Is there a role for rehabilitation streaming following total knee arthroplasty?

This study aimed to determine whether total knee arthroplasty recipients exhibiting comparatively poor mobility at entry to rehabilitation and who received supervised therapy, had better rehabilitation outcomes than those who received less supervision. Total knee arthroplasty participants randomized to supervised (n = 159) or home-based therapy (n = 74) took part in the study. 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. Low performers in the unsupervised compared with the supervised group exhibited significantly poorer 6MWT scores (absolute δ = 8.5%, p = 0.003; change δ = 8.1%, p = 0.007) when therapy ceased (10 weeks post-surgery). No differences in 6MWT were seen between the high performing subgroups or in the recovery of WOMAC subscales between any subgroups.

Patients manifesting comparatively poor mobility at the commencement of physiotherapy may recover their mobility, but not perceived function, more rapidly if streamed to supervised therapy.