Arms
Arm Details
Outcomes
Baselines
Outcome Details
Design
Quality
Results
Print Data

Extraction form for project: Major Joint Replacement (P)Rehab

Arms

Arm Name	Arm Description
Neuromuscular exercise programme plus a knee school educational package
A knee school educational package alone

Arm Details

N/A

Outcomes

Type	Domain	Specific measurement (i.e., tool/definition/specific outcome)	Populations	Timepoints
Continuous	Chair Stand Test		All Participants	3 (months) Baseline (N/A)
Continuous	Muscle strength (Newton) - Knee extension op		All Participants	3 (months) Baseline (N/A)
Continuous	Muscle strength (Newton) - Knee flexion op		All Participants	3 (months) Baseline (N/A)
Continuous	Knee-bending/30s°		All Participants	3 (months) Baseline (N/A)
Continuous	ROM of the knee - Flexion op		All Participants	3 (months) Baseline (N/A)
Continuous	ROM of the knee - Extension op		All Participants	3 (months) Baseline (N/A)
Continuous	Performance, walking short distances -- 4x10m fast pace	20 m walk test	All Participants	3 (months) Baseline (N/A)
Continuous	Performance, ambulatory transitions -- timed up and go [TUG]		All Participants	3 (months) Baseline (N/A)
Continuous	Physical activity - METs 7 day		All Participants	3 (months) Baseline (N/A)
Continuous	Physical activity - Steps		All Participants	3 (months) Baseline (N/A)
Continuous	Physical activity - Adapted NHANES III METs	energy expenditure, average MET’s, physical activity duration, steps per day and the physical activity distribution (sedentary, moderate, vigorous and very vigorous)	All Participants	3 (months) Baseline (N/A)
Continuous	KOOS ADL function		All Participants	3 (months) Baseline (N/A)
Continuous	KOOS pain		All Participants	3 (months) Baseline (N/A)
Continuous	KOOS symptoms		All Participants	3 (months) Baseline (N/A)
Continuous	KOOS sport and recreation		All Participants	3 (months) Baseline (N/A)
Continuous	KOOS quality of life		All Participants	3 (months) Baseline (N/A)

Baselines

1. Sex (females %)

Enter NR in not reported.


	50

2. Age - continuous data (in years)

Preferentially enter data for total sample only (not per arm). Feel free to calculate weighted means/% as needed. Select and enter data for all that apply. Categorical age data are in the next question.


	Mean... SD... SE... 95% CI... Median... Range... Not reported

3. Race/ethnicity

Preferentially extract total sample only (not per arm). Feel free to determine the weighted average % across reported arms and enter that single number. Select and enter data for all that apply. Percentages only (not proportions).


	White...% Black...% Hispanic/Latino...% Asian...% Other race/ethnicity 1...% Other race/ethnicity 2...% Not reported

4. BMI - continuous data (Kg/m^2)

Preferentially enter data for total sample only (not per arm). Feel free to calculate weighted means/% as needed. Select and enter data for all that apply. 


	Mean... SD... SE... 95% CI... Median... Range... Not reported

5. Comorbidities

Define the comorbidities. If % reported, enter % for total sample and each study arm. Skip those that are not reported. For BP, enter the mean SBP/DBP (or MAP). Just the mean, not the SD etc. For P<0.10 column, leave blank if no difference between arms.

	Definition of category	%	P<0.10 between arms (Y/blank)
Cardiovascular disease
Cancer
Osteoporosis
Musculoskeletal disease
Lung disease
Psychological disorder
Comorbidities NR
Other (please specify):


	Mean... SD... SE... 95% CI... Median... Range... Not reported

7. Insurance status

Preferentially extract total sample only (not per arm). Feel free to determine the weighted average % across reported arms and enter that single number. Select and enter data for all that apply. Percentages only (not proportions).

Private, Medicare, Medicaid, Other public (100% for most countries).


	Private...% Medicare...% Medicaid...% Other public...% Not reported...%

8. Prior arthroplasty of contralateral joint (%)

Enter NR in not reported.


	NR

9. Preoperative symptoms/severity (e.g., osteoarthritis severity, impaired function, fraility)

Extract as defined by study. 


	NR

10. Narcotic use (%)

Enter NR in not reported.


	NR

11. Caregiver support (%)

Enter NR in not reported.


