OBJECTIVE: To develop a rating scale for assessing the therapeutic validity of therapeutic exercise programmes. The therapeutic validity of therapeutic exercise in patients awaiting primary total knee or hip replacement was studied by using this rating scale. Finally, the association between therapeutic validity of preoperative therapeutic exercise and its effectiveness in terms of postoperative functional recovery was studied. METHODS: (Quasi) randomised clinical trials on preoperative therapeutic exercise in adults awaiting TJR on postoperative recovery of functioning within three months after surgery were identified through database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Therapeutic validity of the interventions was assessed with a nine-item, expert-based rating scale (scores range from 0 to 9; score >= 6 reflecting therapeutic validity), developed in a four-round Delphi study. Effects were pooled using a random-effects model and meta-regression was used to study the influence of therapeutic validity on pooled effectiveness. RESULTS: Of the 7,482 articles retrieved, 12 studies (737 patients) were included. None of the included studies demonstrated therapeutic validity and two demonstrated low risk of bias. Therapeutic exercise was not associated with: (1) observed functional recovery during the hospital stay (standardised mean difference (SMD) -1.19; 95% confidence interval (CI) -2.46 to 0.08); (2) observed recovery within three months of surgery (SMD -0.15, 95% CI -0.42 to 0.12); and (3) self-reported recovery within three months of surgery (SMD -0.07; 95% CI -0.35 to 0.21) compared with control participants. Meta-regression showed no statistically significant relationship between therapeutic validity and pooled-effects. CONCLUSION: Preoperative therapeutic exercise for total knee or hip replacement did not demonstrate beneficial effects on postoperative functional recovery compared to a control group. However, poor therapeutic validity of the therapeutic exercise programmes may have hampered potentially beneficial effects, since none of the studies met the predetermined quality criteria. Future review studies on therapeutic exercise should address therapeutic validity.

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