Home-based Tele-rehabilitation Versus Hospital-based Outpatient Rehabilitation for Pain and Function After Initial Total Knee Arthroplasty: A Systematic Review and Meta-analysis

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2023 Dec 22

PMID 38134064

Authors

Hui Zhang

Junqing Wang

Zekun Jiang

Tao Deng

Kang Li

Yong Nie

Affiliations

Soon will be listed here.

Abstract

Background: This systematic review and meta-analysis aims to compare the effectiveness of home-based tele-rehabilitation programs with hospital-based rehabilitation programs in improving pain and function at various time points (≤6 weeks, ≤14 weeks, and ≤ 52 weeks) following the initial total knee arthroplasty.

Methods: This study used PRISMA and AMSTAR reporting guidelines. We systematically searched 5 databases (PubMed, Embase, Web of Science, Cochrane Library, and Medline) to identify randomized controlled trials published from January 1, 2019, to January 1, 2023. The primary outcomes were pain, knee injury and osteoarthritis outcome score, and mobility (knee range of motion).

Results: We included 9 studies involving 1944 patients. Low-quality evidence showed hospital-based rehabilitation was better than home-based tele-rehabilitation in knee injury and osteoarthritis outcome score (mean difference [MD], -2.62; 95% confidence interval [CI], -4.65 to -0.58; P = .01) at ≤ 14 weeks after total knee arthroplasty. Based on low-quality evidence, home-based tele-rehabilitation was better than hospital-based rehabilitation in knee range of motion (MD, 2.00; 95% CI, 0.60 to 3.40; P = .005). There was no significant difference between hospital-based rehabilitation and home-based tele-rehabilitation in knee pain at ≤ 6 weeks (MD, 0.18; 95% CI, -0.07 to 0.42; P = .16), 14 weeks (MD, 0.12; 95% CI, -0.26 to 0.49; P = .54), and ≤ 52 weeks (MD, 0.16; 95% CI, -0.11 to 0.43; P = .24).

Conclusion: Home-based tele-rehabilitation and hospital-based rehabilitation programs showed comparable long-term outcomes in pain, mobility, physical function, and patient-reported health status after primary total knee arthroplasty. Considering the economic costs, home-based tele-rehabilitation programs are recommended as a viable alternative to hospital-based rehabilitation programs.

Citing Articles

Quality indicators for the rehabilitation before and after total knee arthroplasty in Japan: a modified Delphi method and practice test.

Hiyama Y, Taniguchi M, Ohtera S, Wada O, Tanaka S, Kako M Arthroplasty. 2025; 7(1):11.

PMID: 40045402 PMC: 11884041. DOI: 10.1186/s42836-024-00297-5.

Efficacy of telerehabilitation for total knee arthroplasty: a meta-analysis based on randomized controlled trials combined with a bibliometric study.

Liu X, Yang G, Xie W, Lu W, Liu G, Xiao W J Orthop Surg Res. 2024; 19(1):874.

PMID: 39726029 PMC: 11670389. DOI: 10.1186/s13018-024-05381-9.

References

Barker K, Room J, Knight R, Dutton S, Toye F, Leal J . Home-based rehabilitation programme compared with traditional physiotherapy for patients at risk of poor outcome after knee arthroplasty: the CORKA randomised controlled trial. BMJ Open. 2021; 11(8):e052598. PMC: 8404435. DOI: 10.1136/bmjopen-2021-052598. View

Hyodo K, Masuda T, Aizawa J, Jinno T, Morita S . Hip, knee, and ankle kinematics during activities of daily living: a cross-sectional study. Braz J Phys Ther. 2017; 21(3):159-166. PMC: 5537477. DOI: 10.1016/j.bjpt.2017.03.012. View

Hunter D, Bierma-Zeinstra S . Osteoarthritis. Lancet. 2019; 393(10182):1745-1759. DOI: 10.1016/S0140-6736(19)30417-9. View

Pamilo K, Torkki P, Peltola M, Pesola M, Remes V, Paloneva J . Fast-tracking for total knee replacement reduces use of institutional care without compromising quality. Acta Orthop. 2017; 89(2):184-189. PMC: 5901516. DOI: 10.1080/17453674.2017.1399643. View

