Research Paper

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Literature Evaluation Table

Student Name:

Mananita Gerochi-Caparas

Summary of Clinical Issue (200-250 words):

The main goal of evidence-based practice is to improve patient management and to decrease the unwarranted difference in the provision of services. With the continuous flow of modern research information, it is vital for medical practitioners to routinely update their procedures and policies to involve the most effective practice methods for their clients or patients. Presently, there is longevity growth in the geriatric population, prompting the need for Total Knee Replacement. About 700,000 knee replacement procedures are carried out every year in the U.S. This number is expected to rise to about 3.5 million procedures annually by 2030.

The health care industry has developed the Continuous Passive Motion technique that enables swift and healthy recovery times for patients who have undergone Total Knee Replacement procedure. Continuous Passive Motion is carried out using a machine called CPM, which moves the replaced knee joint through a managed range of motions in order to reduce inflammation, pain, and joint stiffness. It is used to enhance the range of motion in patients who have undergone Total Knee Replacement procedure.

Though surgeons progressively use Continuous Passive Motion after the operation, this technique has come under criticism concerning its effectiveness in enhancing mobility and reducing joint rigidity and swelling (Levi, B. (2021). Consequently, there are several quantitative and qualitative research articles that prove the ineffectiveness of utilizing Continuous Passive Motion.

PICOT Question:

In geriatric post-surgery Total Knee Replacement patients, how efficient is Continuous Passive Motion therapy in concurrence with physical activity in connection to pain, recovery time, joint rigidness, and physical mobility versus physical activity alone beginning at post-surgery day zero up to discharge from the post-surgical orthopedic unit?

Criteria	Article 1	Article 2	Article 3
APA-Formatted Article Citation with Permalink	Levi, B. (2021). A critical appraisal of “Prospective Randomized Trial of the Efficacy of Continuous Passive Motion Post Total Knee Arthroplasty: Experience of the Hospital for Special Surgery.” Retrieved from https://hdl.handle.net/2346.1/36264	Martin, S., Bernhard, K., Wolfgang, R., & Kirsten, S. (2018). Randomized, prospective, monocentric study to compare the outcome of continuous passive motion and controlled active motion after total knee arthroplasty. Technology and Health Care 26 (3), 499-506. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29630570	Mei-Chu, C., Chiu-Chu, L., Jih-Yang, K., & Feng-Chih, K. (2020). The effects of immediately programmed cryotherapy and continuous passive motion in patients after computer-assisted total knee arthroplasty: a prospective, randomized controlled trial. Journal of Orthopaedic Surgery and Research 15 (1), 1-8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles /PMC7469108/
How Does the Article Relate to the PICOT Question?	The article relates to the PICOT question because it examines whether there is an additional benefit in CPM use during a short hospitalization period.	This article compares postoperative outcomes using CAM and CPM, in addition to standard physiotherapeutic exercises immediately after total knee arthroplasty.	This article elucidates whether immediate programmed cryotherapy and CPM could help to improve ROM swiftly after TKA.
Quantitative, Qualitative (How do you know?)	Quantitative because randomized controlled trials were used.	Quantitative because the randomized monocentric study was used.	Quantitative because randomized controlled trials were used.
Purpose Statement	The purpose of this quantitative research is to assess whether there is an additional benefit in CPM use during a short hospitalization period.	The purpose of this quantitative research is to compare postoperative outcomes using CAM and CPM, in addition to standard physiotherapeutic exercises immediately after total knee arthroplasty.	The main purpose of this quantitative research is to establish whether immediate programmed cryotherapy and CPM could help to improve ROM swiftly.
Research Question	Is CPM effective compared to passive stretching for increasing knee range of motion?	Comparison of postoperative outcomes using CAM and CPM, in addition to standard physio-therapeutical exercises immediately after total knee arthroplasty.	Can immediate programmed cryotherapy and CPM help improve ROM swiftly after TKA.
Outcome	CPM group scored an average of 56 points four days after the surgery on the HSS versus 45 points in the control group.	The knee-associated problems scale improved significantly in both groups, but CAM group shows better results in terms of pain, flexion, and quality of life.	NRS scale showed 0-10 points which was the primary outcome of the interest
Setting (Where did the study take place?)	The study took place in a hospital.	In the hospital and after discharge.	Medical center
Sample	40 patients took part in the research.	50 patients of between 62-78 years.	60 patients participated in the study.
Method	Randomized controlled trials.	Randomized monocentric study.	Randomized controlled trials.
Key Findings of the Study	CPM has a favorable effect on pain and muscle strength in the first two weeks after surgery.	CAM and CPM results in significant improvements after TKA, however, CAM shows better results in terms of pain, flexion, and quality of life.	The effects of CAM are contentious.
Recommendations of the Researcher	The research elaborately illustrates the benefits of CPM on muscle strength and pain.	The research provides a compelling evidence of the benefits of CPM after TKA.	The research provides a compelling evidence of the benefits of CPM.

