{
  "abstract": "Background\n\nAffecting 21-35% of patients after total knee arthroplasty (TKA), kinesiophobia critically impedes postoperative rehabilitation. Whether exercise-based interventions reduce kinesiophobia more effectively than routine postoperative rehabilitation remains unclear.Methods\n\nWe systematically searched 11 databases from inception to July 11, 2026, for RCTs comparing exercise-based rehabilitation with routine postoperative rehabilitation in adults undergoing primary TKA. The primary outcome was kinesiophobia. Secondary outcomes included knee function, pain, balance, mobilization time, and adherence. Random-effects meta-analyses were performed using RevMan 5.4. Certainty of evidence was assessed using GRADE.Results\n\nEleven RCTs (N = 1,096) were included. Exercise-based rehabilitation was associated with a reduction in kinesiophobia (SMD = - 1.22, 95% CI [- 1.72, - 0.72]; I² = 93%; low certainty) and improvements in knee function (SMD = 1.19, 95% CI [0.67, 1.71]; I² = 93%; low certainty). For pain, the ≤ 4-week pooled estimate (SMD = - 1.09, 95% CI [- 2.03, - 0.14]; I² = 94%) was not interpretable due to extreme heterogeneity and was not robust: after exclusion of the single acute in-hospital trial, the confidence interval crossed zero (SMD = - 1.09, 95% CI [- 2.28, 0.09]). Leave-one-out sensitivity analyses otherwise supported the directional conclusions for kinesiophobia and knee function, although effect sizes were unstable and certainty remained low.Conclusion\n\nLow-certainty evidence suggests that exercise-based rehabilitation may be associated with reductions in kinesiophobia at ≤ 4 weeks and an interpretable 12-week improvement in knee function after TKA; the ≤ 4-week and ≥ 24-week functional subgroup estimates were not interpretable because of extreme heterogeneity, and the early pain signal was possible but non-robust. Effect sizes should be interpreted with caution due to substantial heterogeneity, risk of bias, and sensitivity to outlying studies. Well-designed, multicenter RCTs with rigorous blinding and standardized protocols are urgently needed.",
  "abstract_shown": true,
  "affiliations": [
    "Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Hohhot, 010059, China.",
    "The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Hohhot, 010010, China.",
    "The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Hohhot, 010010, China. 38277540@qq.com."
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hongbo Wen"
    },
    {
      "affs": [
        1
      ],
      "name": "Ting Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Tingting Xie"
    },
    {
      "affs": [
        2
      ],
      "name": "Huiqin Xue"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fn9x4z6vxrr7h.bib",
  "cited_by": 0,
  "doi": "10.1186/s12891-026-10640-3",
  "fulltext_url": "https://europepmc.org/articles/PMC13718169",
  "id": "fn9x4z6vxrr7h",
  "issns": [
    "1471-2474"
  ],
  "landing_url": "https://europepmc.org/article/MED/42958196",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Systematic Review"
    ],
    [
      "openalex",
      "2746|Total Knee Arthroplasty Outcomes"
    ]
  ],
  "openalex": "W7223131667",
  "pdf_url": "https://europepmc.org/articles/PMC13718169?pdf=render",
  "pmcid": "PMC13718169",
  "pmid": "42958196",
  "published": "2026-10-21",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/fn9x4z6vxrr7h.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T00:20:36Z",
      "native_id": "MED:42958196",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42958196"
    },
    {
      "first_seen": "2026-11-02T12:22:17Z",
      "native_id": "PMC13718169",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12891-026-10640-3"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Total Knee Arthroplasty Outcomes",
      "subfield": "surgery"
    }
  ],
  "title": "Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.",
  "title_text": "Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:22:17Z",
  "url": "https://research.draconitic.com/paper/fn9x4z6vxrr7h",
  "venue": "BMC musculoskeletal disorders",
  "versions": []
}