Event Title
Routine formal physical therapy vs. unsupervised home exercise after primary total knee arthroplasty
Location
Philadelphia, PA
Start Date
11-5-2022 1:00 PM
End Date
11-5-2022 4:00 PM
Description
Introduction: Postoperative rehabilitation and therapy has long been considered an essential component to a successful total knee arthroplasty (TKA) procedure. However, recent evidence has challenged the necessity of formal supervised therapy after discharge. In this review and meta-analysis, we aimed to compare objective and self-reported measures following primary TKA between patients who received supervised therapy and patients who were given unsupervised exercise regimens following discharge.
Methods: A systematic literature search was conducted of six databases to identify randomized controlled trials comparing supervised and unsupervised exercise regimens following discharge after primary TKA. The change from baseline was extracted for objective measures including knee flexion ROM, lower extremity strength, aerobic capacity, and self-reported measures including physical function outcomes and quality of life and was compared between the two groups using meta-analysis when possible. Outcomes were divided into short-term (<6 months from surgery) and long-term (≥6 months from surgery).
Results: Eleven studies involving 1,884 cases were included in this study. No significant differences between the two groups were observed with regards to change in baseline for short-term knee flexion ROM (p = 0.68), lower-extremity strength (p = 0.63), or patient-reported quality of life (p = 0.45), as well as long-term knee flexion ROM (p = 0.65), patient-reported quality of life (p = 0.24) or patient-reported physical outcome scores (p = 0.29). A small difference in short-term patient reported physical outcomes was observed in favor of the supervised cohort (SMD 0.29 [0.01, 0.56]; I2 = 82%; p = 0.04).
Conclusion: Supervised therapy provides no clinically significant improvement over unsupervised regimens in the post-discharge period after primary TKA for most patients. Further study is warranted to determine which subset of patients may benefit from supervised care.
Routine formal physical therapy vs. unsupervised home exercise after primary total knee arthroplasty
Philadelphia, PA
Introduction: Postoperative rehabilitation and therapy has long been considered an essential component to a successful total knee arthroplasty (TKA) procedure. However, recent evidence has challenged the necessity of formal supervised therapy after discharge. In this review and meta-analysis, we aimed to compare objective and self-reported measures following primary TKA between patients who received supervised therapy and patients who were given unsupervised exercise regimens following discharge.
Methods: A systematic literature search was conducted of six databases to identify randomized controlled trials comparing supervised and unsupervised exercise regimens following discharge after primary TKA. The change from baseline was extracted for objective measures including knee flexion ROM, lower extremity strength, aerobic capacity, and self-reported measures including physical function outcomes and quality of life and was compared between the two groups using meta-analysis when possible. Outcomes were divided into short-term (<6 months from>surgery) and long-term (≥6 months from surgery).
Results: Eleven studies involving 1,884 cases were included in this study. No significant differences between the two groups were observed with regards to change in baseline for short-term knee flexion ROM (p = 0.68), lower-extremity strength (p = 0.63), or patient-reported quality of life (p = 0.45), as well as long-term knee flexion ROM (p = 0.65), patient-reported quality of life (p = 0.24) or patient-reported physical outcome scores (p = 0.29). A small difference in short-term patient reported physical outcomes was observed in favor of the supervised cohort (SMD 0.29 [0.01, 0.56]; I2 = 82%; p = 0.04).
Conclusion: Supervised therapy provides no clinically significant improvement over unsupervised regimens in the post-discharge period after primary TKA for most patients. Further study is warranted to determine which subset of patients may benefit from supervised care.