Efficacy and safety of a self-developed home-based enhanced knee flexion exercise program compared with standard supervised physiotherapy to improve mobility and quality of life after total knee arthroplasty: a randomized control study

Tianyang Xu,Chunyan Zhu,Yue Qiao,Qiuming Gao,Guodong Li,Kaiyuan Liu,Hengli Lu,Dong Yang

doi:10.1186/s13018-021-02516-0

Abstract

BackgroundThis randomized controlled study compared standard supervised physiotherapy (SPT) with a self-developed, home-based, enhanced knee flexion exercise program involving a low stool (KFEH) in patients who underwent total knee arthroplasty (TKA).MethodsPatients were recruited from July 2014 to December 2015 and randomly assigned to one of two groups: KFEH (n = 60) and SPT (n = 59). Outcomes (joint function) were evaluated according to the Knee Society Score (KSS), visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and range of motion (ROM) assessment at selected time points (preoperatively; 1 week; 1, 3, and 6 months; and 1 year after surgery).ResultsPain and functional improvement were observed in both groups. Non-inferiority of KFEH was evident 12 months postoperatively; however, patients in the KFEH group exhibited better ROM at 1 month (P < 0.01). Absolute WOMAC and KSS scores were slightly better in the KFEH group, although the difference was not statistically significant. There was no difference in VAS scores and complication rates between the two groups. Additionally, the home program would save patient time and decrease the economic burden associated with in-hospital SPT.ConclusionConsidering rehabilitation and economic efficiency as well as the COVID pandemic, a home-based enhanced knee flexion exercise program for TKA rehabilitation is recommended.

Highlights

This randomized controlled study compared standard supervised physiotherapy (SPT) with a selfdeveloped, home-based, enhanced knee flexion exercise program involving a low stool (KFEH) in patients who underwent total knee arthroplasty (TKA)
One patient in the KFEH group was withdrawn from the study because she sustained a fracture due to a fall 3 months postoperatively
Three patients in the KFEH group and two in the SPT group were withdrawn from analysis to treat other systemic diseases postoperatively, which required inpatient nursing

Summary

Introduction

This randomized controlled study compared standard supervised physiotherapy (SPT) with a selfdeveloped, home-based, enhanced knee flexion exercise program involving a low stool (KFEH) in patients who underwent total knee arthroplasty (TKA). Physical therapistsupervised programs are a commonly used standard for functional rehabilitation for patients who undergo TKA Such programs are supervised by a physical therapist during the hospital stay and in an outpatient facility for approximately 10–20 weeks postoperatively [3]. Such a standard program requires professional and licensed therapists and the appropriate equipment and should be performed in the hospital or an accredited outpatient facility. As such, these posthospitalization programs require more outpatient facility visits (2–3 times/week) and related costs [4]. Time and economic burdens have, limited the use of these programs

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Discussion

Conclusion