This study aims to perform a network meta-analysis (NMA) to evaluate and compare the effectiveness of various physical therapy modalities in mitigating postoperative pain following total knee arthroplasty (TKA). Method: This systematic review and NMA were conducted according to PRISMA-NMA guidelines. A comprehensive literature search was conducted across multiple databases, including PubMed, SPORTDiscus, The Cochrane Library, Embase, Web of Science, CINAHL Plus, and China National Knowledge Infrastructure, to identify randomized controlled trials (RCTs) assessing the effects of eight physical therapy modalities on postoperative pain in patients with TKA. Data were synthesized using a frequentist framework, and the outcome was pain reduction, assessed using validated pain scales such as the Visual Analogue Scale. A total of 42 RCTs involving 3,165 participants were included. The NMA revealed that electroacupuncture, manual lymphatic drainage (MLD), kinesio taping, and cryotherapy all significantly alleviated pain following TKA compared to controls. Effect sizes (standardized mean differences SMDs) ranging from -0.57 (95% confidence interval CI: -1.12 to -0.01) for MLD to -0.98 (95% CI: -1.50 to -0.45) for cryotherapy. Among these interventions, cryotherapy demonstrated the greatest likelihood of being the most effective (Surface under the cumulative ranking curve = 88.0%), followed by kinesio taping (83.1%) and electroacupuncture (64.0%). Among these interventions, electroacupuncture (SMD = 0.59, 95% CI: 0.00 to 1.19), kinesio taping (SMD = 0.86, 95% CI: 0.18 to 1.54), and cryotherapy (SMD = 0.95, 95% CI: 0.31 to 1.59) demonstrated significant pain reduction compared to the continuous passive motion. This NMA suggests that cryotherapy is the most effective physical therapy modality for pain relief after TKA, followed by kinesio taping and electroacupuncture. These findings advocate for the incorporation of physical therapy modalities into postoperative care, presenting a ranked comparison of various interventions and supplying robust evidence for clinical decision-making.
Guo et al. (Thu,) studied this question.