	NR

12. Surgical incision procedure (HIP)

Please select the incision approach used for HIP replacement (NB. the incision approach to the knee is always the same, the anterior)


	Anterior...% Lateral...% Posterior...% Other (name) Not reported...%

13. Surgical approach (KNEE)

Please select the approach used for KNEE replacement (https://www.healthline.com/health/total-knee-replacement-surgery/surgical-options#Partial-knee-replacement)


	Removal of the posterior cruciate ligament (posterior-stabilized)...% Preservation of the posterior cruciate ligament (cruciate-retaining)...% Not reported...%

14. Type of implant

Copy text, where reported


	Describe... Not reported...

15. Perioperative protocols

List any used


	Enhanced recovery after surgery (ERAS)...% Early ambulation/mobilization...% Other (name)...% Not reported...%

16. Fixation approach


	Cemented...% Uncemented...% Hybrid...% Not reported...%


	Mean... SD... SE... 95% CI... Median... Range... Not reported

18. Note/comment about baseline characteristics

Outcome Details

N/A

Design

1. Study eligibility

Use this for papers that were mistakingly screened in. 


	Yes No...Reason for exclusion

2. Study design

Check one


	RCT NRCS CEA Other...Specify

3. If not an RCT, what was the directionality?

Skip if an RCT.


	Prospective Retrospective Other...Specify Not reported

4. If NRCS, what analytic method was used to account for differences between study arms?

Skip if not an NRCS.


	Australia Canada Germany Netherlands UK USA Spain China Other...Specify Not reported

6. Funder

Define non-industry: academia, government, non-profit, etc. 
Indicate both funding (money) and sponsorship (in-kind contributions including equipment.)


	Industry (fully or in part) Non-industry (fully) Not reported (or unclear)

7. Study name

For studies with multiple papers, include identifier (study name, database/registry name, or (medical) center) and years of study if necessary (eg, Albany Medical Center 2001-13).


	NEMEX-TJR

8. Associated articles

Enter the PMIDs or other identifiers of co-publications. Skip if none.


	23641782

9. ClinicalTrials.gov identifier

Enter NCT number (include "NCT") of associated NCT files. Skip if none.


	NCT00913575

10. Study period

Years (not months) when people were treated. If either is not reported, enter NR

	Start year	End year
Years	2009	2012

11. Number of centers

Enter NR if not reported


	1

12. Inclusion criteria

Keep succinct. Use common abbreviations. Omit criteria of minor relevance (eg, language, consent)


	On a waiting list for primary TKR and sufficient time existed before the operation date in order to take at minimum 8 sessions of the training program; aged 55 to 90 years; understood German; and lived at home

13. Exclusion criteria

Keep succinct. Use common abbreviations. Omit criteria of minor relevance (eg, language, consent). 
Enter NR if not reported.


	Revision surgery; history of inflammatory arthritis; cognitive impairments; absence before or after surgery; and inability to walk at least 3 meters with or without a walking aid

14. Setting of the SURGERY

Choose the best descriptor based on following list of types of hospitals
https://www.ncbi.nlm.nih.gov/books/NBK333506/table/ch04.sec1.table1/

	%	Paste text
First-level hospital
Second-level hospital
Third-level hospital
Unclear	100	Centre on Aging and Mobility, University of Zurich
Not reported

15. Setting of the (P)REHABILITATION

Choose the best descriptor 


	Acute inpatient (postoperative)...% Other inpatient facility (e.g., skilled nursing facility)...% Physical therapy/rehabilitation facility (outpatient)...% Home...% Gym or other community center...% Other (specify)...% Not reported...%

16. Time, relative to surgery, when BASELINE was assessed (weeks)

Use (−) numbers to indicate number of weeks prior to surgery and (+) numbers to indicate number of weeks after surgery


	-12 to -6

17. Time, relative to surgery, when the (P)REHABILITATION began (weeks)

Use (−) numbers to indicate number of weeks prior to surgery and (+) numbers to indicate number of weeks after surgery


	-12 to -6

18. Note/comment about design or overall study

Quality

1. Cochrane - RANDOM SEQUENCE GENERATION (selection bias)

Selection bias (biased allocation to interventions) due to inadequate generation of a randomized sequence. <br /><span style='color: blue;'>NO (low RoB)<span style='color: black;'> if the investigators describe a random component in the sequence generation process such as: referring to a random number table, using a computer random number generator. If randomization done off-site (e.g., centrally), can assume low risk of bias. <br /><span style='color: red;'>YES (high RoB)<span style='color: black;'> if the investigators describe a non-random component in the  sequence generation process, such as: sequence generated by odd or even date of birth, date (or day) of admission, hospital or clinic record number; or allocation by judgement of the clinician, preference of the participant, etc. <br /><span style='color: orange;'>UNSURE<span style='color: black;'> if not reported (e.g., says only "randomized").<br /><span style='color: brown;'>NOT APPLICABLE<span style='color: black;'> if not an RCT.

