Rehabilitation at home can be just as good as hospital-based rehabilitation for patients after knee surgery

Donghai Li, Zhouyuan Yang, Pengde Kang, Xiaowei Xie. Home-based compared with hospital-based rehabilitation program for patients undergoing total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials American journal of physical and medical rehabilitation. 2016 Aug.

Review question

• How does home-based rehabilitation compare to hospital-based rehabilitation in terms of quality of life and physical performance after hospital discharge following knee replacement surgery for osteoarthritis?

Background

• Many elderly individuals undergo knee replacement surgery to treat pain and joint dysfunction resulting from osteoarthritis. However, upon discharge there are numerous rehabilitation programs with little evidence supporting their effectiveness.
• Currently, patients are discharged to home after knee replacement surgery and receive outpatient rehabilitation routinely at the hospital. However, one idea catching interest is home-based rehabilitation which allows patients to receive physiotherapy and rehabilitation in their homes.
• This study aimed to compare home-based with hospital-based rehabilitation after knee replacement surgery for osteoarthritis patients, in terms of quality of life and physical performance improvements.

How the review was done

• A detailed search of four electronic databases was conducted for studies published from 1974 to February 2016. Studies that compared the effects and costs of home-based rehabilitation to hospital-based rehabilitation after knee replacement surgery for osteoarthritis patients were included.
• A total of 168 studies were identified in searches, and seven were included in the review after assessments for eligibility.
• This review was funded with support from the National Natural Science Fund of China.

What the researchers found

• This review found that home-based rehabilitation is similar to hospital-based rehabilitation in terms of physical performance at 12 and 52 weeks post-surgery.
• The review also found that the hospital-based group had less pain than the home-based group. However, range of motion of knee flexion in the home-based group was better than the hospital-based group.          
• This review found that the costs of the two rehabilitation programs were similar. 

Conclusion

• This review found that the use of home-based rehabilitation is comparable to hospital-based rehabilitation, in terms of quality of life and physical performance of patients such as knee range of motion. The study concludes that rehabilitation at home can be recommended as an alternative. However, these results should be used with caution as further research with more participants is required.