Home-Based vs. Conventional Rehabilitation Following Total Knee Arthroplasty
Bibliographic record
Abstract
Objective: The aim of this meta-analysis was to investigate whether home-based physical therapy (HPT) is as safe and effective as the conventional inpatient/outpatient physical therapy (CPT) after total knee arthroplasty (TKA). Methods: Three databases (PubMed, Web of Science, and Cochrane) were systematically searched on 8 January 2024. Randomized controlled trials (RCTs) comparing HPT with CPT following TKA were included. The outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), 6 min walking test, range of motion (ROM), 36-Item Short Form Survey (SF-36), and visual analogue scale (VAS) for pain, and were analyzed at short-term (≤12 weeks) and mid/long-term follow-ups (>12 weeks). Results: Twenty RCTs (3706 patients) were included. Both groups experienced significant improvements, but no differences emerged when comparing all analyzed outcomes. WOMAC improvement was 36.2 points with HPT (p < 0.0001) vs. 39.2 with CPT (p < 0.0001); KOOS increased by 24.8 points with HPT (p < 0.0001) vs. 25.2 points with CPT (p < 0.0001); OKS improved by 16.1 points with HPT (p < 0.0001) vs. 16.3 points with CPT (p < 0.0001); ROM improved by 6.3° with HPT (p = n.s.) vs. 7.7° with CPT (p = 0.029); SF-36 improved by 3.3 points with HPT (p = n.s) vs. 7.4 points with CPT (p = n.s.); and VAS pain decreased by 2.5 points with HPT (p < 0.0001) vs. 3.0 points with CPT (p < 0.0001). Conclusions: HPT is a valid option for the post-operative rehabilitation of patients undergoing TKA, leading to results similar to CPT. This questions the need for a more complex and expensive management of these patients, considering the additional HPT benefits of healthcare cost reductions, early patient discharge, and less in-person physical therapy sessions, with equal patient final satisfaction. While this review offers a comprehensive representation of numerous studies, the research underlines significant heterogeneity in the reported data, thereby diminishing the overall robustness of the analysis, and future studies are needed to confirm the study results.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.014 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.025 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".