human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: & NA ; This prospect i ve study was performed to investigate whether postoperative alternate flexion and extension splinting ( daily change in position of immobilization by splinting ) was useful in restoring full range of motion ( ROM )  after total knee arthroplasty as compared with continuous passive motion . The  alternate flexion and extension splinting group and the  continuous passive motion group were each composed of 34 knees .  Final ROM was measured at an average of 3.5 years postoperatively . Squatting was possible in 31 knees ( 45.6 % ) of the alternate flexion and extension  splinting group . The postoperative ROM of the osteoarthritic knees ( 131.8 ° ± 12.3 ° ) was significantly greater than that of the rheumatoid knees ( 121.9 ° ± 22.4 ° ) ( p < 0.05 ) . The postoperative ROM of the alternate flexion and extension splinting group ( 135.1 ° ± 11.9 ° ) also was significantly greater than that of the continuous passive motion group ( 120.0 ° ± 19.7 ° ) ( p < 0.01 ) . There was no statistically significant relationship between the posterior slope of tibial cutting and the postoperative ROM . It is suggested that alternate flexion and extension splinting is effective in restoring full ROM after total knee arthroplasty Purpose . Continuous passive motion is frequently used post-operatively to increase knee range of motion after total knee arthroplasty in spite of little conclusive evidence . The aim of this study was to examine whether continuous passive motion ( CPM ) as an adjunct to active exercises had any short time effects ( after one week and three months ) on pain , range of motion , timed walking and stair climbing . Method . A r and omized controlled trial was conducted . A total of 63 patients undergoing primary TKA were r and omly assigned into an experimental group receiving CPM and active exercises and a control group receiving active exercises only . Outcomes were assessed by goniometer , visual analogue scale ( VAS ) , timed ‘ Up and Go ’ test ( TUG ) , timed 40 m walking distance and timed stair climbing . Results . There were no statistical differences between the treatment groups for any outcome measures either at one week or after three months . For the whole group , a significant and 50 % reduction in pain score was found after three months ( p < 0.01 ) . Compared with before surgery , a significantly impaired knee flexion range of motion ( p < 0.01 ) and a significantly decreased number of patients able to climb stairs were found after three months ( p < 0.01 ) . Conclusion . CPM was not found to have an additional short-time effect compared with active physiotherapy . After three months considerable pain relief was obtained for the whole group , the patients preoperative ROM was not restored and the number of patients able to climb stairs had decreased Sixty primary total knee arthroplasties in 43 Chinese patients were included into a prospect i ve study . Twenty-six patients who had unilateral knee arthroplasty were r and omized to receive continuous passive motion ( CPM ) or immobilization in the first week . The 2 groups of patients were comparable in demographic data and preoperative knee range of motion ( ROM ) . In 17 patients who had 1-stage sequential bilateral arthroplasties , one side had CPM and the other side was immobilized . The active knee ROM was assessed regularly until 1 year after the operation . For all patients , the early active knee ROM in the CPM group was significantly better than the immobilization group . There was no difference after 7 days , however . For patients who had 1-stage bilateral total knee arthroplasties , the active knee ROM was significantly better on the CPM side until day 28 . After 4 weeks , there was no difference between the CPM group and the immobilization group . Immobilization after total knee arthroplasty does not preclude good ROM 68 consecutive patients who had primary knee arthroplasties because of arthrosis were r and omized to postoperative continuous passive motion ( CPM ) or active physical therapy ( APT ) . Rehabilitation in both groups was initiated on the first postoperative day . The CPM group sustained less postoperative knee swelling with more rapid initial improvement in knee flexion than did the APT group , but there were no differences between the groups in knee flexion at discharge . Postoperative pain rating and hospitalization times were similar in the two groups A prospect i ve r and omized single blind investigation after total knee arthroplasty was performed to evaluate two rehabilitation protocol s ( one with CPM and the other without CPM ) . A series of 87 consecutive total knee arthroplasties in 76 patients ( 72 women and 4 men ) was analyzed . The average age of the patients was 64.7 years .  