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• W2941758884 abstract "<h3>Importance</h3> Recent publication of the largest trials to date investigating rehabilitation after total knee arthroplasty (TKA) necessitate an updated evidence review. <h3>Objective</h3> To determine whether inpatient or clinic-based rehabilitation is associated with superior function and pain outcomes after TKA compared with any home-based program. <h3>Data Sources</h3> MEDLINE, Embase, CINAHL, and PubMed were searched from inception to November 5, 2018. Search terms included<i>knee arthroplasty</i>,<i>randomized controlled trial</i>,<i>physiotherapy</i>, and<i>rehabilitation</i>. <h3>Study Selection</h3> Published randomized clinical trials of adults who underwent primary unilateral TKA and commenced rehabilitation within 6 postoperative weeks in which those receiving postacute inpatient or clinic-based rehabilitation were compared with those receiving a home-based program. <h3>Data Extraction and Synthesis</h3> Two reviewers extracted data independently and assessed data quality and validity according to the PRISMA guidelines. Data were pooled using a random-effects model. Data were analyzed from June 1, 2015, through June 4, 2018. <h3>Main Outcomes and Measures</h3> Primary outcomes were mobility (6-minute walk test [6MWT]) and patient-reported pain and function (Oxford knee score [OKS] or Western Ontario and McMaster Universities Osteoarthritis Index) reported at 10 to 12 postoperative weeks. The GRADE assessment (Grading of Recommendations, Assessment, Development, and Evaluation) was applied to the primary outcomes. <h3>Results</h3> Five unique studies involving 752 unique participants (451 [60%] female; mean [SD] age, 68.3 [8.5] years) compared clinic- and home-based rehabilitation, and 1 study involving 165 participants (112 [68%] female; mean [SD] age, 66.9 [8.0] years) compared inpatient and home-based rehabilitation. Low-quality evidence showed no clinically important difference between clinic- and home-based programs for mobility at 10 weeks (6MWT favoring home program; mean difference [MD], −11.89 m [95% CI, −35.94 to 12.16 m]) and 52 weeks (6MWT favoring home program; MD, −25.37 m [95% CI, −47.41 to −3.32 m]). Moderate-quality evidence showed no clinically important difference between clinic- and home-based programs for patient-reported pain and function at 10 weeks (OKS MD, −0.15 [95% CI, −0.35 to 0.05]) and 52 weeks (OKS MD, 0.10 [95% CI, −0.14 to 0.34]). <h3>Conclusions and Relevance</h3> Based on low- to moderate-quality evidence, no superiority of clinic-based or inpatient programs compared with home-based programs was found in the early subacute period after TKA. This evidence suggests that home-based rehabilitation is an appropriate first line of therapy after uncomplicated TKA for patients with adequate social supports." @default.
• W2941758884 created "2019-05-03" @default.
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• W2941758884 date "2019-04-26" @default.
• W2941758884 modified "2023-10-04" @default.
• W2941758884 title "Assessment of Outcomes of Inpatient or Clinic-Based vs Home-Based Rehabilitation After Total Knee Arthroplasty" @default.
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• W2941758884 doi "https://doi.org/10.1001/jamanetworkopen.2019.2810" @default.
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