Continuous Passive Motion (CPM): Difference between revisions

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Joint stiffness after surgery or injury is reported to progress through four stages: bleeding, edema, granulation tissue, and fibrosis. <ref name=":1">O'Driscoll SW, Giori NJ. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev. 2000 Mar-Apr;37(2):179-88. Erratum in: J Rehabil Res Dev 2001 Mar-Apr;38(2):291. </ref> When applied during the first two stages, CPM  can ensure the maintenance of normal periarticular soft tissue compliance and prevent the development of stiffness by helping pump blood and edema fluid away from the joint and periarticular tissues. <ref name=":1" />  In other words, CPM prevents the initial or delayed accumulation of periarticular interstitial fluids. <ref name=":1" />
Joint stiffness after surgery or injury is reported to progress through four stages: bleeding, edema, granulation tissue, and fibrosis. <ref name=":1">O'Driscoll SW, Giori NJ. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev. 2000 Mar-Apr;37(2):179-88. Erratum in: J Rehabil Res Dev 2001 Mar-Apr;38(2):291. </ref> When applied during the first two stages, CPM  can ensure the maintenance of normal periarticular soft tissue compliance and prevent the development of stiffness by helping pump blood and edema fluid away from the joint and periarticular tissues. <ref name=":1" />  In other words, CPM prevents the initial or delayed accumulation of periarticular interstitial fluids. <ref name=":1" />


The duration of each session and the total period of CPM application remain controversial. <ref>Lenssen T.A., van Steyn M.J., Crijns Y.H., Waltjé E.M., Roox G.M., Geesink R.J., van den Brandt P.A., De Bie R.A. [https://pubmed.ncbi.nlm.nih.gov/18442423/ Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty.] BMC Musculoskelet Disord. 2008 Apr 29;9:60. </ref>A Cochrane review suggests that short-term use of CPM offers greater short-term ROM benefits, but long-term improvements are yet to be demonstrated to justify its routine use. <ref>Harvey L.A., Brosseau L., Herbert R.D. [https://pubmed.ncbi.nlm.nih.gov/24500904/ Continuous passive motion following total knee arthroplasty in people with arthritis.] Cochrane Database Syst Rev. 2014 Feb 6;(2):CD004260. </ref>
The duration of each session and the total period of CPM application remain controversial. <ref>Lenssen T.A., van Steyn M.J., Crijns Y.H., Waltjé E.M., Roox G.M., Geesink R.J., van den Brandt P.A., De Bie R.A. [https://pubmed.ncbi.nlm.nih.gov/18442423/ Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty.] BMC Musculoskelet Disord. 2008 Apr 29;9:60. </ref>A Cochrane review reports that short-term use of CPM offers greater short-term ROM benefits, but long-term improvements are yet to be demonstrated to justify its routine use. <ref>Harvey L.A., Brosseau L., Herbert R.D. [https://pubmed.ncbi.nlm.nih.gov/24500904/ Continuous passive motion following total knee arthroplasty in people with arthritis.] Cochrane Database Syst Rev. 2014 Feb 6;(2):CD004260. </ref> This is also supported by the latest systematic review by Yang et al. <ref>Yang X., Li G., Wang H., Wang C. [https://pubmed.ncbi.nlm.nih.gov/30831093/ Continuous Passive Motion After Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Associated Effects on Clinical Outcomes.] Arch Phys Med Rehabil. 2019 Sep;100(9):1763-1778. </ref>which suggests that evidence favouring the routine use of CPM machines is still lacking.


== Clinical bottom line ==
== Clinical bottom line ==

Revision as of 16:27, 20 November 2022

Original Editor - Angeliki Chorti Top Contributors - Angeliki Chorti and Lucinda hampton
[1]

Introduction[edit | edit source]

Continuous Passive Motion (CPM) therapy uses machines to move a joint passively i.e. without the patient exerting any effort. A motorised device moves the joint repetitively to a set of number of degrees and movement speed, determined by the physiotherapist. CPM machines are most commonly applied to the knee, but there are versions for other joints such as the hip, shoulder and elbow.

Uses of CPM[edit | edit source]

CPM is most commonly used after joint surgery to promote the recovery of normal joint range of motion (ROM) and thus, to prevent joint stiffness complications. It is frequently recommended after knee joint replacement or knee cartilage repair surgery. Uses of the CPM are also reported in pediatric orthopaedic surgeries or injuries for maintaining hip and knee range of motion.[2] CPM was introduced in the early post-operative period and was combined with physiotherapy for maximum results. The device was well tolerated, without interfering with open wounds, nursing care or external fixation devices. [2]

CPM is also recommended for prophylaxis against thrombosis after total knee replacement, with some support from a small number of studies for its use. [3]

Mechanisms of action and timing[edit | edit source]

Joint stiffness after surgery or injury is reported to progress through four stages: bleeding, edema, granulation tissue, and fibrosis. [4] When applied during the first two stages, CPM can ensure the maintenance of normal periarticular soft tissue compliance and prevent the development of stiffness by helping pump blood and edema fluid away from the joint and periarticular tissues. [4] In other words, CPM prevents the initial or delayed accumulation of periarticular interstitial fluids. [4]

The duration of each session and the total period of CPM application remain controversial. [5]A Cochrane review reports that short-term use of CPM offers greater short-term ROM benefits, but long-term improvements are yet to be demonstrated to justify its routine use. [6] This is also supported by the latest systematic review by Yang et al. [7]which suggests that evidence favouring the routine use of CPM machines is still lacking.

Clinical bottom line[edit | edit source]

Continuous Passive Motion (CPM) therapy uses machines to move a joint passively and repetitively to a set of number of degrees and movement speed. CPM machines are most commonly applied to the knee, but there are versions for other joints.CPM is most commonly used after joint surgery to prevent joint stiffness complications and for prophylaxis against thrombosis. The duration of each session and the total period of CPM application remain controversial.

References[edit | edit source]

  1. ↑ Ravedave, CC BY-SA 3.0 <http://creativecommons.org/licenses/by-sa/3.0/>, via Wikimedia Commons [accessed 15-11-2022]
  2. ↑ 2.0 2.1 Guidera K.J., Hontas R., Ogden J.A. Use of continuous passive motion in pediatric orthopedics. J Pediatr Orthop. 1990 Jan-Feb;10(1):120-3.
  3. ↑ He M.L., Xiao Z.M., Lei M., Li TS.., Wu H., Liao J. Continuous passive motion for preventing venous thromboembolism after total knee arthroplasty. Cochrane Database Syst Rev. 2014 Jul 29;(7):CD008207.
  4. ↑ 4.0 4.1 4.2 O'Driscoll SW, Giori NJ. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev. 2000 Mar-Apr;37(2):179-88. Erratum in: J Rehabil Res Dev 2001 Mar-Apr;38(2):291.
  5. ↑ Lenssen T.A., van Steyn M.J., Crijns Y.H., Waltjé E.M., Roox G.M., Geesink R.J., van den Brandt P.A., De Bie R.A. Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty. BMC Musculoskelet Disord. 2008 Apr 29;9:60.
  6. ↑ Harvey L.A., Brosseau L., Herbert R.D. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. 2014 Feb 6;(2):CD004260.
  7. ↑ Yang X., Li G., Wang H., Wang C. Continuous Passive Motion After Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Associated Effects on Clinical Outcomes. Arch Phys Med Rehabil. 2019 Sep;100(9):1763-1778.
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