Criteria	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	Nils, W., Marco, E., Kai, S., & Michael, S. (2020). Impact of continuous passive motion on rehabilitation following total knee arthroplasty. Physiotherapy Research International 25 (4), e1869. Retrieved from https://doi.org/10.1002/pri.1869	Patel, Z. H., Dibyendunarayan, B., & Ramalingam, T. (2017). Effectiveness of Conventional Physiotherapy along with Continuous Passive Motion after Total Knee Arthroplasty. Indian Journal of Physiotherapy & Occupational Therapy 11 (4). Retrieved from https://www.academia.edu/3667244v0/ Effectiveness_of_conventional_phsiotherapy _along_with_continous	Tomokazu, Y., Shigeki, K., Hisashi, S., Norihito, A., Kojiro, H., Akihiro, K., & Masashi, Y. (2021). Feasibility and efficacy of knee extension training using a single-joint hybrid assistive limb, versus conventional rehabilitation during the early postoperative period after total knee arthroplasty. Journal of Rural Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC7788304
How Does the Article Relate to the PICOT Question?	This article analyzes the impact of CPM on early rehabilitation after TKA and the clinical outcome over time.	This article compares the effectiveness of conventional physiotherapy program along with CPM application.	This article evaluates the feasibility and efficacy of treatment for the recovery of knee joint function after TKA using a robotic suit.
Quantitative, Qualitative (How do you know?)	Quantitative study because it uses randomized methods.	Quantitative because it uses prospective randomized clinical trial.	Quantitative study because it uses prospective case control method.
Purpose Statement	This quantitative study analyzes the impact of CPM on early rehabilitation after TKA and the clinical outcome over time.	This quantitative study compares the effectiveness of conventional physiotherapy program along with CPM application after TKA.	This quantitative study evaluates the feasibility and efficacy of treatment for the recovery of knee joint function after TKA using a robotic suit.
Research Question	What is the impact of CPM on early rehabilitation after TKA and the clinical outcome over time?	What is the difference between the effectiveness of conventional physiotherapy program along with CPM application after TKA?	How is the feasibility and efficacy of treatment for the recovery of knee joint function after TKA using a robotic suit?
Outcome	CPM patients showed a higher flexion of 110 degrees.	There is significant difference in knee flexion range in the experiment group as compared to the controlled group.	Extension lag greatly improved in the experimental group after the 2nd and 3rd session.
Setting (Where did the study take place?)	Patient homes during and after discharge.	Hospital	Hospital
Sample	40 patients	34 patients	Average age of 71.3± 6.2 years for experimental group and 74.9 ± 8.7 years in the controlled group.
Method	Randomized clinical trial	Prospective randomized clinical trial	Prospective case-control study
Key Findings of the Study	CPM significantly improved knee flexion in the early postoperative stage.	CPM improves early knee motion and enhances functionality.	HAL-SJ- based training is effective and safe, and leads to instantaneous improvement of extension lag, without worsening knee joint pain.
Recommendations of the Researcher	More research is needed to establish other benefits of CPM.	The research is expiatory and descriptive.	This study suggests that HAL-SJ training is safe after postoperative procedures.

References

Levi, B. (2021). A critical appraisal of “Prospective Randomized Trial of the Efficacy of Continuous Passive Motion Post Total Knee Arthroplasty: Experience of the Hospital for Special Surgery”

Martin, S., Bernhard, K., Wolfgang, R., & Kirsten, S. (2018). Randomized, prospective, monocentric study to compare the outcome of continuous passive motion and controlled active motion after total knee arthroplasty. Technology and Health Care 26 (3), 499-506.

Mei-Chu, C., Chiu-Chu, L., Jih-Yang, K., & Feng-Chih, K. (2020). The effects of immediate programmed cryotherapy and continuous passive motion in patients after computer-assisted total knee arthroplasty: a prospective, randomized controlled trial. Journal of Orthopaedic Surgery and Research 15 (1), 1-8.

Nils, W., Marco, E., Kai, S., & Michael, S. (2020). Impact of continuous passive motion on rehabilitation following total knee arthroplasty. Physiotherapy Research International 25 (4), e1869.

Patel, Z. H., Dibyendunarayan, B., & Ramalingam, T. (2017). Effectiveness of Conventional Physiotherapy along with Continuous Passive Motion after Total Knee Arthroplasty. Indian Journal of Physiotherapy & Occupational Therapy 11 (4), 2017

Tomokazu, Y., Shigeki, K., Hisashi, S., Norihito, A., Kojiro, H., Akihiro, K., & Masashi, Y. (2021). Feasibility and efficacy of knee extension training using a single-joint hybrid assistive limb, versus conventional rehabilitation during the early postoperative period after total knee arthroplasty. Journal of Rural Medicine