Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement

Piva, Sara R.; Schneider, Michael J.; Moore, Charity G.; Catelani, Maria Beatriz C.; Gil, Alexandra B.; Klatt, Brian A.; DiGioia, Anthony M.; Almeida, Gustavo J.; Khoja, Samannaaz S.; Sowa, Gwendolyn; Irrgang, James J.

doi:10.1001/jamanetworkopen.2019.0018

Cited by 18 publications

(36 citation statements)

References 65 publications

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“…Not all patients need physiotherapy to help them recover, and some patients will recover fully using self-directed rehabilitation. [28][29][30][31] It is, thus, pertinent to focus our resources on those who are most likely to be at risk of a poor outcome, least likely to be able to engage with a self-management approach and able to benefit from rehabilitation input.…”

Section: Outpatient Rehabilitation Approachesmentioning

confidence: 99%

Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT

Barker

Room

Knight

et al. 2020

Health Technol Assess

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Background Over 100,000 primary knee arthroplasty operations are undertaken annually in the UK. Around 15–30% of patients do not report a good outcome. Better rehabilitation strategies may improve patient-reported outcomes. Objectives To compare the outcomes from a traditional outpatient physiotherapy model with those from a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty. Design An individually randomised, two-arm controlled trial with a blinded outcome assessment, a parallel health economic evaluation and a nested qualitative study. Setting The trial took place in 14 NHS physiotherapy departments. Participants People identified as being at high risk of a poor outcome after knee arthroplasty. Interventions A multicomponent home-based rehabilitation package delivered by rehabilitation assistants with supervision from qualified therapists compared with usual-care outpatient physiotherapy. Main outcome measures The primary outcome was the Late Life Function and Disability Instrument at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function); Knee injury and Osteoarthritis Outcome Score; Quality of Life subscale; Physical Activity Scale for the Elderly; EuroQol-5 Dimensions, five-level version; and physical function assessed using the Figure-of-8 Walk Test, 30-Second Chair Stand Test and Single Leg Stance. Data on the use of health-care services, time off work and informal care were collected using participant diaries. Results In total, 621 participants were randomised. A total of 309 participants were assigned to the COmmunity based Rehabilitation after Knee Arthroplasty (CORKA) home-based rehabilitation programme, receiving a median of five treatment sessions (interquartile range 4–7 sessions). A total of 312 participants were assigned to usual care, receiving a median of four sessions (interquartile range 2–6 sessions). The primary outcome, Late Life Function and Disability Instrument function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual-care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference 0.49 points, 95% confidence interval –0.89 to 1.88 points; p = 0.48). There were no statistically significant differences between the groups in any of the patient-reported or physical secondary outcome measures at 6 or 12 months post randomisation. The health economic analysis found that the CORKA intervention was cheaper to provide than usual care (£66 less per participant). Total societal costs (combining health-care costs and other costs) were lower for the CORKA intervention than usual care (£316 less per participant). Adopting a societal perspective, CORKA had a 75% probability of being cost-effective at a threshold of £30,000 per quality-adjusted life-year. Adopting the narrower health and social care perspective, CORKA had a 43% probability of being cost-effective at the same threshold. Limitations The interventions were of short duration and were set within current commissioning guidance for UK physiotherapy. Participants and treating therapists could not be blinded. Conclusions This randomised controlled trial found no important differences in outcomes when post-arthroplasty rehabilitation was delivered using a home-based, rehabilitation assistant-delivered rehabilitation package or a traditional outpatient model. However, the health economic evaluation found that when adopting a societal perspective, the CORKA home-based intervention was cost-saving and more effective than, and thus dominant over, usual care, owing to reduced time away from paid employment for this group. Further research could look at identifying the risk of poor outcome and further evaluation of a cost-effective treatment, including the workforce model to deliver it. Trial registration Current Controlled Trials ISRCTN13517704. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 65. See the NIHR Journals Library website for further project information.

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Section: Outpatient Rehabilitation Approachesmentioning

confidence: 99%

Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT

Barker

Room

Knight

et al. 2020

Health Technol Assess

View full text Add to dashboard Cite

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“…The functional performance tests were assessed at the 5-and 10-week visits, using an averaged z-score (or standard score) to calculate a cumulative score for the six-minute walk (distance in feet), stair climbing (time divided by steps), TUG (time), and unilateral balance (time) tests [49]. On average, the z-scores were close to zero, meaning the scores for each individual subject did not differ from the mean score across all subjects.…”

Section: Statistical Analysesmentioning

confidence: 99%

A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study

Bell

Onyeukwu

Smith

et al. 2020

Sensors

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Rehabilitation has been shown to improve functional outcomes following total knee replacement (TKR). However, its delivery and associated costs are highly variable. The authors have developed and previously validated the accuracy of a remote (wearable) rehabilitation monitoring platform (interACTION). The present study’s objective was to assess the feasibility of utilizing interACTION for the remote management of rehabilitation after TKR and to determine a preliminary estimate of the effects of the interACTION system on the value of rehabilitation. Specifically, we tested post-operative outpatient rehabilitation supplemented with interACTION (n = 13) by comparing it to a standard post-operative outpatient rehabilitation program (n = 12) using a randomized design. Attrition rates were relatively low and not significantly different between groups, indicating that participants found both interventions acceptable. A small (not statistically significant) decrease in the number of physical therapy visits was observed in the interACTION Group, therefore no significant difference in total cost could be observed. All patients and physical therapists in the interACTION Group indicated that they would use the system again in the future. Therefore, the next steps are to address the concerns identified in this pilot study and to expand the platform to include behavioral change strategies prior to conducting a full-scale randomized controlled trial. Trial registration: ClinicalTrials.gov NCT02646761 “interACTION: A Portable Joint Function Monitoring and Training System for Remote Rehabilitation Following TKA” 6 January 2016.

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“…The SenseWear Pro3 was also used to assess light PA, MVPA, and sedentary time in inactive older adults participating in a 12‐week intervention tailored to decrease sedentary behavior or increase MVPA (60). In adults aged 60 and older with total knee replacement due to OA or inflammatory arthritis, the device was used to compare change in energy expenditure during activity of at least light intensity following clinic‐based physiotherapy, community‐based exercise, or usual care (61).…”

Section: Sensewear Pro3mentioning

confidence: 99%

Wearable Physical Activity Measurement Devices Used in Arthritis

Jasmin

Chan

Sandhu

et al. 2020

Arthritis Care & Research

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Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement

Cited by 18 publications

References 65 publications

Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT

Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT

A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study

Wearable Physical Activity Measurement Devices Used in Arthritis

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