Rehabilitación domiciliaria postartroplastia total de rodilla: estudio coste-efectividad

Abstract

IntroductionHome rehabilitation allows an earlier return to home in patients undergoing total knee arthroplasty. Material and methodsWe performed a simple observational study with consecutive enrolment of patients from November 2005 to May 2008. Study populationAdult patients referred to the home-based rehabilitation service of Hospital Clinic in Barcelona after total knee arthroplasty for gonarthrosis. InterventionWe conducted a multidisciplinary home-based rehabilitation program with assessments before treatment, at discharge from rehabilitation and at 6 months follow-up. The outcomes measured were the Western Ontario and McMaster Universities Index (WOMAC), the Barthel Index (BI), and range of motion (ROM) scores. Costs were compared using parameters of the Catalan Health Service. Wilcoxon's non-parametric test was used to analyze WOMAC outcomes. Quantitative data were analyzed using Student's t test. ResultsA total of 530 patients were recruited. Of these, 78% achieved a degree of independence, with a BI score of 100. The ROM for knee flexion was greater than 100° in 96.4% and the average rating of all the patients in the questionnaire WOMAC was 13.48 (CI: 12.27-14.68). The average length of hospital stay was reduced to 5.1 days, and the cost of home rehabilitation was half that in the outpatient setting. ConclusionThe home rehabilitation model reduces length of hospital stay and cost and has optimal functional results.