Efficacy and safety of knee flexion enhanced standardized home exercise program comparing supervised physiotherapy to improve mobility and quality of life after Total knee arthroplasty

Xu, Tianyang; Fan, Lin; Yang, Dong; Liu, Kaiyuan; Gao, Qiuming; Li, Guodong

doi:10.21203/rs.3.rs-32993/v1

Cited by 1 publication

(3 citation statements)

References 27 publications

(36 reference statements)

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“…A total of 1,884 cases in 11 studies were included in this review and meta-analysis (Table 1) [11][12][13][14][15][16][17][18][19][20][21]. All studies were published between 2003 and 2020.…”

Section: Resultsmentioning

confidence: 99%

“…As access to technology improves over time, this may also fuel discussion for the need to develop web-based programs to help provide access for patients unable to commute to outpatient-based appointments. Additionally, there is a cost reduction benefit associated with unsupervised exercise regimens that were demonstrated by several studies included in this review [ 13 , 14 , 21 ]. In a retrospective study conducted on 2,971 total joint arthroplasty (TJA) patients in an insurance claims database, Yayac et al.…”

Section: Reviewmentioning

confidence: 99%

“…Additionally, while a cost analysis between the two cohorts would have been useful, this was only reported in two of the included studies [ 13 , 21 ]. Although both demonstrated a substantially higher cost involved in supervised PT as expected, we were unable to perform any data synthesis due to the many factors that could have influenced cost, such as differences in healthcare costs based on country, equipment used in each study, and frequency of therapy visits.…”

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Chaudhry¹,

Hayes²,

Wells³

et al. 2023

Cureus

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Although postoperative physical therapy (PT) has long been considered essential to successful total knee arthroplasty (TKA) recovery, recent literature has suggested that unsupervised home exercise regimens may offer similar benefits to formal supervised sessions. We aimed to compare objectively measured physical function and subjective patient-reported outcomes (PROs) between primary TKA patients who received formal supervised physical therapy sessions and those who received unsupervised home exercise regimens after discharge. Six electronic databases were queried to identify randomized controlled trials comparing supervised physical therapy to unsupervised home exercise regimens in primary TKA patients after discharge. Outcomes of interest included change from baseline in objective measures (knee flexion range of motion (ROM), lower extremity strength, and aerobic capacity) and PROs (physical function and quality of life scores). These outcomes were subdivided into short-term (<6 months from surgery; closest data point to three months is used if multiple measurements were made in this time period) and long-term (≥6 months from surgery; closest data point to 12 months is used if multiple measurements were made in this time period) assessments.A total of 1,884 cases performed in 11 studies were included in this review. There were no significant differences between cohorts with regard to short-term knee flexion ROM (p = 0.7), lower extremity strength (p = 0.6), or patient-reported quality of life (p = 0.5), as well as long-term knee flexion ROM (p = 0.7), patientreported quality of life (p = 0.2), or patient-reported physical outcome scores (p = 0.3). A small difference in short-term patient-reported physical outcomes was observed in favor of the supervised cohort (standardized mean difference (SMD): 0.3 (95% confidence interval (CI): 0.01, 0.6); I 2 = 82%; p = 0.04).Formal supervised physical therapy regimens do not confer clinically significant benefits over unsupervised home exercise regimens following primary TKA. The routine use of supervised physical therapy after discharge may not be warranted. Further study is needed to determine the subset of patients that may benefit from supervised care.

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