Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Key Takeaway

Low-certainty evidence suggests structured exercise rehabilitation may reduce kinesiophobia and improve knee function after total knee arthroplasty, though substantial study heterogeneity warrants clinical caution.

Wen H., Zhang T., Xie T., Xue H.. (2026). Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. https://doi.org/10.1186/s12891-026-10640-3

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What this study found

This systematic review and meta-analysis of 11 randomized controlled trials (1,096 total patients) evaluated the impact of targeted exercise-based rehabilitation on kinesiophobia (fear of movement) following primary total knee arthroplasty (TKA). The meta-analysis found that exercise-based interventions were associated with meaningful reductions in post-operative kinesiophobia (SMD = -1.22) and improvements in general knee physical function (SMD = 1.19) when compared to routine post-surgical care. However, early pain reduction benefits at four weeks or less were highly inconsistent across studies and proved non-robust during sensitivity analyses.

Why it matters

Kinesiophobia affects approximately 21% to 35% of individuals following knee replacement surgery, presenting a substantial psychological barrier to early mobilization and long-term functional recovery. For physical medicine and rehabilitation professionals, these findings support integrating structured movement therapies to help patients overcome movement-related anxiety. Addressing fear-avoidance beliefs alongside mechanical recovery can help optimize patient engagement and post-operative progress.

Limitations

The study authors emphasized several critical limitations that mandate a cautious interpretation of the findings:

Low evidence certainty: Overall evidence certainty was rated as low using GRADE criteria due to risk of bias in many included trials.
Extreme heterogeneity: Statistical heterogeneity among trials consistently exceeded 90%, reflecting wide variations in exercise protocols, intervention timelines, and measurement tools.
Unstable pain outcomes: Early pain estimates lost statistical significance after sensitivity analysis, indicating fragile findings.

Robust, standardized multicenter trials are needed to clarify optimal exercise strategies for reducing kinesiophobia after total knee replacement.

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