Kinesitherapy with CPM was performed in 30 ( 34.5 % ) cases , where as in 57 ( 65.5 % ) cases kinesitherapy without CPM was performed . Early functional results according to the HSS scale were assessed on the 14th day after surgery . In the group treated with CPM there were 26.7 % excellent results , 70.0 % good results and 3.3 satisfactory results . The group treated without CPM there were 26.3 % excellent results , 70.2 % good results and 3.5 % satisfactory results . No statistically significant differences were noted between the results yielded by these two rehabilitation protocol A prospect i ve , controlled , r and omized trial of continuous passive motion and immobilization after knee arthroplasty revealed that continuous passive motion significantly improved early and late flexion of the knee , reduced the duration of stay in the hospital , and did not increase the incidence of superficial infection or problems with wound-healing . Flexion of the knee beyond 40 degrees progressively diminished viability of the edges of the wound , particularly the lateral edge . On the basis of these results , a protocol for continuous passive motion was design ed to minimize the detrimental effects on viability of the wound A r and omised , controlled study of the use of postoperative continuous passive motion ( CPM ) and immobilisation regimen after total condylar knee arthroplasty was performed . CPM result ed in a significant increase in both the early and late range of knee flexion . This increase occurred in both rheumatoid and osteoarthritic patients . The improvement of 10 degrees at 12 months allowed additional important function to be attained . CPM result ed in significantly earlier discharge from hospital . It did not increase the clinical incidence of wound healing problems , nor did it significantly increase the postoperative fixed flexion deformity or the extension lag .  CPM can be recommended as a safe and effective modality to achieve more rapid and more successful postoperative rehabilitation after knee arthroplasty This study was conducted to compare postoperative  total knee arthroplasty rehabilitation protocol s. The hypothesis of this study was that patients undergoing total knee arthroplasty could achieve range of motion and hospital discharge in the same period using a postoperative rehabilitation protocol that did not use a continuous passive motion machine . This r and omized prospect i ve study compared 46 total knee arthroplasties in which a continuous passive motion machine was used with 37 total knees that were rehabilitated with  early passive flexion of the knee ( named drop and dangle protocol ) . Postoperative physical therapy regimens were otherwise the same for both groups . Surgical technique was the same for both groups except for closure which was performed in the drop and dangle group with the knee at 90 ° to 95 ° flexion . Only patients with osteoarthritis were included in the study , and in both groups of patients received the same prosthetic components . Patients in the drop and dangle group were discharged from the hospital 1 day earlier ( p = 0.01 ) and had a statistically better extension range of 2.8 ° at 6 months ( p = 0.03 ) . Knees in the drop and dangle group had less drainage ( p = 0.06 ) . Range of motion and hospital discharge can be achieved in a similar time interval with the drop and dangle technique as with using a continuous passive motion device , and that such a device is not required for postoperative knee rehabilitation Background Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty . Although research suggests that Continuous Passive Motion ( CPM ) should be implemented in the first rehabilitation phase after surgery , there is substantial debate about the duration of each session and the total period of CPM application . A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion . It also suggested , however , that future research should concentrate on the treatment period during which CPM should be administered . Methods In a r and omised controlled trial we investigated the effectiveness of prolonged  CPM  use in the home situation as an adjunct to st and ardised PT . Efficacy was assessed in terms of faster improvements in range of motion ( RoM ) and functional recovery , measured at the end of the active treatment period , 17 days after surgery . Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were r and omised over two treatment groups . The experimental group received CPM + PT for 17 consecutive days after surgery , whereas the usual care group received the same treatment during the in-hospital phase ( i.e. about four days ) , followed by PT alone ( usual care ) in the first two weeks after hospital discharge . From 18 days to three months after surgery , both groups received st and ardised PT . The primary focus of rehabilitation was functional recovery ( e.g. ambulation ) and regaining RoM in the knee . Results Prolonged use of CPM slightly improved short-term RoM  in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-st and ard PT programme . Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessment s. Conclusion Although results indicate that prolonged CPM use might have a small short-term effect on RoM , routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered , since neither long-term effects nor transfer to better functional performance was detected . Trial Registration IS RCT Effect of continuous passive motion ( CPM ) protocol s on outcomes after total knee arthroplasty . In this prospect i ve r and omized controlled study , 147 patients were assigned to 1 of 3 treatment groups : CPM from 0 degrees to 40 degrees and increased by 10 degrees per day , CPM from 90 degrees to 50 degrees ( early flexion ) and gradually progressed into full extension over a 3-day period , and a no-CPM group . The CPM was administered twice a day for 3 hours over a 5-day period . All patients participated in the same postoperative physiotherapy program . Patients were assessed preoperatively , day 5 , 3 months , and 1 year postoperatively . The early flexion group had significantly more range of flexion than both the st and ard and control groups at day 5 . There was no significant difference between the groups for any other variable tested at any time frame . Key words : total knee arthroplasty , CPM , rehabilitation , outcomes Continuous passive motion ( CPM ) , though of doubtful value , is yet routinely practice d post-total knee arthroplasty ( TKA ) . We prospect ively distributed 84 patients with TKA to 1 of the 3 st and ard rehabilitation regimes : no-CPM , 1-day-CPM , and 3-day-CPM .  