Osteoarthritis
Conditions
Keywords
home-based physical therapy, outpatient physical therapy, unicompartmental knee arthroplasty, PT (Physical Therapy), osteoarthritis
Brief summary
To determine whether home-based physical therapy (HBPT) is not clinically inferior to formal outpatient physical therapy (OPT) after hospital discharge of patients undergoing a unicompartmental knee arthroplasty (UKA).
Detailed description
Given that current practice trends are requiring treatments to be both clinically and cost effective, research has begun to focus on evaluating the effect of specific interventions. Many surgeon and patients have believed formal OPT is necessary to optimize functional outcomes following orthopaedic procedures. However, the literature has begun to call into question the need for OPT following total hip arthroplasty, total knee arthroplasty, total shoulder arthroplasty, anterior cruciate ligament reconstruction, meniscectomy, and rotator cuff repair. A randomized controlled trial was done to compare face-to-face rehabilitation with in-home telerehabilitation following total knee arthroplasty. Utilizing the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as the primary outcome, the authors demonstrated noninferiority of telerehabilitation compared to face-to-face rehabilitation. Other secondary outcomes of Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and isometric strength did not exhibit a difference between the treatment groups. (see citation below) Based on these findings, it appears that the high cost of formal OPT doesn't translate into a meaningful improvement of functional outcome. Because patient's undergoing UKA have a higher pre-operative functional status than patients having a TKA (Total Knee Arthroplasty), it is reasonable to think that patients following a UKA are better equipped to succeed with HBPT. As a result, the hypothesis of the current study is that HBPT will prove to be non-inferior to formal OPT in the setting of UKA.
Interventions
OTHEROutpatient Physical Therapy
traditional outpatient physical therapy which occurs at a physical therapy office
OTHERHome Base Physical Therapy
Patients will be provided a packet of exercises via a website which allows access to instructional physical therapy videos specifically designated for UKA patients and equipment to perform the home based physical therapy
Sponsors
Rothman Institute Orthopaedics
Rush University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Scheduled for a unicompartmental knee arthroplasty
Exclusion criteria
* Require inpatient physical therapy beyond post-operative day one * \< 18 years old * Decline to participate
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change from baseline in Knee Society Score | at 3 weeks, 3 months, and 1 year after surgery |
| Change from baseline in Western Ontario and McMaster Universities Osteoarthritis Index | at 3 weeks, 3 months, and 1 year after surgery |
| Change from baseline in Knee range of motion | at 3 weeks, 3 months, and 1 year after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complications | Will be assessed at 3 weeks, 3 months, and 1 year after surgery | Deep Vein Thrombosis or Pulmonary Embolus Return to the OR within 30 days Re-admission within 30 days Superficial infection Deep infection Periprosthetic fracture Knee stiffness (defined as \< 90 degrees flexion at 3 weeks post-operative or \< 110 degrees flexion at 6 weeks post-operative) |
| Cost comparison | Will be assessed at 3 weeks, 3 months, and 1 year after surgery | — |
Countries
United States
Outcome results
None listed