Otago Exercise Program improves knee function and mobility after total knee arthroplasty in meta-analysis

This systematic review and meta-analysis examined the effectiveness of the Otago Exercise Program (OEP) versus conventional rehabilitation for patients recovering from total knee arthroplasty (TKA). The analysis synthesized data from randomized controlled trials (RCTs) involving a total of 1,088 participants. The specific clinical setting (e.g., inpatient, outpatient, home-based) was not reported. The evidence quality was assessed using GRADE methodology, risk of bias was evaluated with the Cochrane Handbook, and publication bias was examined using Egger's test, establishing a structured framework for evaluating the findings.

The intervention was the Otago Exercise Program, a structured regimen of strength and balance exercises. The comparator was conventional rehabilitation, though the specific protocols for either arm were not detailed in the provided data. The frequency and duration of the OEP were explored in subgroup analyses. The primary follow-up period for the analyzed outcomes was 1.0 month post-intervention.

For the primary outcome of knee joint function, the OEP showed a significant improvement compared to conventional rehabilitation. The standardized mean difference (SMD) was 1.80 (95% CI: 0.80, 2.79) for programs with a frequency of 3 or fewer sessions per week. For programs with a duration longer than 1 month, the SMD was 2.57 (95% CI: 0.51, 4.64). Absolute numbers for these outcomes were not reported. Key secondary outcomes also demonstrated improvements: knee flexion angle increased by a mean difference (MD) of 11.24 degrees (95% CI: 9.16, 13.32), balance improved by an MD of 3.45 (95% CI: 2.50, 4.40), fall efficacy improved with an SMD of 0.61 (95% CI: 0.43, 0.79), and functional capacity improved with an SMD of 0.99 (95% CI: 0.80, 1.18). Reductions in pain and joint swelling were indicated based on descriptive analysis, but no specific effect sizes, confidence intervals, or p-values were reported for these endpoints.

Detailed safety and tolerability findings were not reported. The analysis did not provide data on adverse events, serious adverse events, discontinuation rates, or general tolerability of the Otago Exercise Program compared to conventional care. This represents a significant gap in the evidence base for clinical decision-making.

This meta-analysis contributes to the broader evidence on post-TKA rehabilitation by quantitatively synthesizing RCT data for a specific, structured exercise program. Many prior landmark studies and guidelines emphasize early mobilization and physiotherapy, but this analysis attempts to define the potential added value of the OEP's particular focus on strength and balance. The reported effect sizes for function and mobility are notably large, which merits careful scrutiny in the context of the study's limitations.

The analysis has several key methodological limitations. The authors explicitly state that further high-quality, large-scale RCTs are required to validate the effects. The subgroup analyses for exercise frequency and duration are based on a limited number of studies and yield very wide confidence intervals (e.g., 0.51 to 4.64), indicating substantial uncertainty. Outcomes for pain and joint swelling were derived from descriptive analysis only, lacking robust statistical synthesis. Furthermore, the reporting lacks absolute event rates or participant numbers for outcomes, relying solely on summary effect measures, which limits clinical interpretability.

The clinical implications are tentative. The results suggest the Otago Exercise Program may be a beneficial component of rehabilitation for some patients after TKA, particularly for improving objective measures of knee flexion and balance. However, given the evidence limitations—especially the lack of safety data, the uncertain optimal dosing (frequency/duration), and the need for validation—it should not yet be considered a standard-of-care replacement for conventional therapy. It may be reasonable to consider elements of the program for patients where improving balance and functional capacity are prioritized goals.

Several important questions remain unanswered. The optimal protocol for the OEP after TKA—including specific exercises, session frequency, total duration, and timing of initiation—is not defined. The safety profile and comparative risk of adverse events are unknown. The long-term benefits beyond 1 month are not established. Furthermore, the efficacy in specific patient subgroups (e.g., by age, comorbidities, or preoperative function) and the cost-effectiveness compared to standard rehabilitation have not been evaluated.