We recorded a unique " Timed up and go " test besides pain , Western Ontario and McMaster Universities ( WOMAC ) , short form-12 ( SF-12 ) , range of motion , knee and calf swelling , and wound healing parameters . Our st and ardized and elaborate measurements preoperatively and on postoperative days 3 , 5 , 14 , 42 , and 90 showed no statistically significant difference among the 3 groups in each parameter . We concluded that CPM gives no benefit in immediate functional recovery post-TKA , and in fact , the postoperative knee swelling persisted longer . We have since then discontinued its use in our patients without any untoward effect OBJECTIVES We prospect ively evaluated the effects of continuous passive motion ( CPM ) started after two different time intervals following total knee arthroplasty ( TKA ) on short- and long-term results , in comparison with st and ard physical therapy . METHODS Eighty-six patients were r and omized to three groups following TKA for primary osteoarthritis . The control group ( n=28 ) received only conventional physical therapy . Group I and II , each consisting of 29 patients , were treated with conventional physical therapy combined with CPM that was started on the first and third postoperative days , respectively , and continued until discharge with three one-hour sessions daily . Preoperative and postoperative measurements of the knee range of motion were recorded . Clinical and functional results were assessed using the Knee Society rating system . The patients were followed-up for at least two years ( range 26 to 52 months ) . RESULTS The duration of CPM  was 22 hours in group I , and 19 hours in group II ( p>0.05 ) . Knee flexion values measured in the CPM groups on day 3 and at discharge showed significant differences with those of the control group , but no significant differences were found between the groups after the first postoperative month in this respect ( p>0.05 ) . The mean duration to reach 100 degrees of passive knee flexion ( p=0.03 ) and the mean length of hospital stay ( p=0.04 ) in the CPM groups were shorter by three and two days compared to the control group , respectively . Clinical and functional knee scores showed significant improvements in 
    Output:
    
agent
The estimates for risk of manipulation and adverse events are very imprecise and the estimate for the risk of adverse events does not distinguish between a clinical ly important increase and decrease in risk .
There was insufficient evidence to determine the effect of CPM on participants ' global assessment of treatment effectiveness .
CPM does not have clinical ly important effects on active knee flexion ROM , pain , function or quality of life to justify its routine use .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: & NA ; This prospect i ve study was performed to investigate whether postoperative alternate flexion and extension splinting ( daily change in position of immobilization by splinting ) was useful in restoring full range of motion ( ROM )  after total knee arthroplasty as compared with continuous passive motion . The  alternate flexion and extension splinting group and the  continuous passive motion group were each composed of 34 knees .  Final ROM was measured at an average of 3.5 years postoperatively . Squatting was possible in 31 knees ( 45.6 % ) of the alternate flexion and extension  splinting group . The postoperative ROM of the osteoarthritic knees ( 131.8 ° ± 12.3 ° ) was significantly greater than that of the rheumatoid knees ( 121.9 ° ± 22.4 ° ) ( p < 0.05 ) . The postoperative ROM of the alternate flexion and extension splinting group ( 135.1 ° ± 11.9 ° ) also was significantly greater than that of the continuous passive motion group ( 120.0 ° ± 19.7 ° ) ( p < 0.01 ) . There was no statistically significant relationship between the posterior slope of tibial cutting and the postoperative ROM . It is suggested that alternate flexion and extension splinting is effective in restoring full ROM after total knee arthroplasty Purpose . Continuous passive motion is frequently used post-operatively to increase knee range of motion after total knee arthroplasty in spite of little conclusive evidence . The aim of this study was to examine whether continuous passive motion ( CPM ) as an adjunct to active exercises had any short time effects ( after one week and three months ) on pain , range of motion , timed walking and stair climbing . Method . A r and omized controlled trial was conducted . A total of 63 patients undergoing primary TKA were r and omly assigned into an experimental group receiving CPM and active exercises and a control group receiving active exercises only . Outcomes were assessed by goniometer , visual analogue scale ( VAS ) , timed ‘ Up and Go ’ test ( TUG ) , timed 40 m walking distance and timed stair climbing . Results . There were no statistical differences between the treatment groups for any outcome measures either at one week or after three months . For the whole group , a significant and 50 % reduction in pain score was found after three months ( p < 0.01 ) . Compared with before surgery , a significantly impaired knee flexion range of motion ( p < 0.01 ) and a significantly decreased number of patients able to climb stairs were found