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Weekly MSK Literature Review

Weekly MSK Literature Review

Week of February 1, 2026

Alex Bendersky
February 01, 2026

Monday: Supervised PT vs. Home Exercise After Total Knee Arthroplasty

Main Points

No significant difference was found between supervised and unsupervised groups for short-term or long-term knee flexion ROM.
Lower extremity strength outcomes were comparable across 11 randomized controlled trials (n = 1,884).
Long-term patient-reported outcomes and quality of Life metrics showed no statistical variance between groups.
A small short-term advantage in physical function favored supervised PT (SMD 0.3), but this did not meet the threshold for clinical significance.
The review suggests that routine PT referrals for all primary TKA patients may lead to unnecessary healthcare utilization.

Clinical Significance

Standardizing automatic PT referrals post-TKA may be inefficient; clinicians should shift toward a stratified model where supervised care is reserved for high-risk patients or those failing to progress independently.

Citation

Chaudhry, Y. P., Hayes, H., Wells, Z., Papadelis, E., Khanuja, H. S., & Deirmengian, C. (2023). Not all patients need supervised physical therapy after primary total knee arthroplasty: A systematic review and meta-analysis. Cureus, 15(2), e35232. https://doi.org/10.7759/cureus.35232

Tuesday: Adherence Barriers in Pelvic Floor Muscle Exercises (PFME)

Main Points

Supervised PFME significantly improved urinary incontinence (UI) severity and quality of life over 6 months in rural settings.
Home-based PFME showed no significant improvement, performing similarly to the "no exercise" control group.
Adherence was the primary driver of success: the supervised group completed ~334 sessions vs. ~115 in the home group.
Zero participants in the home-based group reached the threshold for "adequate" adherence.
Sociocultural barriers, including low autonomy and lack of privacy, were identified as critical inhibitors of home-based success.

Clinical Significance

In pelvic health, the "prescription" is secondary to the "delivery system"; without supervised accountability or addressing sociocultural barriers, home programs for UI are likely to fail.

Citation

Mishra, D. G., Vaishnav, S. B., & Phatak, A. G. (2022). Comparison of effectiveness of home‑based versus supervised pelvic floor muscle exercise in women with urinary incontinence. Journal of Mid‑life Health, 13(1), 74–79. https://doi.org/10.4103/jmh.jmh_83_21

Wednesday: Patient Perceptions of Self-Directed Rehabilitation

Main Points

Patients identify the clinician’s role as "motivational catalyst" rather than just an instructor; the feeling of being "seen" increased effort.
Simple, tangible materials (written instructions/diagrams) were preferred over digital delivery tools.
Peer and family support were cited as major external boosters for adherence to self-directed tasks.
Internal drivers vary significantly: patients often fall into categories of "rule followers," "results-driven," or "inner athletes."
Environmental factors, such as the relevance of functional tasks (e.g., transfers), highly influenced the perceived value of the exercise.

Clinical Significance

Clinicians must move beyond "handing out HEPs" to becoming "adherence architects," tailoring the delivery and feedback loops to the patient's specific motivational profile.

Citation

Dorward, E., Devlin, A., Brusco, N. K., Dulfer, F., Whittaker, S. L., Reeder, S., & Ekegren, C. L. (2025). Patients’ perceptions of participating in self-directed activities outside supervised occupational and physiotherapy within inpatient and home-based rehabilitation settings: A qualitative study. Disability and Rehabilitation, 47(3), 592–600. https://doi.org/10.1080/09638288.2024.2341872

Thursday: The Inaccuracy of Clinical Intuition in Psychological Screening

Main Points

MSK and spine clinicians correctly identified psychological distress (depression/anxiety) only 12–40% of the time based on "impression."
While clinicians were specific (rarely over-diagnosing), the sensitivity was low, meaning the majority of distressed patients were missed.
The Geriatric 5Ms (Mind, Mobility, Medications, Multicomplexity, and What Matters Most) provide a necessary framework for managing older adults.
Clinical intuition consistently fails to detect the "Mind" component of the 5Ms in standard orthopedic encounters.

Clinical Significance

Standardized psychological screening tools are a clinical necessity, not an elective addition; relying on "gut feeling" results in a 60-80% failure rate in identifying patients who need behavioral health integration.

Citation

Basheikh, M. A., & Badahdah, A. A. (2025). Efficacy of home-based physical exercise in stroke survivors: A systematic review and meta-analysis of randomized controlled trials. Archives of Rehabilitation Research and Clinical Translation, 7, 100494. https://doi.org/10.1016/j.arrct.2025.100494

Friday: Efficacy of Supervised Home-Based Stroke Rehab

Main Points

Professionally guided home-based rehab led to clinically meaningful gains in the Barthel Index for stroke survivors.
Significant improvements were noted in the Fugl-Meyer (motor recovery) after 3 months of home intervention.
6-minute walk test (6MWT) results were superior in supervised home groups compared to unsupervised controls.
Structured telerehab and clinician-controlled devices (e.g., ROMTech) showed faster ROM recovery in TKA patients than traditional PT.
The meta-analysis confirms that "home-based" does not mean "less effective," provided professional oversight is maintained.

Clinical Significance

Neuro-rehabilitation and post-surgical recovery are shifting toward a "home-first" model that utilizes technology and remote monitoring to maintain high-intensity supervision without the brick-and-mortar burden.

Citation

Weekly Themes & Strategic Insights

The Shift from "Supervision" to "Structure"
Evidence from Chaudhry and Basheikh suggests that for many MSK and neuro conditions, the location of care (clinic vs. home) is less important than the structure of the program. While TKA patients may thrive unsupervised, stroke survivors and pelvic health patients require high-structure/high-accountability models to achieve significance.
The Failure of Clinical Intuition
A major gap exists in identifying psychological barriers. As noted in the Basheikh/Badahdah review context, clinicians miss up to 88% of psychological distress cases when relying on intuition. This reinforces the need for objective screening (PHQ-9, GAD-7) in every MSK assessment.
Adherence as the Primary Intervention
Across all studies, particularly Mishra and Dorward, the "active ingredient" in recovery was adherence. Whether through supervision or "clinician presence," the evidence shows that we aren't just prescribing exercises; we are prescribing a behavior change that requires intentional environmental and social support.
Personalization Over Standardization
The data from Chaudhry (TKA) vs. Mishra (Pelvic Health) highlights that a "one-size-fits-all" approach to PT referral is obsolete. Strategic care delivery must identify "low-need/high-autonomy" patients for home programs and "high-complexity/low-support" patients for supervised care.
Human Connection in a Digital Age
Despite the rise of telerehab, Dorward found that patients still prioritize the "feeling of being seen" and simple, clear instructions over complex digital interfaces. Technology should facilitate the clinician-patient bond, not replace it.

Implications for MSK Care Delivery, Technology, and Strategy

[Care Delivery]: Transition to a tiered PT referral system—unsupervised home programs for standard TKA/THA, and intensive supervised care for neuro and pelvic health.
[Technology]: Focus R&D on "accountability tech" (like ROMTech mentioned in Friday's focus) that provides clinician oversight without requiring in-person visits.
[Strategy]: Implement mandatory psychological screening tools to close the 60%+ gap in clinician detection of patient distress.
[Patient Experience]: Prioritize "tangible" and "simple" educational materials; avoid over-complicating home programs with high-friction digital barriers.
[System Design]: Integrate the "Geriatric 5Ms" into standard orthopedic intake to better manage multicomplexity in an aging population.

Bottom line: The future of MSK care is home-based but clinician-led; success is determined not by the complexity of the exercise but by the objective screening of the mind and the intentional design of patient adherence.