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Evidence summaries

Multidisciplinary Rehabilitation after Joint Replacement at the Hip and Knee

Early multidisciplinary rehabilitation after hip or knee joint replacement may improve outcomes at the level of activity and participation. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 5 studies with a total of 619 subjects. All trials were of low quality with differences in study design and outcomes used. For inpatient settings (n=261, 2 trials) early commencement of rehabilitation and clinical pathways led to more rapid attainment of functional milestones (Functional Independence Measure (FIM) transfer WMD 0.5, 95% CI 0.15 to 0.85, number needed to treat to benefit [NNTB] = 6, FIM ambulation WMD 1.55, 95%CI 0.96 to 2.14, NNTB = 3), shorter hospital stay, fewer post-operative complications and reduced costs in the first three to four months. Home-based multidisciplinary care (n=358, 3 trials) improved functional gain (Oxford Hip Score [OHS] WMD at 6 months -7.00, 95%CI -10.36 to -3.64, NNT = 2) and quality of life and reduced hospital stay in the medium term (six months). No trials addressed longer-term outcomes following hip replacement only.

Comment: The quality of evidence is downgraded by limitations in study quality (lack of blinding) and by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Khan F, Ng L, Gonzalez S, Hale T, Turner-Stokes L. Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev 2008 Apr 16;(2):CD004957. [PubMed]

Primary/Secondary Keywords