Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial)
Importance: Comparative effectiveness trials have not shown superiority of one type of physical rehabilitation over another following total hip (THA) and knee (TKA) arthroplasty. We therefore ask the fundamental effectiveness question: Does physical rehabilitation “work” better than no physical reha...
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Elsevier
2024-12-01
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| Series: | Osteoarthritis and Cartilage Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2665913124000979 |
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| author | T. Mark-Christensen K. Thorborg T. Kallemose T. Bandholm |
| author_facet | T. Mark-Christensen K. Thorborg T. Kallemose T. Bandholm |
| author_sort | T. Mark-Christensen |
| collection | DOAJ |
| description | Importance: Comparative effectiveness trials have not shown superiority of one type of physical rehabilitation over another following total hip (THA) and knee (TKA) arthroplasty. We therefore ask the fundamental effectiveness question: Does physical rehabilitation “work” better than no physical rehabilitation? Objective: To compare the effectiveness of a 6-week program of physical rehabilitation (home-based telerehabilitation, or home-based rehabilitation) to no physical rehabilitation following THA and TKA. Design: 3-arm,randomized, controlled, superiority trial with blinded outcome assessments. 377 patients (210 THA/167 TKA) were screened for eligibility before the targeted sample size of 168 patients was reached. Outcome measures were assessed at baseline, at the end of intervention (6 weeks), and 3 and 12 months postoperatively. The primary outcome was the Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee injury and Osteoarthritis Outcome Score (KOOS)-subscale: function in daily living. Secondary outcomes included: HOOS/KOOS-subscales: pain, symptoms, and quality of life, patient global assessment, analgesics, walking aids, 30-s chair stand test, 4 × 10 m fast-paced walk test, exercise adherence, and satisfaction. Results: Comparing physical rehabilitation (home-based telerehabilitation, and home-based rehabilitation) to no physical rehabilitation, the mean group-differences for the primary outcome were 3.3 (95%CI: −1.9 to 8.6; p = 0.10) points at 6 weeks, and 1.9 (95%CI: −3.7 to 7.6; p = 0.25) and 2.6 (95%CI: −4.4 to 9.6; p = 0.23) points at the 3- and 12-months follow-ups, respectively. Conclusion: Physical rehabilitation was not superior to the no physical rehabilitation comparator following THA or TKA in terms of self-reported function or any of the secondary outcomes. Trial registration: NCT03750448 (November 23, 2018), URL: https://clinicaltrials.gov/ct2/show/NCT03750448. |
| format | Article |
| id | doaj-art-c1bc6ea7abe149be9b0cc37885bc21be |
| institution | OA Journals |
| issn | 2665-9131 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Osteoarthritis and Cartilage Open |
| spelling | doaj-art-c1bc6ea7abe149be9b0cc37885bc21be2025-08-20T01:52:48ZengElsevierOsteoarthritis and Cartilage Open2665-91312024-12-016410053010.1016/j.ocarto.2024.100530Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial)T. Mark-Christensen0K. Thorborg1T. Kallemose2T. Bandholm3Department of Rehabilitation, Centre of Health, Regional Municipality of Bornholm, Rønne, Bornholm, Denmark; Department of Clinical Research, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, Denmark; Corresponding author. Kettegaard Allé 30, DK-2650 Hvidovre, Denmark.Sports Orthopaedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Institute for Clinical Medicine, Copenhagen University, Denmark; Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkDepartment of Clinical Research, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, DenmarkDepartment of Clinical Research, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, Denmark; Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, DenmarkImportance: Comparative effectiveness trials have not shown superiority of one type of physical rehabilitation over another following total hip (THA) and knee (TKA) arthroplasty. We therefore ask the fundamental effectiveness question: Does physical rehabilitation “work” better than no physical rehabilitation? Objective: To compare the effectiveness of a 6-week program of physical rehabilitation (home-based telerehabilitation, or home-based rehabilitation) to no physical rehabilitation following THA and TKA. Design: 3-arm,randomized, controlled, superiority trial with blinded outcome assessments. 377 patients (210 THA/167 TKA) were screened for eligibility before the targeted sample size of 168 patients was reached. Outcome measures were assessed at baseline, at the end of intervention (6 weeks), and 3 and 12 months postoperatively. The primary outcome was the Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee injury and Osteoarthritis Outcome Score (KOOS)-subscale: function in daily living. Secondary outcomes included: HOOS/KOOS-subscales: pain, symptoms, and quality of life, patient global assessment, analgesics, walking aids, 30-s chair stand test, 4 × 10 m fast-paced walk test, exercise adherence, and satisfaction. Results: Comparing physical rehabilitation (home-based telerehabilitation, and home-based rehabilitation) to no physical rehabilitation, the mean group-differences for the primary outcome were 3.3 (95%CI: −1.9 to 8.6; p = 0.10) points at 6 weeks, and 1.9 (95%CI: −3.7 to 7.6; p = 0.25) and 2.6 (95%CI: −4.4 to 9.6; p = 0.23) points at the 3- and 12-months follow-ups, respectively. Conclusion: Physical rehabilitation was not superior to the no physical rehabilitation comparator following THA or TKA in terms of self-reported function or any of the secondary outcomes. Trial registration: NCT03750448 (November 23, 2018), URL: https://clinicaltrials.gov/ct2/show/NCT03750448.http://www.sciencedirect.com/science/article/pii/S2665913124000979Total hip arthroplastyTotal knee arthroplastyTotal joint replacementRehabilitationTelerehabilitation |
| spellingShingle | T. Mark-Christensen K. Thorborg T. Kallemose T. Bandholm Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial) Osteoarthritis and Cartilage Open Total hip arthroplasty Total knee arthroplasty Total joint replacement Rehabilitation Telerehabilitation |
| title | Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial) |
| title_full | Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial) |
| title_fullStr | Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial) |
| title_full_unstemmed | Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial) |
| title_short | Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial) |
| title_sort | clinical benefit of physical rehabilitation after total hip and knee arthroplasty a pragmatic randomized controlled trial the draw1 trial |
| topic | Total hip arthroplasty Total knee arthroplasty Total joint replacement Rehabilitation Telerehabilitation |
| url | http://www.sciencedirect.com/science/article/pii/S2665913124000979 |
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