슬관절 전치환술 환자 대상 간호사 주도 운동 프로그램 효과: 체계적 문헌고찰 및 메타분석

Abstract

Purpose: This systematic review and meta-analysis evaluated the effectiveness of nurse-led exercise programs in adults who underwent total knee arthroplasty (TKA). These programs were defined as nurse-delivered interventions involving planning, implementation, and monitoring. Methods: Nine databases were searched for studies published until October 2023. Eleven studies (three randomized controlled trials, eight quasi-experimental studies, N=732) with nurse-planned, delivered, and monitored exercise were included. Two reviewers extracted data and assessed bias using RoB 1 and RoBANS 2. A random-effects meta-analysis was performed using SPSS 29. Heterogeneity was examined with x 2 and I 2 . Results: The program duration ranged from 10 days to 16 weeks. Across the review, pain (k=9), knee range of motion (ROM) (k=8), and fear of falling (k=4) were analyzed. The meta-analysis included six, five, and two studies, respectively. Nurse-led exercise markedly reduced pain (Hedges’ g=-1.06, 95% CI -2.00 to -0.13, I2 =93.4%) and improved ROM (g=0.79, 95% CI 0.06 to 1.52, I2 =88.6%). The change in fear-of-falling was non-significant (g=-1.66, 95% CI -3.53 to 0.22, I2 =94.4%). Narrative findings suggested additional gains in gait speed and exercise self-efficacy. Conclusion: Nurse-led exercise programs relieved pain and enhanced knee mobility after TKA, supporting their integration into routine postoperative rehabilitation. Larger, more rigorous trials are needed to clarify balance-related outcomes and reduce heterogeneity.