after three months ( p < 0.01 ) . Conclusion . CPM was not found to have an additional short-time effect compared with active physiotherapy . After three months considerable pain relief was obtained for the whole group , the patients preoperative ROM was not restored and the number of patients able to climb stairs had decreased Sixty primary total knee arthroplasties in 43 Chinese patients were included into a prospect i ve study . Twenty-six patients who had unilateral knee arthroplasty were r and omized to receive continuous passive motion ( CPM ) or immobilization in the first week . The 2 groups of patients were comparable in demographic data and preoperative knee range of motion ( ROM ) . In 17 patients who had 1-stage sequential bilateral arthroplasties , one side had CPM and the other side was immobilized . The active knee ROM was assessed regularly until 1 year after the operation . For all patients , the early active knee ROM in the CPM group was significantly better than the immobilization group . There was no difference after 7 days , however . For patients who had 1-stage bilateral total knee arthroplasties , the active knee ROM was significantly better on the CPM side until day 28 . After 4 weeks , there was no difference between the CPM group and the immobilization group . Immobilization after total knee arthroplasty does not preclude good ROM 68 consecutive patients who had primary knee arthroplasties because of arthrosis were r and omized to postoperative continuous passive motion ( CPM ) or active physical therapy ( APT ) . Rehabilitation in both groups was initiated on the first postoperative day . The CPM group sustained less postoperative knee swelling with more rapid initial improvement in knee flexion than did the APT group , but there were no differences between the groups in knee flexion at discharge . Postoperative pain rating and hospitalization times were similar in the two groups A prospect i ve r and omized single blind investigation after total knee arthroplasty was performed to evaluate two rehabilitation protocol s ( one with CPM and the other without CPM ) . A series of 87 consecutive total knee arthroplasties in 76 patients ( 72 women and 4 men ) was analyzed . The average age of the patients was 64.7 years .  Kinesitherapy with CPM was performed in 30 ( 34.5 % ) cases , where as in 57 ( 65.5 % ) cases kinesitherapy without CPM was performed . Early functional results according to the HSS scale were assessed on the 14th day after surgery . In the group treated with CPM there were 26.7 % excellent results , 70.0 % good results and 3.3 satisfactory results . The group treated without CPM there were 26.3 % excellent results , 70.2 % good results and 3.5 % satisfactory results . No statistically significant differences were noted between the results yielded by these two rehabilitation protocol A prospect i ve , controlled , r and omized trial of continuous passive motion and immobilization after knee arthroplasty revealed that continuous passive motion significantly improved early and late flexion of the knee , reduced the duration of stay in the hospital , and did not increase the incidence of superficial infection or problems with wound-healing . Flexion of the knee beyond 40 degrees progressively diminished viability of the edges of the wound , particularly the lateral edge . On the basis of these results , a protocol for continuous passive motion was design ed to minimize the detrimental effects on viability of the wound A r and omised , controlled study of the use of postoperative continuous passive motion ( CPM ) and immobilisation regimen after total condylar knee arthroplasty was performed . CPM result ed in a significant increase in both the early and late range of knee flexion . This increase occurred in both rheumatoid and osteoarthritic patients . The improvement of 10 degrees at 12 months allowed additional important function to be attained . CPM result ed in significantly earlier discharge from hospital . It did not increase the clinical incidence of wound healing problems , nor did it significantly increase the postoperative fixed flexion deformity or the extension lag .  CPM can be recommended as a safe and effective modality to achieve more rapid and more successful postoperative rehabilitation after knee arthroplasty This study was conducted to compare postoperative  total knee arthroplasty rehabilitation protocol s. The hypothesis of this study was that patients undergoing total knee arthroplasty could achieve range of motion and hospital discharge in the same period using a postoperative rehabilitation protocol that did not use a continuous passive motion machine . This r and omized prospect i ve study compared 46 total knee arthroplasties in which a continuous passive motion machine was used with 37 total knees that were rehabilitated with  early passive flexion of the knee ( named drop and dangle protocol ) . Postoperative physical therapy regimens were otherwise the same for both groups . Surgical technique was the same for both groups except for closure which was performed in the drop and dangle group with the knee at 90 ° to 95 ° flexion . Only patients with osteoarthritis were included in the study , and in both groups of patients received the same prosthetic components . Patients in the drop and dangle group were discharged from the hospital 1 day earlier ( p = 0.01 ) and had a statistically better extension range of 2.8 ° at 6 months ( p = 0.03 ) . Knees in the drop and dangle group had less drainage ( p = 0.06 ) . Range of motion and hospital