Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
- 1Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Hohhot, 010059, China.
- 2The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Hohhot, 010010, China.
- 3The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Hohhot, 010010, China. [email protected].
Abstract
Background
Affecting 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
We 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
Eleven 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
Low-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.
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BibTeX
@article{wen2026exercisebased,
title = {{Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.}},
author = {Hongbo Wen and Ting Zhang and Tingting Xie and Huiqin Xue},
journal = {BMC musculoskeletal disorders},
year = {2026},
month = oct,
doi = {10.1186/s12891-026-10640-3},
url = {https://europepmc.org/article/MED/42958196},
note = {CC BY},
}
RIS
TY - JOUR
TI - Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
AU - Hongbo Wen
AU - Ting Zhang
AU - Tingting Xie
AU - Huiqin Xue
PY - 2026
DA - 2026/10/21
JO - BMC musculoskeletal disorders
DO - 10.1186/s12891-026-10640-3
UR - https://europepmc.org/article/MED/42958196
AB - Background Affecting 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 We 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 Eleven 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 Low-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.
SN - 1471-2474
ER -