Best Evidence Topics

Randomised control trial

Beaupre, L.A., Lier, D., Davies, D.M. and Johnston, B.C.
The Effect of a Preoperative Exercise and Education Program on Functional Recovery, Health Related Quality of Life, and Health Service Utilization Following Primary Total Knee Arthroplasty
Journal of Rheumatology
2004,Vol 31(6);1166-73.
  • Submitted by:Stephanie Purcell - Senior OT
  • Institution:MRI
  • Date submitted:30th November 1999
Before CA, i rated this paper: 7/10
1 Objectives and hypotheses
1.1 Are the objectives of the study clearly stated?
2 Design
2.1 Is the study design suitable for the objectives
2.2 Who / what was studied?
  The effectiveness of a preoperative exercise/education program on functional recovery, health related quality of life, health service utilisation, and costs following primary total knee arthroplasty.
2.3 Was this the right sample to answer the objectives?
2.4 Is the study large enough to achieve its objectives? Have sample size estimates been performed?
  Yes. One hundred and thirty one subjects were used in the study.
2.5 Were all subjects accounted for?
2.6 Were all appropriate outcomes considered?
2.7 Has ethical approval been obtained if appropriate?
  No ethical approval was reported.
2.8 Were the patients randomised between treatments?
2.9 How was randomisation carried out?
  Consecutively numbered opaque envelopes.
2.10 Are the outcomes clinically relevant?
3 Measurement and observation
3.1 Is it clear what was measured, how it was measured and what the outcomes were?
WOMAC questionnaire, measuring pain stiffness and function.
ROM using a goniometer.
Quads/Hams strength using a dynamometer.
SF36 questionnaire, measuring health status.
Health Service Utilisation
3.2 Are the measurements valid?
3.3 Are the measurements reliable?
3.4 Are the measurements reproducible?
3.5 Were the patients and the investigators blinded?
  The assessors were blinded. The authors did not report whether the selection of patients and implementation of the intervention was blinded.
4 Presentation of results
4.1 Are the basic data adequately described?
4.2 Were groups comparable at baseline?
4.3 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
4.4 Are the results internally consistent, i.e. do the numbers add up properly?
4.5 Were side effects reported?
  Yes. Complications were documented.
5 Analysis
5.1 Are the data suitable for analysis?
5.2 Are the methods appropriate to the data?
5.3 Are any statistics correctly performed and interpreted?
6 Discussion
6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?
6.2 Is the discussion biased?
7 Interpretation
7.1 Are the authors' conclusions justified by the data?
  Conclusions are unclear in the main text. There is a clear conclusion in the abstract.
7.2 What level of evidence has this paper presented? (using CEBM levels)
7.3 Does this paper help me answer my problem?
After CA, i rated this paper: 8/10
8 Implementation
8.1 Can any necessary change be implemented in practice?
  No evidence to support the use of pre operative exercise class prior to primary total knee arthroplasty.
8.2 What aids to implementation exist?
8.3 What barriers to implementation exist?