Abstract
BackgroundPrimary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement.Methods/designTwo hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises.The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective.DiscussionThis research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency.Trial registrationISRCTN32087234, registered on 11 February 2015.
Highlights
Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability
The feasibility work highlighted the importance of complementing the collection of outcome measures by postal questionnaire with telephone calls to maximise completion rates
Another limitation of the trial which warrants acknowledgement is the lack of blinding, because of the group-based nature of the physiotherapy intervention
Summary
Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. The operation is effective for many patients, a considerable proportion of patients experience long-term pain and functional limitations after surgery [3, 4]. An estimated 20 % of patients report long-term pain after TKR [3] and 52 % of patients report functional limitations, compared to 22 % of age- and gender-matched people without TKR and no previous history of knee disorders [4]. Evidence suggests that many patients do not return to more demanding activities after TKR, such as gardening [4, 5], kneeling [6], sports [7] and valued leisure activities [8]
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