Effects of exercise and continuous passive motion on ROM and quality of life in patients
following a total knee arthroplasty
In acute-care patients who have recently undergone a total knee arthroplasty (TKA), is exercise
coupled with continuous passive motion (CPM) more effective than exercise alone as measured
by Range of Motion (ROM) and quality of life?
Clinical Bottom Line:
1. Neither CPM plus standard exercises (SE) nor Slider Board (SB) plus SE in long-term
measurements have any advantage for ROM and quality of life over SE alone.
2. Effectiveness of CPM and SB in the short-term was not thoroughly determined in this study.
Study Design: Randomized Clinical Trial (RCT). The study purpose was to compare SE alone
vs. CPM plus SE vs. SB plus SE. The authors hypothesized that both CPM and SB results would
be similar to each other and better than SE alone.
Sample: Ninety-three patients who received a TKA from a hospital in Alberta, Canada
completed the study. The mean age was 68.4 years (SD = 8.6), and 56% were women. No
preoperative significant differences existed among the subjects.
Methods: Each subject was randomly placed in one of three groups. The control group (SE,
n=32), followed a standard exercise routine. The SE plus CPM group (n=33) performed CPM an
average of 1.8 times per day for 1.7 hours each session and received SE treatment. The SE plus
SB group (n=28) participated 1.7 times per day at 16 minutes per session in using the Slider
Board and received SE treatment. Upon discharge, patients discontinued use of CPM and SB
and resumed outpatient and home health physical therapy as deemed necessary.
Outcome Measures: ROM of active and passive knee flexion and extension, as measured by
Goniometer, which has been well documented in its reliability and validity. The Western
Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Medical Outcomes
Study 36-Item Short Form Health Survey (SF-36) were also used as quality of life measures.
Results: Measures at 3 and 6 months for all the groups had no significant difference. Measures
at "5-7" days also had no statistical difference.
Appraisal and Application
Strengths: The study was an RCT. The therapist who performed ROM measurements was
blinded as to which group each subject was assigned to. It provided very good evidence that
there is no statistically significant difference in the long term between the three groups.
Limitations: The short-term measure of 5 to 7 days is not a reliable time period for measurement.
These measurements all needed to be taken on the same day because there could be a great
variation of ROM between the fifth and seventh days which makes this measurement unreliable.
, Davies DM, Jones CA, Cinats JG. Exercise combined with continuous passive
motion or slider board therapy compared with exercise only: A randomized controlled trial of
patients following total knee arthroplasty. Physical Therapy. 2001;1029-1037.
Appraised by: Curt Jensen Date Appraised: Aug. 4, 2008