CHICAGO – Patients who undergo total knee replacement surgery recover just as well with postoperative, group-based, outpatient physiotherapy or a monitored, home-based physiotherapy program as with a one-on-one, outpatient center–based program, according to findings from a randomized study involving 249 patients.
With the exception of patient satisfaction with physiotherapy – which was significantly greater for the 85 patients who were randomized to one-on-one therapy and the 84 who were randomized to group-based therapy than it was for the 80 patients who received home-based therapy (mean satisfaction rates, 90%, 84%, and 73%, respectively) – no significant differences were seen in any other outcome measures during the first postsurgical year, Victoria W.M. Ko of the University of New South Wales, Sydney, and her colleagues reported in a poster at the annual meeting of the American College of Rheumatology.
For example, WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index function scores at postoperative week 10 (the primary outcome measure) were similar at a mean of 44.0, 39.32, and 35.0 in the one-on-one patients, the group-based therapy patients, and the home-based therapy patients, respectively. There also were no differences among groups in recovery of mobility as measured by a 6-minute walk distance and a timed stair test, or in HRQOL (Health-Related Quality of Life) score, knee range of motion, or patient-related overall recovery at 52 weeks, the investigators found.
Furthermore, the home-based program patients were no more likely than those in the other groups to be readmitted to the hospital or to experience any other complications.
Patient in the single-blind study were consecutive adults (mean age, 67 years) who were awaiting total knee replacement, were enrolled 2 weeks prior to surgery, and were randomized 2 weeks after surgery. During the 6-week therapy period, those who were randomized to receive one-on-one therapy or group-based therapy received 12 physiotherapy sessions, and those in the home-based program were prescribed home exercises supplemented with two sessions of one-on-one therapy and a telephone follow-up. All patients were assessed preoperatively and at postoperative weeks 2, 10, 26, and 52.
The findings are important because of the increasing volume of total knee replacement surgeries performed annually, and because home-based therapy provides a safe and more resource-efficient alternative to center-based physiotherapy, the investigators concluded. They added that this approach "will also circumvent access issues frequently associated with center-based care."
The authors reported that they had no disclosures relevant to this study.