medwireNews: Clinic-based or inpatient rehabilitation programs are not superior to home-based programs for individuals who undergo total knee replacement (TKR) without complications, suggests a systematic review and meta-analysis.
There were “no clinically important differences” between programs with respect to any of the measured outcomes, including mobility and patient-reported pain and function, say the investigators.
These results indicate that “home-based rehabilitation is an appropriate first line of therapy after uncomplicated [total knee arthroplasty] for patients with adequate social supports,” they add, but point out that the evidence was generally of low or moderate quality.
The analysis included five studies comprising 752 individuals who commenced rehabilitation – either clinic- or home-based (monitored or unmonitored) – within 3 months of undergoing elective, unilateral TKR, and also one study with 165 participants that compared an inpatient with a monitored domiciliary program.
In two studies that evaluated the 6-minute walk distance, the mean difference between the clinic- and home-based rehabilitation groups was 11.89 m at 10–12 weeks and 3.05 m at 26 weeks, favoring the home-based programs at both timepoints; neither difference was statistically significant. The average difference between the programs at 52 weeks was a significant 25.73 m, again in favor of home-based rehabilitation, but this was not considered clinically significant, the study authors remark.
Similarly, there appeared to be little difference between clinic- and home-based programs with regard to patient-reported pain and function in the three studies that reported on this outcome. The mean difference in the Oxford knee score was a nonsignificant 0.15 points in favor of home-based rehabilitation at 10 weeks and a nonsignificant 0.10 points in favor of clinic-based rehabilitation at 52 weeks.
The findings were similar for the single study that evaluated inpatient versus home-based rehabilitation, with comparable mobility and pain and function scores across groups, but the authors urge caution in interpreting this result.
And Mark Buhagiar, from the Catholic Diocese of Parramatta in New South Wales, Australia, and team conclude in JAMA Network Open: “Care that aligns with this evidence would incorporate home-based rehabilitation as the first line of therapy, reserving the more intensely supervised approaches for the most impaired patients or those without adequate social supports.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
JAMA Netw Open 2019; 2: e192810
See also:
- Pros and cons of knee replacement options reviewed
- Longevity of hip, knee replacements in OA patients estimated
- Declining rates of knee arthroscopy in a US population
- Further support for benefits of knee replacement in patients with OA
- Surgical interventions for OA may be cost-effective
- Knee replacement practice in OA patients questioned