Li D, Yang Z, Kang P, Xie X . Home-Based Compared with Hospital-Based Rehabilitation Program for Patients Undergoing Total Knee Arthroplasty for Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Phys Med Rehabil. 2016; 96(6):440-447. DOI: 10.1097/PHM.0000000000000621. View

Hamilton D, Beard D, Barker K, Macfarlane G, Tuck C, Stoddart A . Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial. BMJ. 2020; 371:m3576. PMC: 7551789. DOI: 10.1136/bmj.m3576. View

Tripuraneni K, Foran J, Munson N, Racca N, Carothers J . A Smartwatch Paired With A Mobile Application Provides Postoperative Self-Directed Rehabilitation Without Compromising Total Knee Arthroplasty Outcomes: A Randomized Controlled Trial. J Arthroplasty. 2021; 36(12):3888-3893. DOI: 10.1016/j.arth.2021.08.007. View

Price A, Alvand A, Troelsen A, Katz J, Hooper G, Gray A . Knee replacement. Lancet. 2018; 392(10158):1672-1682. DOI: 10.1016/S0140-6736(18)32344-4. View

Buhagiar M, Naylor J, Harris I, Xuan W, Adie S, Lewin A . 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; 2(4):e192810. PMC: 6487570. DOI: 10.1001/jamanetworkopen.2019.2810. View

10.

Rowe P, Myles C, Walker C, Nutton R . Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?. Gait Posture. 2000; 12(2):143-55. DOI: 10.1016/s0966-6362(00)00060-6. View

11.

Swank A, Kachelman J, Bibeau W, Quesada P, Nyland J, Malkani A . Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. J Strength Cond Res. 2011; 25(2):318-25. DOI: 10.1519/JSC.0b013e318202e431. View

12.

Bell K, Onyeukwu C, Smith C, Oh A, DeVito Dabbs A, Piva S . A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study. Sensors (Basel). 2020; 20(21). PMC: 7663639. DOI: 10.3390/s20216118. View

13.

Noble P, Gordon M, Weiss J, Reddix R, Conditt M, Mathis K . Does total knee replacement restore normal knee function?. Clin Orthop Relat Res. 2005; (431):157-65. DOI: 10.1097/01.blo.0000150130.03519.fb. View

14.

Xiao C, Li J, Kang Y, Zhuang Y . Follow-up of a Wuqinxi exercise at home programme to reduce pain and improve function for knee osteoarthritis in older people: a randomised controlled trial. Age Ageing. 2020; 50(2):570-575. DOI: 10.1093/ageing/afaa179. View

15.

Crawford D, Duwelius P, Sneller M, Morris M, Hurst J, Berend K . 2021 Mark Coventry Award: Use of a smartphone-based care platform after primary partial and total knee arthroplasty: a prospective randomized controlled trial. Bone Joint J. 2021; 103-B(6 Supple A):3-12. DOI: 10.1302/0301-620X.103B6.BJJ-2020-2352.R1. View

16.

Xu T, Yang D, Liu K, Gao Q, Lu H, Qiao Y . Efficacy and safety of a self-developed home-based enhanced knee flexion exercise program compared with standard supervised physiotherapy to improve mobility and quality of life after total knee arthroplasty: a randomized control study. J Orthop Surg Res. 2021; 16(1):382. PMC: 8202539. DOI: 10.1186/s13018-021-02516-0. View

17.

Bettger J, Green C, Holmes D, Chokshi A, Mather 3rd R, Hoch B . Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty: VERITAS, a Randomized Controlled Trial. J Bone Joint Surg Am. 2019; 102(2):101-109. DOI: 10.2106/JBJS.19.00695. View

18.

Piva S, Schneider M, Moore C, Catelani M, Gil A, Klatt B . Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement: A Randomized Clinical Trial. JAMA Netw Open. 2019; 2(2):e190018. PMC: 6484600. DOI: 10.1001/jamanetworkopen.2019.0018. View

19.

Sharma L . Osteoarthritis of the Knee. N Engl J Med. 2021; 384(1):51-59. DOI: 10.1056/NEJMcp1903768. View

20.

Bennell K, Schwartz S, Teo P, Hawkins S, Mackenzie D, McManus F . Effectiveness of an Unsupervised Online Yoga Program on Pain and Function in People With Knee Osteoarthritis : A Randomized Clinical Trial. Ann Intern Med. 2022; 175(10):1345-1355. DOI: 10.7326/M22-1761. View