Authors' objectives: To explore the medical literature regarding the efficacy and or effectiveness of coldcompression devices in rehabilitation following joint surgeries.

Authors' results and conclusions: Out of the 170 selected citations, the ones written in languages other than English, as well as the ones published earlier than 2003 were discarded. Several studies were not relevant because of the intervention, population, or outcome that were studied. Hence, these were excluded. There were citations of pilot studies, study protocols, conference abstracts, editorials, bibliographic records, and practice guidelines, as well as case reports, case series, and observational studies. All were excluded. Seven systematic reviews (three with a meta-analysis) and six randomized controlled trials (RCTs) were summarized. The medical literature on the efficacy and effectiveness of cold-compression devices in rehabilitation following joint surgeries is limited and equivocal. The seven systematic reviews (three with a meta-analysis) and six randomized controlled trials (RCTs) selected for this review were also equivocal on this efficacy/effectiveness question. All systematic reviews included primary studies with serious methodological shortcomings and heterogeneity. The RCTs included had better methodological rigor compared to the methodological quality of the primary studies included in the systematic reviews. The main finding from several systematic reviews and RCTs was ‘less pain and less analgesic consumption’ with cold-compression cryotherapy at the early stages following a joint surgery. Very rarely, cryotherapy may cause complications, including frostbite, which may lead to skin compromise or, even more rare, injury to the peroneal nerve. In general, the use of cryotherapy – either for acute/immediate care or long-term rehabilitation – is not spelled out. However, these two could be distinct concepts and might impact the efficacy question. When cryo-compression is compared with ice alone, there is usually a positive effect on pain and sometimes, on other variables. However, when cryo-compression is compared with compression alone, no positive effects are observed. This brings about the ‘confounder’ question which requires further investigation. In conclusion, based on the selected RCTs and systematic reviews/meta-analyses, there is moderate to high-level evidence that cryo-compression devices are effective in reducing pain and narcotic analgesic consumption after joint surgeries, particularly in the earlier stages post-operation. However, due to the low methodological quality of the primary studies that contributed to the systematic reviews/meta-analyses, the findings should be interpreted with caution. At this time, a clear effect cannot be demonstrated for other commonly studied outcomes, such as range of motion (ROM), swelling/girth, function, and hospital stay. Better quality studies are needed to make inferences about patient satisfaction and the cost-effectiveness of these devices.

Authors' methods: A systematic literature search was undertaken on April 15 and April 16, 2024. The search was conducted using nine commercial medical literature databases.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2024

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/efficacy-effectiveness-of-cold-compression-therapies-post-joint-surgery?lang=en

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

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