Efficacy and safety of home-based exercises versus individualized supervised outpatient physical therapy programs after total knee arthroplasty: a systematic review and meta-analysis

Abstract

Purpose The aim of the present study was to evaluate the efficacy and safety of non‐supervised home‐based exercise versus individualized and supervised programs delivered in clinic‐based settings for the functional recovery immediately after discharge from a primary TKA. Methods Medline, Embase, Cochrane, and PEDro databases were screened, from inception to April 2015, in search for randomized clinical trials (RCT) of home‐based exercise interventions versus individualized and supervised outpatient physical therapy after primary TKA. Target outcomes were: knee range of motion (ROM), patient‐reported pain and function, functional performance, and safety. Risk of bias was assessed with the PEDro scale. After assessing homogeneity, data were combined using random effects meta‐analysis and reported as standardized mean differences or mean differences. We set a non‐inferiority margin of four points in mean differences. Results The search and selection process identified 11 RCT of moderate quality and small sample sizes. ROM active extension data suitable for meta‐analysis was available from seven studies with 707 patients, and ROM active flexion from nine studies with 983 patients. Most studies showed no difference between groups. Pooled differences were within the non‐inferiority margin. Most meta‐analyses showed significant statistical heterogeneity. Conclusion Short‐term improvements in physical function and knee ROM do not clearly differ between outpatient physiotherapy and home‐based exercise regimes in patients after primary TKA; however, this conclusion is based on a meta‐analysis with high heterogeneity. Level of evidence I.

A randomized comparison of supervised clinical exercise versus a home exercise program in patients with chronic low back pain

“…For example, authors of a study demonstrated that HEP and supervised exercises were equally effective in short term improvements in physical function and knee range of motion after total knee replacement at equivalents costs for patients with after total knee replacement [24]. Their study was based on a meta-analysis that had significant statistical heterogeneity.…”

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

“…Functional rehabilitation, an important measurement to evaluate a successful TKA surgery, often takes few months, if not, years. Physical therapy plays an integral role in promoting functional rehabilitation following TKA, which could signi cant improvements were observed in function, quadriceps strength, and length of stay [8][9][10]. After the surgical procedure, early and su cient rehabilitation programs, including physical therapy, will be greatly helpful to restore the function and range of motion (ROM) [10].…”

“…Physical therapy plays an integral role in promoting functional rehabilitation following TKA, which could signi cant improvements were observed in function, quadriceps strength, and length of stay [8][9][10]. After the surgical procedure, early and su cient rehabilitation programs, including physical therapy, will be greatly helpful to restore the function and range of motion (ROM) [10]. These rehabilitation programs or physical therapy could and should be continued after hospital discharge [11].…”

“…The physical therapist-supervised program is a commonly used standard of functional rehabilitation for patients underwent TKA. Typically, this physical therapy program supervised by a physical therapist during the hospital stay and in an outpatient facility for about 10-20 weeks [10]. Obviously, this standard program needs assistance of licensed therapists and professional equipments, and should be performed in the hospital or an outpatient facility.…”

Sensor Positioning Influences the Accuracy of Knee Rom Data of an E-Rehabilitation System: A Preliminary Study with Healthy Subjects

“…Physiotherapy exercise provided at home is an appealing approach with the possibility of wider acceptability and uptake in the near future [9]. Studies have shown that standardized home programs were not inferior to inpatient or outpatient physiotherapy in regard to their effects on functional status, health related quality of life (HRQOL) and range of movement (ROM) of the operated joint [10][11][12][13].…”