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Abstract
Total knee replacement (TKR) is widely accepted as a cost-effective management for the pain and functional impairment associated with end-stage osteoarthritis. With the number of procedures performed markedly increasing each year, there is mounting pressure on physiotherapists to meet a rising demand for post-operative rehabilitation with existing resources. There is an urgency to identify effective, yet resource-efficient rehabilitation delivery. Resource-intensive one-to-one therapy continues to be the most common mode of rehabilitation delivery after TKR in Australia, despite the lack of evidence of its superiority over home-based programmes from the limited research conducted in this area. The use of group-based therapy, another alternative mode of rehabilitation delivery, has not been compared to one-to-one therapy in rehabilitation after TKR. The primary aim of this thesis was to compare the effectiveness of one-to-one therapy, group-based therapy and a monitored home programme on improving patient-reported and performance-based functional outcomes in the short- and long-term, through a randomised, superiority trial. In designing this trial the rationale for two secondary investigations into outcome measures used after TKR also emerged. One study investigates the utility of an extended walk test for patients one year after TKR; the other compares the responsiveness of two widely used disease-specific patient-reported outcome measures and a generic health-related quality of life measure during early and longer term recovery after TKR.
This thesis has confirmed that outpatient one-to-one therapy delivered within the first two months after surgery is not superior to group-based therapy or a monitored home programme in improving function after TKR, as measured by a range of patient-reported and performance-based outcomes. Service providers should consider adopting these alternative modes of rehabilitation delivery as a viable strategy to meet the needs of increasing patient numbers without compromising treatment effectiveness and patient satisfaction. The thesis also provides construct validity for the Six-minute walk test as a measure of functional ambulation after TKR which, surprisingly, has been lacking up till now. Finally, the thesis provides psychometric evidence for patient-reported outcome tools that are relevant for evaluating rehabilitation after TKR and in a time frame that is relevant to short-term rehabilitation.