in an Australian setting. Primarily the aim was to determine the alignment between the treatment provided and guideline-based management. Secondary aims included the capture of both patient-reported improvement after 3-months and patient satisfaction with treatment. Whether patient-reported outcome measures (PROMS) were routinely used was also ascertained. A prospective, observational study enrolling adults >=45 years with knee OA across nine primary care physiotherapy practices. Knee injury OA Outcome Score (KOOS) and Routine Assessment Patient Index 3 (RAPID3) were collected (baseline; 3 months) by researchers along with satisfaction with treatment. Treatment details and use of PROMS were obtained from physiotherapy record audit and patient interview. The treatment provided was compared to the minimum core elements of management stipulated in OA management guidelines. Twenty-six adults (58% female, mean age 60 (9) years, 54% overweight or obese) participated. 100% were prescribed ≥1 appropriate exercise(s); 42% received OA education; 12% received weight management advice. Mean improvement (95%CI) in KOOS Pain was 9.8 (3.4 to 16.1) and RAPID3 was −3.4 (−5.5 to −1.3). Satisfaction with treatment was high (8.3/10). No PROMs were used for assessment or monitoring. Primary care physiotherapy treatment of knee OA did not meet minimum criteria per clinical practice guidelines. However, participant improvement at three months reached minimally important change thresholds for patient-reported measures and satisfaction was high. The data provide useful insights about areas that are deficient, thus, should inform future implementation strategies designed to improve care delivery and the uptake of routine measurement of patient-reported outcomes. [ABSTRACT FROM AUTHOR]