Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial)

T Mark-Christensen; K Thorborg; T Kallemose; T Bandholm

doi:10.1016/j.ocarto.2024.100530

Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial)

Osteoarthr Cartil Open. 2024 Oct 16;6(4):100530. doi: 10.1016/j.ocarto.2024.100530. eCollection 2024 Dec.

Authors

T Mark-Christensen^{1

2}, K Thorborg^{3

4

5}, T Kallemose², T Bandholm^{2

4

5

6}

Affiliations

¹ Department of Rehabilitation, Centre of Health, Regional Municipality of Bornholm, Rønne, Bornholm, Denmark.
² Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.
³ Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Institute for Clinical Medicine, Copenhagen University, Denmark.
⁴ Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark.
⁵ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁶ Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.

Abstract

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.

Keywords: Rehabilitation; Telerehabilitation; Total hip arthroplasty; Total joint replacement; Total knee arthroplasty.

Publication types

Clinical Trial

Associated data

ClinicalTrials.gov/NCT03750448