The Use of Continuous Passive Motion after TKA: Should We Use Them?

Darcy JamesUtica College PHT 769Spring 2015

CPMs: A Brief Background

Typical intervention added to PT services in acute care to encourage early motion

The number of TKR surgeries will rise to 3.5 million in the United States by year 2030 creating a larger demand for rehabilitation services

(Herbold et al., 2014; The Hospital for Sick Children, 2010)

CPMs: A History

Used since the 1980s to promote early mobilization and improve knee flexion range of motion

Concept introduced by RB Salter in the late 1970s Estimated that 9 million patients have

been treated with CPMs

(Maniar et al., 2012; The Hospital for Sick Kids, 2010)

Why This Topic?

Benefits of CPM usage are controversial as the results are conflicting

Despite the lack of evidence for effectiveness, CPMs are still used today

(Denis et al., 2006; Maniar et al., 2012)

The Search

Google Scholar & Science Direct Most recent articles

(PEDro, 2015)

The Articles

To Use or Not to Use Continuous Passive Motion Post Total Knee Arthroplasty presenting functional assessment results in early recovery (7)

Maniar, Baviskar, Singhi, & Rathi (2012)

Randomized controlled trial 84 participants

Intervention Control: conventional physical therapy only Experimental 1: 1 day-CPM group, received conventional physical

therapy and 2 CPM applications of 15 minutes each on day 2 of TKA

Experimental 2: 3-day CPM group, received conventional physical therapy for 2 applications of 15 minutes each daily for 3 days

Conclusion No significant beneficial role of CPM in the immediate functional

recovery after TKA

Effectiveness of Continuous Passive Motion and Conventional Physical Therapy After Total Knee Arthroplasty: A Randomized Clinical Trial (7) Denis, Moffet, Caron, Oullet, Paquet, & Nolet (2006)

Randomized clinical trial 81 participants

Intervention Control group: conventional physical therapy intervention only Experimental 1: conventional physical therapy and 35 minutes of

CPM applications daily Experimental 2: conventional physical therapy and 2 hours of CPM

applications daily

Conclusion The results do not support the addition of CPM applications to

conventional physical therapy because they did not further reduce knee impairments/disability or reduce length of hospital stay

Randomized Controlled Trial of the Effectiveness of Continuous Passive Motion After Total Knee Replacement (6)

Herbold, Bonistall, Blackburn, Agolli, Gaston, Gross, Kuta, & Babyar (2014)

Randomized controlled trial 141 participants

Intervention Group 1: conventional 3 hours of therapy per day Group 2: received addition of daily CPM use for 2 hours

throughout the length of stay

Conclusion CPM did not provide an additional benefit over the

conventional interventions used in an inpatient rehabilitation facility for patient after TKR

The Efficacy of Continuous Passive Motion After Total Knee Arthroplasty: A Comparison of Three Protocols (6)

Boese, Weis, Phillips, Lawton-Peters, Gallo, & Centeno (2014)

Randomized controlled trial 160 participants

Intervention Control: no CPM Experimental 1: CPM device on and moving from the immediate

post-operative period Experimental 2: CPM device on and stationary at 90 degrees

flexion for the first night and then moving throughout the rest of the stay

Conclusion The use of CPM provided no benefits to patients recovering from

TKA

Effectiveness of Continuous Passive Motion in an Inpatient Rehabilitation Hospital After Total Knee Replacement: A Matched Cohort Study (5)

Herbold, Bonistall, & Blackburn (2012)

Matched cohort study 61 matched pairs (122 participants)

Intervention Use of CPM for 2 hours per day as an adjunct to the 3

hours of physical and occupational therapy customary in an inpatient rehabilitation facility

Conclusion The application of CPM did not significantly influence

any of the outcome variables

The Verdict

Based on the results, the addition of CPM does not offer any additional benefit to conventional physical therapy after total knee replacement

References

Boese, CK., Weis, M., Phillips, T., Lawton-Peters, S., Gallo, T., Centeno, L. (2014). The efficacy of continuous passive motion after total knee arthroplasty: a comparison of three protocols. Journal of Arthroplasty, 29(6), 1158-62. Doi:10.1016/j.arth.2013.12.005.

Denis, M., Moffet, H., Caron, F., Ouellet, D., Paquet, J., Nolet, L. (2006). Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial. Physical Therapy, 86(2), 174-85.

Herbold, JA., Bonistall, K., & Blackburn, M. (2012). Effectiveness of continuous passive motion in an inpatient rehabilitation hospital after total knee replacement: a matched cohort study. PM&R, 4(10), 719-725. Doi:10.1016/j.pmrj.2012.07.004.

Herbold, JA., Bonistall, K., Blackburn, M., Agolli, J., Gaston, S., Gross, C., Kuta, A., & Babyar, S. (2014). Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement. Archives of Physical Medicine and Rehabilitation, 95(7), 1240-5. Doi: 10.1016/j.apmr.2014.03.012.

Maniar, RN., Baviskar, JV., Singhi, T., Rathi, SS. (2012). To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery. Journal of Arthroplasty, 27(2), 193-200. Doi:10.1016/j.arth.2011.04.009.

PEDro. (2 February 2015). PEDro scale. Retried from www.pedro.org.au/english/downloads/pedro-scale/.

The Hospital for Sick Children. (May 2010). Remembering Dr. Robert Salter. Retrieved from www.sickkids.ca/aboutsickkids/newsroom/past-news/2010/dr-robert-salter.html.

Questions?