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Is there a role for rehabilitation streaming following total knee arthroplasty? Preliminary insights from a randomized controlled trial
Naylor JM, Crosbie J, Ko V
Journal of Rehabilitation Medicine 2015 Mar;47(3):235-241
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 delta 8.5%, p = 0.003; change delta 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.

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