Continuous Passive Motion (CPM): Difference between revisions

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== Uses of CPM ==
== Uses of CPM ==
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.  
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.<ref name=":0">Guidera K.J., Hontas R., Ogden J.A. [https://pubmed.ncbi.nlm.nih.gov/2298887/ Use of continuous passive motion in pediatric orthopedics.] J Pediatr Orthop. 1990 Jan-Feb;10(1):120-3. </ref> 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. <ref name=":0" />
Uses of the CPM are also reported in pediatric orthopaedic surgeries or injuries for maintaining hip and knee range of motion.<ref name=":0">Guidera K.J., Hontas R., Ogden J.A. [https://pubmed.ncbi.nlm.nih.gov/2298887/ Use of continuous passive motion in pediatric orthopedics.] J Pediatr Orthop. 1990 Jan-Feb;10(1):120-3. </ref> 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. <ref name=":0" />


== Mechanisms of action and timing ==
== Mechanisms of action and timing ==
The application of CPM primarily focuses on preventing the initial or delayed accumulation of periarticular interstitial fluids. <ref>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>
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" />


Stiffness following surgery or injury to a joint develops as a progression of four stages: bleeding, edema, granulation tissue, and fibrosis. Continuous passive motion (CPM) properly applied during the first two stages of stiffness acts to pump blood and edema fluid away from the joint and periarticular tissues. This allows maintenance of normal periarticular soft tissue compliance. CPM is thus effective in preventing the development of stiffness if full motion is applied immediately following surgery and continued until swelling that limits the full motion of the joint no longer develops. This concept has been applied successfully to elbow rehabilitation, and explains the controversy surrounding CPM following knee arthroplasty.
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>
 
== References ==

Revision as of 01:10, 30 September 2022

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 as well.

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.[1] 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. [1]

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. [2] 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. [2] In other words, CPM prevents the initial or delayed accumulation of periarticular interstitial fluids. [2]

The duration of each session and the total period of CPM application remain controversial. [3]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. [4]

References[edit | edit source]

  1. 1.0 1.1 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.
  2. 2.0 2.1 2.2 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.
  3. 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.
  4. 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.