Loading...
The rising volume of total knee arthroplasties (TKAs) in the U.S. has led to increased use of bundled payments for postoperative rehabilitation, which has focused attention on alternative settings for rehabilitation programs. In this meta-analysis, researchers analyzed pain and function outcomes reported in five randomized trials, conducted outside of the U.S., that involved 752 patients (mean age, 68). In each study, rehabilitation — either inpatient, clinic-based outpatient, or home-based — started shortly after TKA; home-based programs could be monitored or unmonitored.
Outcomes at 10 and 52 weeks were similar for mobility (e.g., 6-minute walk), range of motion, pain, and quality of life, regardless of rehabilitation setting. Some measures slightly favored home-based rehabilitation.
Buhagiar MA et al. Assessment of outcomes of inpatient or clinic-based vs home-based rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. JAMA Netw Open 2019 Apr 26; 2:e192810. (https://doi.org/10.1001/jamanetworkopen.2019.2810)
Comment
The number and size of studies in this meta-analysis were not large, but the meta-analysis findings indicate no basis for requiring TKA rehabilitation to take place in either inpatient or clinic-based settings. Home-based programs, even loosely structured and unmonitored, appear to work just as well (although patients with no social support at home might require brief inpatient rehabilitation).