Home-based exercise programs may be a promising alternative to clinic-based physical therapy following knee-replacement surgery

Florez-Garcia M, Garcia-Perez F, Curbelo R, et al. Efficacy and safety of home-based exercises versus individualized supervised outpatient physical therapy programs after total knee arthroplasty: A systematic review and meta-analysis Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Jul.

Review question

• Following discharge from hospital after knee-replacement surgery, how does the safety and effectiveness of non-supervised, home-based exercise compare to programs that are delivered in clinic-based settings that are individualized and supervised?

Background

• Knee-replacement surgery is increasingly needed amongst the aging population. Equally as important as the surgical component of the procedure is the rehabilitation and physical therapy that occur following the procedure.
• Given rising healthcare costs, physical-therapy programs are under scrutiny to prove their effectiveness. Some previous research has demonstrated that home exercise programs may be equally as effective as supervised physical-therapy programs, but more cost-effective for both the individual and health system.
• This study aimed to assess whether non-supervised home-based exercise programs are a viable and promising alternative to clinic-based physical-therapy programs delivered by physiotherapists.

How the review was done

• A detailed search of four electronic databases for studies published up to and including April 2015 was conducted. Studies that focused on home exercise programs, unsupervised physical therapy, and rehabilitation from knee-replacement surgery were included.
• A total of 2,301 studies were identified in searches, and 11 were included in the review after assessments for eligibility.
• This review was self-funded by the authors.

What the researchers found

• This review found that home-based exercise was equivalent to clinic-based physical-therapy programs in terms of knee range of motion and functional status, as reported at three, six and 12 months post-surgery.
• The review also found that patients who used home-based exercise instead of a clinic-based recovery program reported increased physical function, though not at a significant level.
• In terms of safety, three studies in the review found that patients who used home-based care had a similar number of readmissions to patients who used outpatient therapy, indicating that the levels of safety for both treatments are comparable.

Conclusion

• This review found that the use of home-based exercise programs is comparable to physical therapy in clinical settings, in terms of knee range of motion, functional status and safety. Some of these findings, however, are imprecise and more evidence is required to support these results.