2. Cochrane - ALLOCATION CONCEALMENT (selection bias)

Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment<br /><span style='color: blue;'>NO (low RoB)<span style='color: black;'> if the participants and investigators enrolling participants could not foresee assignment because one of the following, or an equivalent method, was used to conceal allocation: central allocation (including telephone, web-based and pharmacy-controlled randomization); or sequentially numbered, opaque, sealed envelopes. <br /><span style='color: red;'>YES (high RoB)<span style='color: black;'> if participants or investigators enrolling participants could possibly foresee assignments and thus introduce selection bias, such as allocation based on: using an open random allocation schedule (e.g. a list of random numbers); assignment envelopes were used without appropriate safeguards (e.g. if envelopes were unsealed or non-opaque or not sequentially numbered); alternation or rotation; date of birth; case record number; or other explicitly unconcealed procedures. <br /><span style='color: orange;'>UNSURE<span style='color: black;'> if not reported (e.g., says only "randomized"). <br /><span style='color: brown;'>NOT APPLICABLE<span style='color: black;'> if not an RCT.

3. Cochrane - PARTICIPANT / patient BLINDING (performance bias)

Detection bias due to knowledge of the allocated interventions by study participants. <br /><span style='color: blue;'>NO (low RoB)<span style='color: black;'> if blinding of patient was ensured and it was unlikely that the blinding could have been broken; if not blinded, may still be low if outcome is not likely to be influenced by lack of blinding (e.g., laboratory data, other fully objective measures). <br /><span style='color: red;'>YES (high RoB)<span style='color: black;'> if no blinding of (potentially) subjective outcome. <span style='color: purple;'>Even if blinding was not possible.<br /><span style='color: orange;'>UNSURE<span style='color: black;'> if not reported and cannot infer one way or the other. <br /><span style='color: brown;'>NB:<span style='color: purple;'> 1) Answer for all study designs. 2) If blinding assessment varies among outcomes, explain in Notes.

4. Cochrane - PERSONNEL / care provider BLINDING (performance bias)

Detection bias due to knowledge of the allocated interventions by personnel (eg, therapist). <br /><span style='color: blue;'>NO (low RoB)<span style='color: black;'> if blinding of the provider was ensured and it was unlikely that the blinding could have been broken; if not blinded, may still be low if outcome is not likely to be influenced by lack of blinding (e.g., laboratory data, other fully objective measures). <br /><span style='color: red;'>YES (high RoB)<span style='color: black;'> if no blinding of (potentially) subjective outcome. <span style='color: purple;'>Even if blinding was not possible.<br /><span style='color: orange;'>UNSURE<span style='color: black;'> if not reported and cannot infer one way or the other. <br /><span style='color: brown;'>NB:<span style='color: purple;'> 1) Answer for all study designs. 2) If blinding assessment varies among outcomes, explain in Notes.

5. Cochrane - OUTCOME ASSESSOR BLINDING (detection bias)

Detection bias due to knowledge of the allocated interventions by outcome assessors. NOTE THAT FOR SOME OUTCOMES, THE PATIENT IS THE OUTCOME ASSESSOR. <br /><span style='color: blue;'>NO (low RoB)<span style='color: black;'> if blinding of the outcome assessment was ensured and it was unlikely that the blinding could have been broken; if not blinded, may still be low if outcome is not likely to be influenced by lack of blinding (e.g., laboratory data, other fully objective measures). <br /><span style='color: red;'>YES (high RoB)<span style='color: black;'> if no blinding of (potentially) subjective outcome. <br /><span style='color: orange;'>UNSURE<span style='color: black;'> if not reported and cannot infer one way or the other. <br /><span style='color: brown;'>NB:<span style='color: purple;'> 1) Answer for all study designs. 2) If blinding assessment varies among outcomes, explain in Notes.

