IS THERE A ROLE FOR REHABILITATION STREAMING FOLLOWING TOTAL KNEE ARTHROPLASTY? PRELIMINARY INSIGHTS FROM A RANDOMIZED CONTROLLED TRIAL

Objective: To determine whether total knee arthroplasty recipients demonstrating comparatively poor mobility at entry to rehabilitation and who received supervised therapy, had better rehabilitation outcomes than those who received less supervision. Design: Retrospective analysis of randomized trial data. Patients: Total knee arthroplasty participants randomized to supervised (n=159) or home-based therapy (n=74). Methods: Participants were dichotomized based on mean target 6-min walk test (6MWT) pre-therapy (second post-surgical week). Absolute and change in 6MWT and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function subscales amongst low performers in the supervised (n=89) and unsupervised (n=36) groups were compared, as were high performers in the supervised (n=70) and unsupervised (n =38) groups. Results: Low performers in the unsupervised compared with the supervised group demonstrated significantly poorer 6MWT scores (absolute 8 =8.5%,p=0.003; change =8.1%, p= 0.007) when therapy ceased (10 weeks post-surgery). No differences in 6MWT were observed between the high performing subgroups or in the recovery of WOMAC subscales between any subgroups. Conclusion: Individuals manifesting comparatively poor mobility at the commencement of physiotherapy may recover their mobility, but not perceived function, more quickly if streamed to supervised therapy.