discharge can be achieved in a similar time interval with the drop and dangle technique as with using a continuous passive motion device , and that such a device is not required for postoperative knee rehabilitation Background Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty . Although research suggests that Continuous Passive Motion ( CPM ) should be implemented in the first rehabilitation phase after surgery , there is substantial debate about the duration of each session and the total period of CPM application . A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion . It also suggested , however , that future research should concentrate on the treatment period during which CPM should be administered . Methods In a r and omised controlled trial we investigated the effectiveness of prolonged  CPM  use in the home situation as an adjunct to st and ardised PT . Efficacy was assessed in terms of faster improvements in range of motion ( RoM ) and functional recovery , measured at the end of the active treatment period , 17 days after surgery . Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were r and omised over two treatment groups . The experimental group received CPM + PT for 17 consecutive days after surgery , whereas the usual care group received the same treatment during the in-hospital phase ( i.e. about four days ) , followed by PT alone ( usual care ) in the first two weeks after hospital discharge . From 18 days to three months after surgery , both groups received st and ardised PT . The primary focus of rehabilitation was functional recovery ( e.g. ambulation ) and regaining RoM in the knee . Results Prolonged use of CPM slightly improved short-term RoM  in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-st and ard PT programme . Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessment s. Conclusion Although results indicate that prolonged CPM use might have a small short-term effect on RoM , routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered , since neither long-term effects nor transfer to better functional performance was detected . Trial Registration IS RCT Effect of continuous passive motion ( CPM ) protocol s on outcomes after total knee arthroplasty . In this prospect i ve r and omized controlled study , 147 patients were assigned to 1 of 3 treatment groups : CPM from 0 degrees to 40 degrees and increased by 10 degrees per day , CPM from 90 degrees to 50 degrees ( early flexion ) and gradually progressed into full extension over a 3-day period , and a no-CPM group . The CPM was administered twice a day for 3 hours over a 5-day period . All patients participated in the same postoperative physiotherapy program . Patients were assessed preoperatively , day 5 , 3 months , and 1 year postoperatively . The early flexion group had significantly more range of flexion than both the st and ard and control groups at day 5 . There was no significant difference between the groups for any other variable tested at any time frame . Key words : total knee arthroplasty , CPM , rehabilitation , outcomes Continuous passive motion ( CPM ) , though of doubtful value , is yet routinely practice d post-total knee arthroplasty ( TKA ) . We prospect ively distributed 84 patients with TKA to 1 of the 3 st and ard rehabilitation regimes : no-CPM , 1-day-CPM , and 3-day-CPM .  We recorded a unique " Timed up and go " test besides pain , Western Ontario and McMaster Universities ( WOMAC ) , short form-12 ( SF-12 ) , range of motion , knee and calf swelling , and wound healing parameters . Our st and ardized and elaborate measurements preoperatively and on postoperative days 3 , 5 , 14 , 42 , and 90 showed no statistically significant difference among the 3 groups in each parameter . We concluded that CPM gives no benefit in immediate functional recovery post-TKA , and in fact , the postoperative knee swelling persisted longer . We have since then discontinued its use in our patients without any untoward effect OBJECTIVES We prospect ively evaluated the effects of continuous passive motion ( CPM ) started after two different time intervals following total knee arthroplasty ( TKA ) on short- and long-term results , in comparison with st and ard physical therapy . METHODS Eighty-six patients were r and omized to three groups following TKA for primary osteoarthritis . The control group ( n=28 ) received only conventional physical therapy . Group I and II , each consisting of 29 patients , were treated with conventional physical therapy combined with CPM that was started on the first and third postoperative days , respectively , and continued until discharge with three one-hour sessions daily . Preoperative and postoperative measurements of the knee range of motion were recorded . Clinical and functional results were assessed using the Knee Society rating system . The patients were followed-up for at least two years ( range 26 to 52 months ) . RESULTS The duration of CPM  was 22 hours in group I , and 19 hours in group II ( p>0.05 ) . Knee flexion values measured in the CPM groups on day 3 and at discharge showed significant differences with those of the control group , but no significant differences were found between the groups after the first postoperative month in this respect ( p>0.05 ) . The mean duration to reach 100 degrees of passive knee flexion ( p=0.03 ) and the mean length of hospital stay ( p=0.04 ) in the CPM groups were shorter by three and two days compared to the control group , respectively . Clinical and functional knee scores showed significant improvements in 
    Output:
    