6. Cochrane - COMPLETE OUTCOME DATA (attrition bias)

Attrition bias due to amount, nature or handling of incomplete outcome data. <br /><span style='color: blue;'>NO (low RoB)<span style='color: black;'> if limited loss of data (between enrolled and analyzed). Operationally, we define as <20% loss-to-followup (see caveat under "high"). However, survival curve analysis (e.g., hazard ratio) with censoring can be considered low risk of bias, regardless of percentage loss. <br /><span style='color: red;'>YES (high RoB)<span style='color: black;'> if ≥20% loss-to-followup or if there is any substantive imbalance between arms (e.g., 2% in one group, 15% in the other). <br /><span style='color: orange;'>UNSURE<span style='color: black;'> only if cannot be assessed because number enrolled (or number who received interventions) or number analyzed not reported. <br /><span style='color: brown;'>NB:<span style='color: purple;'>1) Answer for all study designs. 2) If drop-out varies among outcomes, explain in Notes.

7. Cochrane - SELECTIVE REPORTING (reporting bias)

<span style='color: blue;'>NO (low RoB): <span style='color: black;'>There is low risk of reporting bias if the study protocol is available and all of the study’s pre-specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre-specified way, or if the study protocol is not available but it is clear that the published reports include all expected outcome, including those that were pre-specified (convincing text of this nature may be uncommon). <br /><span style='color: red;'>YES (high RoB): <span style='color: black;'>There is a high risk of reporting bias if not all of the study’s pre-specified primary outcomes have been reported; one or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. subscales) that were not pre-specified; one or more reported primary outcomes were not pre-specified (unless clear justification for their reporting is provided, such as an unexpected adverse effect); one or more outcomes of interest in the review are reported incompletely so that they cannot be entered in a meta-analysis; the study report fails to include results for a key outcome that would be expected to have been reported for such a study.<br /><span style='color: orange;'>UNSURE<span style='color: black;'> if no protocol or otherwise cannot tell. <br /><span style='color: brown;'>NB:<span style='color: purple;'>1) Answer for all study designs.


Value:	Yes No Unsure No Data Not Applicable Other (please specify):
Notes:	One health service utilization outcome (minutes of care by the nursing staff) was specified in the protocol and did not report in the paper.

8. OTHER BIAS(ES)

Consider biases due to problems not covered elsewhere. <br /><span style='color: blue;'>NO (low RoB)<span style='color: black;'> if there are no other biases to address. <br /><span style='color: red;'>YES (high RoB)<span style='color: black;'> if other bias or concern. <span style='color: purple;'>Describe these in the Notes. 

9. ROBINS-I 1.1 Is there potential for confounding of the effect of intervention in this study?

For RCT: <span style='color: blue;'>NO (low RoB)<span style='color: black;'> unless there is a <span style='color: red;'>clinically important baseline difference<span style='color: black;'> in a characteristic that is unaccounted for.<br />
For NRCS:<span style='color: red;'> YES<span style='color: black;'> except possibly in rare situations, such as when studying harms that are very unlikely to be related to factors that influence treatment decisions, no confounding is expected and the study can be considered to be at low risk of bias due to confounding, equivalent to a fully randomized trial. <br /><span style='color: blue;'>
If no risk of confounding, then skip to Question 7 (overall confounding RoB).

10. ROBINS-I 1.2 (variant) Time-varying confounding (crossover)?

Could (or did) participants cross-over between intervention groups after the start of the intervention?
<br /><span style='color: red;'>YES<span style='color: black;'> or <span style='color: blue;'>NO<span style='color: black;'> (answer "no" if no reporting about crossovers)

11. ROBINS-I 1.4. Did the authors fail to use a propensity-score type analysis method that best controlled for all the important confounding domains?

For NRCS (or RCT requiring adjustment):  <br />
<span style='color: red;'>YES (higher RoB):<span style='color: black;'> used stratification, regression, or matching. <br />
<span style='color: blue;'>NO (lower RoB):<span style='color: black;'> used propensity score matching (aka inverse probability weighting) or similar.<br />
<span style='color: purple;'>REJECT if NRCS with no adjustment for confounding

12. ROBINS-I 1.5. If Y/PY to 1.4: Were confounding domains that were controlled for not measured validly and reliably by the variables available in this study?

