1. Home-based rehabilitation programme compared with traditional physiotherapy for patients at risk of poor outcome after knee arthroplasty: the CORKA randomised controlled trial
- Author
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Susan Dutton, Sarah Lamb, Avril Drummond, Karen L Barker, José Leal, Mike Reed, Gary Collins, Andrew James Price, Francine Toye, Denise Hill, Helen Wilson, Jonathan Room, Michael Maia Schlüssel, Jane Harrison, Ruth Knight, Nicola Kenealy, Leon Palmer-Wilson, Ana Glennon, Christian Brookes, Susan Dowdle, Hazel Burt, Sarah Adcock, Justine Theaker, Gladys Nadar Arulmani, Sunil Jain, Genevieve Simpson, Gemma Knight, Tricia Monroe, Gareth Stephens, and Sarah Rich
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Cost-Benefit Analysis ,Psychological intervention ,adult orthopaedics ,State Medicine ,law.invention ,Superiority Trial ,Randomized controlled trial ,Quality of life ,law ,Rehabilitation medicine ,Medicine ,Humans ,Knee ,Single-Blind Method ,Prospective Studies ,Adverse effect ,Arthroplasty, Replacement, Knee ,Physical Therapy Modalities ,Aged ,Rehabilitation ,business.industry ,General Medicine ,Arthroplasty ,Evidence Based Practice ,Physical therapy ,Quality of Life ,business ,Oxford knee score - Abstract
ObjectivesTo evaluate whether a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty offers superior outcomes to traditional outpatient physiotherapy.DesignA prospective, single-blind, two-arm randomised controlled superiority trial.Setting14 National Health Service physiotherapy departments in the UK.Participants621 participants identified at high risk of a poor outcome after knee arthroplasty using a bespoke screening tool.InterventionsA multicomponent home-based rehabilitation programme delivered by rehabilitation assistants with supervision from qualified therapists versus usual care outpatient physiotherapy.Main outcome measuresThe primary outcome was the Late-Life Function and Disability Instrument (LLFDI) at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function), Knee injury and Osteoarthritis Outcome Score Quality of Life subscale, Physical Activity Scale for the Elderly, 5 dimension, 5 level version of Euroqol (EQ-5D-5L) and physical function assessed using the Figure of 8 Walk test, 30 s Chair Stand Test and Single Leg Stance.Results621 participants were randomised between March 2015 and January 2018. 309 were assigned to CORKA (Community Rehabilitation after Knee Arthroplasty) home-based rehabilitation, receiving a median five treatment sessions (IQR 4–7). 312 were assigned to usual care, receiving a median 4 sessions (IQR 2–6). The primary outcome, LLFDI function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference=0.49 points; 95% CI −0.89 to 1.88; p=0.48). There were no statistically significant differences between the groups on any of the patient-reported or physical secondary outcome measures at 6 or 12 months.There were 18 participants in the intervention group reporting a serious adverse event (5.8%), only one directly related to the intervention, all other adverse events recorded throughout the trial related to underlying chronic medical conditions.ConclusionsThe CORKA intervention was not superior to usual care. The trial detected no significant differences, clinical or statistical, between the two groups on either primary or secondary outcomes. CORKA offers an evaluation of an intervention utilising a different service delivery model for this patient group.Trial registration numberISRCTN13517704.
- Published
- 2021