Background
Altered muscle activation patterns are observed in patients undergoing total knee arthroplasty (TKA), resulting in reduced knee joint function, impaired balance, and an increased risk of falls during postoperative recovery. The Otago Exercise Program (OEP) is a rehabilitative intervention designed to enhance muscle strength and improve balance. However, its efficacy in restoring knee joint function and balance in TKA patients remains unclear, with limited clinical evidence. This systematic review and meta-analysis aim to evaluate the effectiveness of OEP on knee joint function, balance, and other recovery outcomes in TKA patients while identifying its essential exercise components.
Objective
To investigate the effects of the Otago Exercise Program on knee joint function, knee flexion angle, balance, fall efficacy, functional capacity, pain, and joint swelling in patients following total knee arthroplasty.
Methods
Randomized controlled trials (RCTs) examining the effects of the Otago Exercise Program on knee joint recovery in TKA patients were systematically retrieved from Web of Science, PubMed, Cochrane Library, Google Scholar, Embase, CKNI, and KISS databases. The search included studies published from database inception to November 30, 2024. Relevant references from the included studies were manually screened to supplement the literature. Two researchers independently conducted the search, screening, and data extraction. The risk of bias was independently assessed using the Cochrane Handbook, and publication bias was evaluated using Egger's test. Meta-analysis, including subgroup analyses, was performed using Review Manager 5.3. The continuous outcomes were analyzed by calculating the mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI) according to whether combining outcomes were measured on different scales or not. The quality of evidence in this study was assessed according to the GRADE methodology.
Results
A total of 12 RCTs involving 1088 participants were included. Compared to conventional rehabilitation, the Otago Exercise Program significantly improved knee joint function. Subgroup analysis revealed that interventions with a frequency of ≤3 sessions per week (SMD = 1.80, 95% CI: [0.80, 2.79]) and a duration of >1 month (SMD = 2.57, 95% CI: [0.51, 4.64]) yielded larger effect sizes and better outcomes. Additionally, improvements were observed in knee flexion angle (MD = 11.24, 95% CI: [9.16, 13.32]), balance (MD = 3.45, 95% CI: [2.50, 4.40]), fall efficacy (SMD = 0.61, 95% CI: [0.43, 0.79]), and functional capacity (SMD = 0.99, 95% CI: [0.80, 1.18]). Descriptive analysis also indicated reductions in pain and joint swelling.
Conclusion
This meta-analysis demonstrates that the Otago Exercise Program significantly enhances knee joint function, knee flexion angle, balance, fall efficacy, and functional capacity in TKA patients while also alleviating pain and joint swelling. However, further high-quality, large-scale randomized controlled trials are required to validate the effects of the Otago Exercise Program on knee joint recovery in this population.