Appropriate control of confounding requires that the variables adjusted for are valid and reliable measures of the confounding domains. 
<br /><span style='color: blue;'>NO (low RoB)<span style='color: black;'> if objective or standard clinical measures (eg, age, sex, time since surgery, duration of osteoarthritis). Also <span style='color: blue;'>NO<span style='color: black;'> if validated subjective measure. For this purpose, we can assume any typically used or named/acronym'ed measure (eg, of severity of osteoarthritis or function) has been validated.<br /><span style='color: red;'>YES<span style='color: black;'> if atypical or one-off subjective measure. <span style='color: red;'> Name the unvalidated measure in the notes.

13. ROBINS-I 1.6. Did the authors control for any post-intervention variables that could have been affected by the intervention?

Controlling for post-intervention (or after the start of the intervention) variables  is not appropriate. For example, compliance, number of sessions, intermediate outcomes (like pain during rehab).<br />
<span style='color: red;'>YES<span style='color: black;'> if any variables in model (other than intervention) were measured after the start of the intervention.<span style='color: purple;'> We might reject these studies.<br />
<span style='color: blue;'>NO<span style='color: black;'> if all variables measured pre-intervention (assume this is the case if not fully explicit).

14. ROBINS-I Risk of bias judgement for BIAS DUE TO CONFOUNDING

<span style='color: red;'>YES<span style='color: black;'> if answered Yes to any questions 1.1 to 1.6.<br />
<span style='color: blue;'>NO<span style='color: black;'> if answered No to all 1.1-1.6

15. ROBINS-I 2.1. Was selection of participants into the study (or into the analysis) based on participant characteristics observed after the start of intervention?

This domain is concerned only with SELECTION into the study based on participant characteristics observed after the start of intervention. Selection based on characteristics observed before the start of intervention can be addressed by controlling for imbalances between experimental intervention and comparator groups in baseline characteristics that are prognostic for the outcome (baseline confounding).<br />
<span style='color: blue;'>NO (low RoB)<span style='color: black;'> for RCT or for NRCS where eligibility criteria (including exclusion reasons) were based on (for example) receiving surgery or other criteria where those in either treatment group were enrolled based on criteria unrelated to their (rehab) treatment. If NO, skip questions 2.2 and 2.3.<br />
<span style='color: red;'>YES (high RoB)<span style='color: black;'> for NRCS where eligibility criteria were based, at least in part, on factors related to the choice of intervention.

16. ROBINS-I 2.2. If YES to 2.1: Were the post-intervention variables that influenced selection likely to be associated with intervention?

Selection bias occurs when selection is related to an effect of either intervention or a cause of intervention and an effect of either the outcome or a cause of the outcome. Therefore, the result is at risk of selection bias if selection into the study is related to both the intervention and the outcome.<br />
<span style='color: red;'>YES<span style='color: black;'> if an eligibility criterion is/may be related choice of intervention.<br />
<span style='color: blue;'>NO<span style='color: black;'> otherwise.

17. ROBINS-I 2.3 If YES to 2.2: Were the post-intervention variables that influenced selection likely to be influenced by the outcome or a cause of the outcome?

Selection bias occurs when selection is related to an effect of either intervention or a cause of intervention and an effect of either the outcome or a cause of the outcome. Therefore, the result is at risk of selection bias if selection into the study is related to both the intervention and the outcome.<br />
<span style='color: red;'>YES<span style='color: black;'> if an eligibility criterion is/may be related to both choice of intervention (Question 2.2)  and to an outcome of interest.<br />
<span style='color: blue;'>NO<span style='color: black;'> otherwise.

18. ROBINS-I 2.5. If YES to 2.2 and 2.3: Were adjustment techniques not used that are likely to correct for the presence of selection biases?

It is in principle possible to correct for selection biases, for example by using inverse probability weights to create a pseudo-population in which the selection bias has been removed, or by modeling the distributions of the missing participants or follow up times and outcome events and including them using missing data methodology. Propensity score analyses etc. would need to specifically account for these issues.<br />
However such methods are rarely used and the answer to this question will usually be <br /><span style='color: red;'>YES<span style='color: black;'>, no appropriate adjustment made. 

