Comparison of Clinic- and Home-Based Rehabilitation Programs After Total Knee Arthroplasty

Abstract

One hundred sixty patients (mean age, 68 +/- 8 years) having primary total knee arthroplasty were assigned randomly to two rehabilitation programs: (1) clinic-based rehabilitation provided by outpatient physical therapists; or (2) home-based rehabilitation monitored by periodic telephone calls from a physical therapist. Both rehabilitation programs emphasized a common home exercise program. Before surgery, and at 12 and 52 weeks after surgery, no statistically significant differences were observed between the clinic- and the home-based groups on any of the following measures: (1) total score on the Knee Society clinical rating scale; (2) total score on the Western Ontario and McMaster Universities Osteoarthritis Index; (3) total score on the Medical Outcomes Study Short Form; (4) pain scale of the Knee Society clinical rating scale; (5) pain scale of the Western Ontario and McMaster Universities Osteoarthritis Index; (6) functional scale of the Western Ontario and McMaster Universities Osteoarthritis Index; (7) distance walked in 6 minutes; (8) number of stairs ascended and descended in 30 seconds; and (9) knee flexion range of motion, on either the per protocol or the intent-to-treat or the analyses. After primary total knee arthroplasty, patients who completed a home exercise program (home-based rehabilitation) performed similarly to patients who completed regular outpatient clinic sessions in addition to the home exercises (clinic-based rehabilitation). Additional studies need to determine which patients are likely to benefit most from clinic-based rehabilitation programs.

Comparison of Supervised and Unsupervised Models of Physical Therapy in Total Knee Arthroplasty: Systematic Review

“…The other three studies did not describe the random sequence generation process clearly. [11][12][13] Only one study described allocation concealment correctly. 6 The other studies did not provide a full description [11][12][13][14] resulting in unclear risk of bias.…”

“…6,[11][12][13] However, none of the studies described the exercises performed during the intervention or their intensity. (Figures 2) (Figure 3) show the results of the internal quality assessment.…”

“…13 Another study in the same line of research compared the use of neuromuscular electrical stimulation (NMES) by an unsupervised group and a supervised group. 12 One study did not detail the intervention.…”

“…[11][12][13][14] Only one study investigated three physical therapy modalities: supervised individual therapy, supervised group therapy and unsupervised home therapy. 6 Two studies compared supervised outpatient care with unsupervised home care 12,14 One study compared the use of continuous passive motion (CPM) devices by an unsupervised group and a supervised group. 13 Another study in the same line of research compared the use of neuromuscular electrical stimulation (NMES) by an unsupervised group and a supervised group.…”

Domiciliary vs Centre-Based Rehabilitation of Older Community Dwellers: Randomised Trial with Economic Evaluation

“…For patients following total knee arthroplasty surgery, patients receiving domiciliary therapy in the form of a home exercise program and two telephone calls during the 12 week period following surgery, recorded similar improvements to those receiving centre-based therapy consisting of up to two hour long physiotherapy sessions per week for 12 weeks following surgery [5]. Home-based cardiac rehabilitation services have been shown to have lower costs and be just as effective as hospital group-based programs in randomised controlled trials [6,7].…”