Bedside pedalling after knee replacement: a small addition to early rehabilitation
BMC Musculoskeletal Disorders · 19 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Early mobilisation after knee replacement is standard, and this trial suggests that a cheap bedside cycle may add short-term gains in pain, motion and function, which is relevant when counselling patients on inpatient rehab after TKR.
The evidence
This single-centre randomised trial in 72 adults having a primary one-sided total knee replacement tested whether adding in-bed pedalling (forward and backward cycling) to the hospital's usual early, accelerated physiotherapy improved recovery more than accelerated physiotherapy alone. At 1 month, the pedalling group had lower pain (VAS 1.91 vs 3.15), more knee flexion (about 124 vs 118 degrees), and better WOMAC function scores (23.06 vs 32.29, lower is better). Flexor strength did not differ between groups. The first measurement was taken on postoperative day 3, after treatment had already started, and follow-up lasted only 1 month.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
RCTDesign starting point: 59.5
Raised the score
- Blinded outcome assessment+6.8
- Adequately powered+6
Lowered the score
- Only 1 months of follow-up−9.3
- Per-protocol analysis only−6
Methods at a glance
Recorded assessment- Outcome assessors blindedMet
- Allocation concealedMet
- Random sequence generatedMet
- Intention-to-treat analysisNot met
- Adequate statistical powerMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 59.5
- Concealed allocation
- +5.1
- Random sequence generation
- +2.5
- Compared against current standard of care
- +3.4
- Blinded outcome assessment
- +6.8
- Per-protocol analysis only
- −6
- Only 1 months of follow-up
- −9.3
- 7% loss to follow-up
- −0.3
- Adequately powered
- +6
- Prospectively registered
- +5.1
- A positive result from only 72 patients
- −3.4
- A positive result from a single centre
- −4.3
- Final rigour score rounded
- 65 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Would you add bedside pedalling to the early rehab order set for every TKR patient, or reserve it for those with slow flexion gains or stiffness in the first days after surgery?
2.How would you counsel a TKR patient about what knee flexion, pain and function to expect at 1 month, and does the possibility of extra short-term gains from pedalling change how you set those expectations?
Original publication title
Effectiveness of combined bed pedaling and accelerated rehabilitation versus accelerated rehabilitation alone after total knee replacement: a randomised controlled trial