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Abstract
Total knee arthroplasty (TKA) is an effective way to manage functional impairment and pain connected with end-stage osteoarthritis. The number undertaken annually in Australia has markedly increased, particularly in the private hospital sector. This escalation is mirrored internationally, and is expected to continue to increase with an ageing population. Whilst the TKA is viewed as highly cost-effective due to impressive gains in functional performance and health-related quality of life, acute-care and associated rehabilitative costs impose a significant financial burden. There is increasing concern regarding sustainability and affordability, and a need to identify effective yet resource-efficient rehabilitation modes post-surgery.
Inpatient rehabilitation continues to be the most common mode of rehabilitation delivery post-TKA in the private sector in Australia. A systematic review and meta-analysis was conducted to determine whether inpatient or clinic-based rehabilitation had been shown to result in superior outcomes after TKA when compared to a monitored or unmonitored home-based or domiciliary program. The primary aim of this thesis was to compare the effectiveness of inpatient rehabilitation to a monitored home-program on improving performance-based and patient-reported functional outcomes in the short- and long-term, through a randomised clinical trial. In designing this trial the rationale for two secondary investigations emerged. One study compares the utility of a simplified walk test to evaluate functional mobility post-TKA. The other investigated the preferences of privately insured consumers and clinicians for different modes of rehabilitation utilised after knee or hip arthroplasty, and the factors which influence decision making for rehabilitation post-surgery.
This thesis has verified that inpatient rehabilitation is not superior to a monitored home program in improving recovery or mobility post-TKA, measured by performance-based and patient-reported outcomes. No evidence of this had been present in the literature prior to this study. The thesis has also shown that, although highly correlated, the 6-minute walk test is not usefully predicted by 15-metre walk test performance pre- or post-TKA. Furthermore, no one rehabilitation mode provided post-TKA has been shown to be singularly preferred by stakeholders, with factors other than the belief that one mode was more effective than another appearing to influence the pathway followed by private consumers.