Nav: Home

CPM for knee or shoulder joints: Advantage only in two therapeutic indications

August 06, 2018

Patients who have had knee or shoulder surgery or who require conservative treatment can benefit from training with motor-driven continuous passive motion (CPM) devices. However, this only applies to two therapeutic indications, and in each case only to one treatment outcome. Patients with stiff shoulder have less pain with CPM treatment than with physiotherapy alone. The range of motion after total knee replacement is improved if CPM is used in addition to physiotherapy. This is the result of the final report published by the Institute for Quality and Efficiency in Health Care (IQWiG). Hence, the conclusion was less favourable than the conclusion of the preliminary report, where the Institute had determined greater benefit of CPM also for pain in rotator cuff tear, a condition involving the rupture of tendons in the shoulder.

Early movement of joint possible

Motor-driven CPM devices allow movement of the joints without the patients needing to use their muscles. With this method, intensive activation of the joints is possible already shortly after surgery.

CPM is used to improve mobility, prevent stiffness and promote healing. It is usually not applied on its own, but as part of a multimodal therapy, supplementing physiotherapy.

Evidence base still best for total knee replacement

Compared with the preliminary report, the researchers could analyse data from two additional studies. The evidence base was still best for the use of CPM in addition to physiotherapy after total knee replacement surgery. Data of 1693 patients were available for this therapeutic indication, whereas data of fewer than 160 patients were available for each of the remaining six research questions.

Further data on rotator cuff tear: no advantage regarding pain

For rotator cuff tear, a condition involving the rupture of tendons in the shoulder requiring surgery, data from two studies with 155 participants in total were now available to the Institute for the comparison of CPM in combination with physiotherapy versus physiotherapy alone. In the preliminary report, this number was 100. Since the study additionally analysed had an opposing result for the outcome "pain", the Institute no longer sees an advantage in its final report.

Regarding the therapeutic indication of stiff shoulder, however, there is still an indication of greater benefit of CPM. The assessment in the therapeutic indication of total knee replacement also remained the same with IQWiG determining a hint of greater benefit. CPM used directly after surgery in addition to physiotherapy improves the patients' ability to move their knees.

Further studies are useful and recommended

The final report also identified evidence gaps: Usable data on health-related quality of life and adverse events are still missing. IQWiG recommends conducting further randomized controlled trials (RCTs) in the therapeutic indications where currently no (greater) benefit can be determined. In these studies, it would be important to standardize both the administration of analgesics and the respective treatment regimens of CPM and physiotherapy, and to provide detailed descriptions of their beginning and duration. Without this information, it is difficult to interpret the results.

In this final report, IQWiG assessed the benefit and harm of CPM only for knee and shoulder joints. Another completed assessment dealt with controlled active motion (CAM) devices for knees in the treatment of anterior cruciate ligament ruptures.

Institute for Quality and Efficiency in Health Care

Related Pain Articles:

Spinal manipulation treatment for low back pain associated with modest improvement in pain, function
Among patients with acute low back pain, spinal manipulation therapy was associated with modest improvements in pain and function at up to six weeks, with temporary minor musculoskeletal harms, according to a study published by JAMA.
Pain in the neck
Researchers led by University of Utah bioengineering assistant professor Robby Bowles have discovered a way to curb chronic pain by modulating genes that reduce tissue- and cell-damaging inflammation.
Can staying active help to prevent chronic pain? Physical activity affects pain modulation in older adults
Older adults with higher levels of physical activity have pain modulation patterns that might help lower their risk of developing chronic pain, reports a study in PAINĀ®, the official publication of the International Association for the Study of Pain (IASP).
Is back pain killing us?
Older people who suffer from back pain have a 13 per cent increased risk of dying from any cause, University of Sydney research has found.
Improving pain care through implementation of the Stepped Care Model for Pain Management
A new study published in the Journal of Pain Research provides evidence that implementation of a Stepped Care Model for Pain Management has the potential to more adequately treat chronic pain.
Surgery for back pain reduces problems with sex life-related pain
For patients with degenerative spinal disease, surgery is more effective in reducing pain that interferes with sexual activity, compared to nonsurgical treatment, reports a study in the Nov.
'Pain paradox' discovery provides route to new pain control drugs
A natural substance known to activate pain in the central nervous system has been found to have the opposite effect in other parts of the body, potentially paving the way to new methods of pain control.
Treating pain without feeding addiction: Study shows promise of non-drug pain management
A new study shows the potential for patients who have both addiction issues and chronic pain to get relief from an approach that combines behavioral therapy and social support to help them manage their pain without painkillers that carry an addiction risk.
Neuropathic pain unmasks subliminal excitation in pain processing circuits
Research by Steven Prescott, at Toronto's Hospital for Sick Children, sheds new light on the mechanism underlying the establishment of neuropathic pain.
The anatomy of pain
Emotions consist of general components that are also elicited by similar impressions and specific components.

Related Pain Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...