19. ROBINS-I - Risk of bias judgement for BIAS IN SELECTION OF PARTICIPANTS INTO THE STUDY

<span style='color: red;'>YES<span style='color: black;'> if answered Yes to any questions 2.1 to 2.3 and 2.6.<br />
<span style='color: blue;'>NO<span style='color: black;'> if answered No to all 2.1-2.6

20. NHLBI - POPULATION NOT PRESPECIFIED OR CLEAR

Were eligibility/selection criteria for the study population NOT prespecified and clearly described? Question reversed to maintain Yes/No meaning across questions.<br /><span style='color: blue;'>NO (good quality)<span style='color: black;'> if prespecified and clear (you could reasonably determine whether a patient in front of you would have been enrolled). By "prespecified" we mean that there were clear participant eligibility, whether prospective or retrospective design. <br /><span style='color: red;'>YES (poor quality)<span style='color: black;'> if not clearly prespecified or described. Explain in Notes.

21. NHLBI - INTERVENTION NOT CLEAR OR CONSISTENT

Was the intervention NOT clearly described and delivered consistently across the study population? Question reversed to maintain Yes/No meaning across questions.<br /><span style='color: blue;'>NO (good quality)<span style='color: black;'> if clear and consistent. Based on article, you are reasonably confident a therapist could reproduce the intervention AND all participants received the same intervention (in regards to the salient features of the intervention). <br /><span style='color: red;'>YES (poor quality)<span style='color: black;'> if not clear or consistently delivered. <br /><span style='color: purple;'>IF NOT CLEAR AND CONSISTENT, WILL LIKELY REJECT.

22. NHLBI - OUTCOMES NOT PRESPECIFIED, CLEAR, VALID

Were the outcome measures NOT prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants? Question reversed to maintain Yes/No meaning across questions.<br /><span style='color: blue;'>No (good quality)<span style='color: black;'> if *all outcomes (of interest)* are clear and valid. Scores, scales, tools, etc. do not need to be formally validated, as long as the outcome measure is reasonable and appropriate. <br /><span style='color: red;'>YES (poor quality)<span style='color: black;'> if *all outcomes (of interest)* are problematic. <span style='color: purple;'>Explain in Notes. <br /><span style='color: brown;'>OTHER.<span style='color: black;'> If only some outcomes are high risk of bias. <span style='color: purple;'>Explain in Notes.

23. ROBINS-I 1.3. Were intervention discontinuations likely to be related to factors that are prognostic for the outcome?

... or related to the choice of intervention?<br />
Usually <span style='color: red;'>YES<span style='color: black;'> unless there is documentation that dropouts (or switches) were unrelated (eg, moved out of town)

24. Adjust Quality Rating (for Key Questions: 1, 2, 3, 4)


Quality Guideline Used:
Select Current Overall Rating:
Notes on this Rating:

Results

Continuous

Chair Stand Test

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Muscle strength (Newton) - Knee extension op

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Muscle strength (Newton) - Knee flexion op

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Knee-bending/30s°

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

ROM of the knee - Flexion op

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

ROM of the knee - Extension op

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Performance, walking short distances -- 4x10m fast pace (20 m walk test)

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Performance, ambulatory transitions -- timed up and go [TUG]

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Physical activity - METs 7 day

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Physical activity - Steps

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Physical activity - Adapted NHANES III METs (energy expenditure, average MET’s, physical activity duration, steps per day and the physical activity distribution (sedentary, moderate, vigorous and very vigorous))

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

KOOS ADL function

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

KOOS pain

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

KOOS symptoms

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

KOOS sport and recreation

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

KOOS quality of life

All Participants
		Descriptive Statistics			Between Arm Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
3 (months)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
Baseline (N/A)
	N Analyzed			Mean Difference
	Mean			95% CI low
	SD			95% CI high
				P-value
		Within Arm Comparisons			Net Comparisons
		Neuromuscular exercise programme plus a knee school educational package	A knee school educational package alone		Neuromuscular exercise programme plus a knee school educational package vs. A knee school educational package alone
Baseline N/A vs. 3 months
	Mean Difference	Saved!	Saved!
	95% CI low	Saved!	Saved!
	95% CI high	Saved!	Saved!
	P-value	Saved!	Saved!

