Effect Of Inpatient Rehab Vs. Home-Based Program For TKA


Title: Inpatient rehabilitation does not improve mobility after total knee arthroplasty versus a monitored home-based program.

Clinical Question: Does initial treatment in an inpatient rehabilitation facility offer greater improvements in mobility when added to a monitored home-based program after undergoing total knee arthroplasty?

Background: Total knee arthroplasty (TKA) is common and postsurgical care varies. No randomized controlled trials have compared inpatient rehabilitation to monitored home-based programs.

Study Design: Multicenter, two intervention groups in parallel, randomized controlled trial with a third observational group.

Setting: Two high-volume arthroplasty hospitals in Sydney, Australia from July 2012 to December 2015.

Synopsis: 165 patients who underwent unilateral TKA were randomized to inpatient rehabilitation followed by a home-based program vs. a home-based program only. A separate observation group (patients who chose home-based program) was included in the analysis of primary outcome. Primary outcome was functional mobility at 26 weeks as measured by walking distance via the 6-minute walk test. All 165 patients were included in an intention-to-treat analysis. The primary outcome was no different among the two randomized groups (adjusted mean difference with imputation, –1.01; 95% CI, –25.56 to 23.55). The per protocol analysis of the primary outcome yielded similar results; nonadherent patients were excluded from the per protocol analysis so the sample size was smaller. There were no between-group differences in the primary outcome when the home-based program was compared to the observation group. Secondary outcomes included patient reported and observer assessed outcomes in function and quality of life. The most significant limitation was that these results are generalizable only to patients considered appropriate for discharge home.

Bottom Line: In total knee arthroplasty patients appropriate for discharge home, inpatient rehabilitation followed by a home-based program did not improve mobility as compared with a monitored home-based program alone.

Citation: Buhagiar MA, Naylor JM, Harris IA, et al. Effect of inpatient rehabilitation vs. a monitored home-based program on mobility in patients with total knee arthroplasty, the HIHO randomized clinical trial. JAMA. 2017;317(10):1037-46. doi: 10.1001/jama.2017.1224.

Dr. Burns is assistant professor in the division of hospital medicine at the University of New Mexico.

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