Rehabilitation Practices for Total Knee Replacement in Pakistan: An Analysis Against Global Guidelines

Author(s) : Muhammad Mustafa Qamar, Rimsha Aamir, Uneeba Amjad Raja, Ayesha Basharat, Muhammad Ramzan, Hafiz Abdul Munem, Asif Islam & Junaid Akhtar

Abstract:

Background:
Achieving full knee extension within the first few weeks following total knee replacement (TKR) is crucial, and physical therapy plays a pivotal role in the rehabilitation process. However, the compliance of current physical therapy practices in Pakistan with international guidelines remains uncertain.
Objective:
This study aimed to evaluate the physiotherapy practices for patients undergoing total knee replacement in Pakistan. Additionally, it sought to determine whether these practices are aligned with contemporary international standards.
Methodology:
A descriptive cross-sectional study was conducted, employing a convenience sampling technique to collect data from 259 physical therapists. A questionnaire was developed based on standard guidelines for total knee replacement rehabilitation.
Results:
The majority of participants were male (60%), with a mean age of 33 ± 4 years and an average clinical experience of 5 years. In preoperative rehabilitation, the most commonly used modalities were ultrasound (42.67%) and strengthening exercises (40.67%). During postoperative Phase I, cryotherapy (42.67%) was favoured, along with a regimen that included an active range of motion exercises, gait training, and continuous passive motion. In Phase II, hot packs were the preferred modality, while electrical muscle stimulation (EMS) was utilized in Phase III. Strengthening exercises and functional training were the primary postoperative exercise regimens in both Phases II and III.
Conclusion:
In Pakistan, modalities were favoured over exercises in every phase of rehabilitation following total knee replacement. In contrast, international guidelines emphasize exercises over modalities.
Keywords: Total Knee Replacement, Preoperative Rehabilitation, Postoperative Rehabilitation