Benefits of direct patient discharge to outpatient physical therapy after total knee arthroplasty.
Jesse C Christensen, Roger J Paxton, Carol Baym and 4 others
PMID 30616406WHAT IT FOUND
One month after knee replacement, patients who went straight to outpatient physical therapy had smaller losses in stair climbing, walking and strength than those who started with home visits.
Direct outpatient care may mean faster recovery, but the study was not randomised.
Key findings
01At 1 month, the primary outcome showed a 10.3-second greater decline in stair climb time for the home health group than the direct outpatient group.
02The home health group had an estimated 2.0-second greater decline on timed up-and-go, a 53.8-meter greater decline on the six-minute walk, and more loss of quadriceps (21.7%) and hamstring (44.7%) strength than the direct outpatient group.
03The home health group reported a 0.53-point greater increase in residual knee pain on the 11-point scale, while quadriceps activation did not differ between groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study looked back at records and did not randomise patients to home health or direct outpatient therapy, so the groups may have differed in ways that affect recovery. The home health group started with more pain and slower stair climbing, even though age, sex and body mass index were similar. Motivation, comorbidities and social support were not measured, and any of these could help explain the outcome differences. Rehabilitation intensity was not directly measured, so the study cannot show that higher intensity caused the better outcomes. The data came from three earlier studies collected over eight years, so treatment details may not have been perfectly uniform.
Declared interests
The authors declared no conflicts of interest. The publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that direct outpatient physical therapy caused faster recovery. The study was retrospective, not randomised, and the home health group started with more pain and slower stair climbing. Rehabilitation intensity, motivation, comorbidities and social support were not measured, so those factors may explain the differences.