Variation in rehabilitation setting after uncomplicated total knee or hip arthroplasty: a call for evidence-based guidelines

Naylor, Justine M.; Hart, A.; Harris, Ian; Lewin, Adriane M.

doi:10.1186/s12891-019-2570-8

Cited by 43 publications

(51 citation statements)

References 60 publications

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“…Physiotherapy is generally thought to be important in achieving optimal results after knee arthroplasty, yet the content of rehabilitation varies worldwide. 7 Some countries such as the US and Australia use prolonged postoperative inpatient rehabilitation, although the effectiveness of this in improving outcomes (compared with outpatient based physiotherapy) has been questioned. 8 In the UK, inpatient rehabilitation is of short duration, with patients typically discharged 3-5 days after arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial

investigators

2020

BMJ

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Objective To evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor outcome after total knee arthroplasty. Design Parallel group randomised controlled trial. Setting 13 secondary and tertiary care centres in the UK providing postoperative physiotherapy. Participants 334 participants with knee osteoarthritis who were defined as at risk of a poor outcome after total knee arthroplasty, based on the Oxford knee score, at six weeks postoperatively. 163 were allocated to therapist led outpatient rehabilitation and 171 to a home exercise based protocol. Interventions All participants were reviewed by a physiotherapist and commenced 18 sessions of rehabilitation over six weeks, either as therapist led outpatient rehabilitation (progressive goal oriented functional rehabilitation protocol, modified weekly in one-one contact sessions) or as physiotherapy review followed by a home exercise based regimen (without progressive input from a physiotherapist). Main outcome measures Primary outcome was Oxford knee score at 52 weeks, with a 4 point difference between groups considered to be clinically meaningful. Secondary outcomes included additional patient reported outcome measures of pain and function at 14, 26, and 52 weeks post-surgery. Results 334 patients were randomised. Eight were lost to follow-up. Intervention compliance was more than 85%. The between group difference in Oxford knee score at 52 weeks was 1.91 (95% confidence interval −0.18 to 3.99) points, favouring the outpatient rehabilitation arm (P=0.07). When all time point data were analysed, the between group difference in Oxford knee score was a non-clinically meaningful 2.25 points (0.61 to 3.90, P=0.01). No between group differences were found for secondary outcomes of average pain (0.25 points, −0.78 to 0.28, P=0.36) or worst pain (0.22 points, −0.71 to 0.41, P=0.50) at 52 weeks or earlier time points, or of satisfaction with outcome (odds ratio 1.07, 95% confidence interval 0.71 to 1.62, P=0.75) or post-intervention function (4.64 seconds, 95% confidence interval −14.25 to 4.96, P=0.34). Conclusions Outpatient therapist led rehabilitation was not superior to a single physiotherapist review and home exercise based regimen in patients at risk of poor outcomes after total knee arthroplasty. No clinically relevant differences were observed across primary or secondary outcome measures. Trials registration Current Controlled Trials ISRCTN23357609 and ClinicalTrials.gov NCT01849445 .

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Section: Introductionmentioning

confidence: 99%

Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial

investigators

2020

BMJ

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“…Use of inpatient rehabilitation following elective total knee and total hip replacements is more common among patients with private health insurance in Australia (56% and 33% vs 8% and 4% uninsured respectively). 1 However, for uncomplicated cases, inpatient rehabilitation is not associated with improved patient outcomes compared with home-based rehabilitation [2][3][4] and is more costly. 5 Cabrini Health, a large Victorian not-for-profit private healthcare service, conducts a high volume of elective orthopaedic surgery and offers home-based and inpatient rehabilitation.…”

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confidence: 99%

Utilisation of inpatient rehabilitation following elective total knee or hip replacements in private hospital setting declined during the COVID‐19 pandemic

Wallis

Young

Zayontz

et al. 2021

Internal Medicine Journal

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“…It is likely that other surgical, psychological and sociological variables could be predictive of discharge destination, however, if this information is not available at the time of retrospective data collection then it will not be included in analysis. In terms of sociological factors, insurance status has been shown to be predictive of IRF discharge [34], however, due to the international variability of insurance models this was excluded from analysis.…”

Section: Discussionmentioning

confidence: 99%

Intrinsic patient factors predictive of inpatient rehabilitation facility discharge following primary total knee arthroplasty: a systematic review and meta-analysis

Sattler

Hing

Rathbone

et al. 2020

BMC Musculoskelet Disord

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Background: Total Knee Arthroplasty (TKA) reduces pain and improves function in those suffering from severe osteoarthritis. A significant cost of TKA is post-acute care, however, current evidence suggests that discharge to an Inpatient Rehabilitation Facility (IRF) has inferior outcomes to home discharge, with no greater benefit in physical function. Only individual studies have investigated TKA patient characteristics predictive of discharge destination, therefore, the aim is to systematically review the literature and meta-analyse intrinsic patient factors predictive of IRF discharge. If predictive factors are known, then early discharge planning and intervention strategies could be implemented. Methods: Databases PubMed, CINAHL, Embase, Cochrane, and Pedro were searched up to October 2019 for all studies investigating pre-operative intrinsic patient factors predictive of IRF discharge. For assessing the methodological quality of included studies, the Quality In Prognosis Studies (QUIPS) tool was used. Statistical analysis and graphical reporting were conducted in R statistical software. To assess the effect of predictors of discharge destination, odds ratios with the corresponding 95%CI were extracted from the results of univariate and multivariable analyses. Results: A total of 9 articles published between 2011 to 2018 with 218,151 TKA patients were included. Of the 13 intrinsic patient factors reported, 6 met the criteria for synthesised review: age, obesity, comorbidity, gender, SF-12/VR-12 survey, and smoking. Due to the heterogeneity of statistical analysis and reporting 2 variables could undergo meta-analysis, gender and smoking. Female gender increased the likelihood of IRF discharge by 78% (OR = 1.78; 95%CI = 1.43-2.20; I2 = 33.3%), however, the relationship between smoking status and discharge destination was less certain (OR = 0.80; 95%CI = 0.42-1.50; I2 = 68.5%).

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Variation in rehabilitation setting after uncomplicated total knee or hip arthroplasty: a call for evidence-based guidelines

Cited by 43 publications

References 60 publications

Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial

Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial

Utilisation of inpatient rehabilitation following elective total knee or hip replacements in private hospital setting declined during the COVID‐19 pandemic

Intrinsic patient factors predictive of inpatient rehabilitation facility discharge following primary total knee arthroplasty: a systematic review and meta-analysis

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