Home-based rehabilitation programme compared with traditional physiotherapy for patients at risk of poor outcome after knee arthroplasty: the CORKA randomised controlled trial

Abstract

ObjectivesTo evaluate whether a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty offers superior outcomes to traditional outpatient physiotherapy.DesignA prospective, single-blind, two-arm randomised controlled superiority trial.Setting14 National Health Service physiotherapy departments in the UK.Participants621 participants identified at high risk of a poor outcome after knee arthroplasty using a bespoke screening tool.InterventionsA multicomponent home-based rehabilitation programme delivered by rehabilitation assistants with supervision from qualified therapists versus usual care outpatient physiotherapy.Main outcome measuresThe primary outcome was the Late-Life Function and Disability Instrument (LLFDI) 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, 5 dimension, 5 level version of Euroqol (EQ-5D-5L) and physical function assessed using the Figure of 8 Walk test, 30 s Chair Stand Test and Single Leg Stance.Results621 participants were randomised between March 2015 and January 2018. 309 were assigned to CORKA (Community Rehabilitation after Knee Arthroplasty) home-based rehabilitation, receiving a median five treatment sessions (IQR 4–7). 312 were assigned to usual care, receiving a median 4 sessions (IQR 2–6). The primary outcome, LLFDI 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% CI −0.89 to 1.88; p=0.48). There were no statistically significant differences between the groups on any of the patient-reported or physical secondary outcome measures at 6 or 12 months.There were 18 participants in the intervention group reporting a serious adverse event (5.8%), only one directly related to the intervention, all other adverse events recorded throughout the trial related to underlying chronic medical conditions.ConclusionsThe CORKA intervention was not superior to usual care. The trial detected no significant differences, clinical or statistical, between the two groups on either primary or secondary outcomes. CORKA offers an evaluation of an intervention utilising a different service delivery model for this patient group.Trial registration numberISRCTN13517704.

Randomised controlled trial of a behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: the PEP-TALK trial

“…Stratification on rehabilitation need may, therefore, be warranted. While previous authors have attempted to identify those at most risk of poor outcomes postoperative,51 52 there remains uncertainty over what physiotherapy intervention is more beneficial for these patients. Further consideration on the optimal rehabilitation programme to promote physical activity for those with the most to gain as opposed to assuming all, as adopted in this trial, may be indicated.…”

The challenges and gains of delivering a home-exercise intervention: a qualitative study of physiotherapists and physiotherapy assistants

“…Additional file 1: Supplementary file. SRQR Equator standards for reporting qualitative research [3].…”

“…It aimed to determine whether a home-based multi-component rehabilitation programme provided to patients deemed at risk of a poor outcome following knee arthroplasty using a bespoke screening tool was better than usual out-patient based care. The CORKA trial rehabilitation package was delivered by physiotherapy assistants with supervision from qualified physiotherapists [ 2 , 3 ].…”

“…In this qualitative study we aimed to understand the gains and challenges of delivering a home-based exercise intervention from the perspective of physiotherapists and physiotherapy assistants to assess the feasibility and any barriers to delivering care in the community setting with this workforce model [ 2 , 3 ].…”

Efficacy of Phase II Remote Home Rehabilitation in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

“…erefore, the proposed study on victims with acute myocardial infarction PCI postoperative stage II remote home rehabilitation, compared with old style casualty rehabilitation efficacy [5], hope by the aid of remote ECG detection technology [6], real-time, and incessant intensive caring of the patient's health auxiliary PCI postoperative patients having acute myocardial infarction, the guidance of doctors treatment outside the hospital rehabilitation treatment and health management for a long time to make the rehabilitation management and follow-up of AMI patients precise and standardized [7], so as to improve patient compliance, further improve the continuity of AMI patients' diagnosis and treatment in and out of the hospital, reduce patients' rehospitalization rate and mortality, and improve the worth of life.…”