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Both outpatient therapist led
rehabilitation and single physiotherapist review and home exercise based
therapeutic regimen have comparable efficacy to improve total knee arthroplasty
outcomes.
A study depicted that in individuals at elevated risk of unsatisfactory outcomes after knee arthroplasty, the outpatient therapist led rehabilitation is not better when compared to a single physiotherapist review and home exercise. No vital differences were witnessed in patient outcome or overall patient satisfaction.
A parallel-group multicentre randomized controlled trial (Targeted Rehabilitation to Improve Outcome [TRIO]) was conducted to determine whether a six-week progressive course of outpatient physiotherapy yields superior outcomes compared to a single physiotherapy review and home exercise based therapy when targeted at patients having inadequate recovery and clinical outcomes after knee surgery.
The study recruited 334 subjects suffering from osteoarthritis of the knee who were identified at risk of unsatisfactory outcomes after knee surgery, on the basis of Oxford knee score, at 6 weeks post-surgery. Participants were allocated either to home-based exercise intervention (n=171) or therapist led outpatient rehabilitation (n=163).
All the subjects were monitored by a physiotherapist and initiated 18 rehabilitation sessions over 6 weeks, either as therapist led outpatient rehabilitation or as physiotherapy review followed by a home exercise. The Oxford knee score at 52 weeks was the primary endpoint. The participant reported outcome parameters of function and pain at 14, 26, and 52 weeks after arthroplasty were the secondary endpoints.
The intervention compliance was found to be greater than 85%. At 52 weeks, the difference in Oxford knee score between the interventions was 1.91 points, supporting the outpatient rehabilitation intervention. When all the time point data were assessed, the difference in Oxford knee score between the interventions was found to be a non-clinically significant 2.25 points.
There were no vital differences between the interventions for secondary endpoints. The outcomes at 14, 26, and 52 weeks after knee arthroplasty is shown in the following table:
Thus, though targeting
rehabilitation interventions to patients at higher risk is a feasible delivery
methodology, the rehabilitation content appears to have little impact on the
clinical outcomes of the patient.
British medical journal
Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial
David F Hamilton et al.
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