Extraction form for project: Major Joint Replacement (P)Rehab

Arms

Arm Details

Outcomes

Baselines

1. Sex (females %)

2. Age - continuous data (in years)

3. Race/ethnicity

4. BMI - continuous data (Kg/m^2)

5. Comorbidities

6. Charlson Comorbidity Index

7. Insurance status

8. Prior arthroplasty of contralateral joint (%)

9. Preoperative symptoms/severity (e.g., osteoarthritis severity, impaired function, fraility)

10. Narcotic use (%)

11. Caregiver support (%)

12. Surgical incision procedure (HIP)

13. Surgical approach (KNEE)

14. Type of implant

15. Perioperative protocols

16. Fixation approach

17. Length of stay

18. Note/comment about baseline characteristics

Outcome Details

Design

1. Study eligibility

2. Study design

3. If not an RCT, what was the directionality?

4. If NRCS, what analytic method was used to account for differences between study arms?

5. Country

6. Funder

7. Study name

8. Associated articles

9. ClinicalTrials.gov identifier

10. Study period

11. Number of centers

12. Inclusion criteria

13. Exclusion criteria

14. Setting of the SURGERY

15. Setting of the (P)REHABILITATION

16. Time, relative to surgery, when BASELINE was assessed (weeks)

17. Time, relative to surgery, when the (P)REHABILITATION began (weeks)

18. Note/comment about design or overall study

Quality

1. Cochrane - RANDOM SEQUENCE GENERATION (selection bias)

2. Cochrane - ALLOCATION CONCEALMENT (selection bias)

3. Cochrane - PARTICIPANT / patient BLINDING (performance bias)

4. Cochrane - PERSONNEL / care provider BLINDING (performance bias)

5. Cochrane - OUTCOME ASSESSOR BLINDING (detection bias)

6. Cochrane - COMPLETE OUTCOME DATA (attrition bias)

7. Cochrane - SELECTIVE REPORTING (reporting bias)

8. OTHER BIAS(ES)

9. ROBINS-I 1.1 Is there potential for confounding of the effect of intervention in this study?

10. ROBINS-I 1.2 (variant) Time-varying confounding (crossover)?

11. ROBINS-I 1.4. Did the authors *fail to* use *a propensity-score type* analysis method that *best* controlled for all the important confounding domains?

12. ROBINS-I 1.5. If Y/PY to 1.4: Were confounding domains that were controlled for *not* measured validly and reliably by the variables available in this study?

13. ROBINS-I 1.6. Did the authors control for any post-intervention variables that could have been affected by the intervention?

14. ROBINS-I Risk of bias judgement for BIAS DUE TO CONFOUNDING

15. ROBINS-I 2.1. Was selection of participants into the study (or into the analysis) based on participant characteristics observed after the start of intervention?

16. ROBINS-I 2.2. If YES to 2.1: Were the post-intervention variables that influenced selection likely to be associated with intervention?

17. ROBINS-I 2.3 If YES to 2.2: Were the post-intervention variables that influenced selection likely to be influenced by the outcome or a cause of the outcome?

18. ROBINS-I 2.5. If YES to 2.2 and 2.3: Were adjustment techniques *not* used that are likely to correct for the presence of selection biases?

19. ROBINS-I - Risk of bias judgement for BIAS IN SELECTION OF PARTICIPANTS INTO THE STUDY

20. NHLBI - POPULATION *NOT* PRESPECIFIED *OR* CLEAR

21. NHLBI - INTERVENTION *NOT* CLEAR *OR* CONSISTENT

22. NHLBI - OUTCOMES *NOT* PRESPECIFIED, CLEAR, VALID

23. ROBINS-I 1.3. Were intervention discontinuations likely to be related to factors that are prognostic for the outcome?

24. Adjust Quality Rating (for Key Questions: 1, 2, 3, 4)

Results

Continuous

Chair Stand Test

Muscle strength (Newton) - Knee extension op

Muscle strength (Newton) - Knee flexion op

Knee-bending/30s°

ROM of the knee - Flexion op

ROM of the knee - Extension op

Performance, walking short distances -- 4x10m fast pace (20 m walk test)

Performance, ambulatory transitions -- timed up and go [TUG]

Physical activity - METs 7 day

Physical activity - Steps

11. ROBINS-I 1.4. Did the authors fail to use a propensity-score type analysis method that best controlled for all the important confounding domains?

12. ROBINS-I 1.5. If Y/PY to 1.4: Were confounding domains that were controlled for not measured validly and reliably by the variables available in this study?

18. ROBINS-I 2.5. If YES to 2.2 and 2.3: Were adjustment techniques not used that are likely to correct for the presence of selection biases?

20. NHLBI - POPULATION NOT PRESPECIFIED OR CLEAR

21. NHLBI - INTERVENTION NOT CLEAR OR CONSISTENT

22. NHLBI - OUTCOMES NOT PRESPECIFIED, CLEAR, VALID