No preference for outpatient rehabilitation program after total knee arthroplasty

Référence

Hsieh CJ, DeJong G, Vita M, Zeymo A, Desale S. Effect of outpatient rehabilitation on functional mobility after single total knee arthroplasty. A randomized clinical trial. JAMA Network Open 2020;3(9):e2016571

Sommaire

Rehabilitation improves post-TKA outcomes, but the optimal physical therapy protocol remains uncertain. These investigators identified adults who weighed less than 300 pounds (135 kg), 40 years or older, who underwent an elective unilateral TKA and initiated outpatient PT within 24 days of surgery. Eligible patients (N = 386) randomly received assignment (concealed allocation) to 8 to 12 weeks (2 to 3 sessions per week) of PT including (1) a body-weight adjustable treadmill to offload partial body weight when walking; (2) a PENS device to relieve muscle spasms, increase range of motion, and re-educate muscles; (3) both the body weight-adjustable treadmill and PENS; or (4) only a standard recumbent bike. Patients self-assessed outcomes using a standardized post-acute care activity and mobility scoring tool and a 6-minute walk test. Complete follow-up occurred for 94% of participants at approximately 2 months. Using modified intention-to-treat analysis with the last observation carried forward, no significant group differences occurred in improved activity and mobility scores or 6-minute walk test results. The study was 80% powered to detect a pre-determined clinically significant change from baseline to treatment discharge scores between the various intervention groups.