EFFECTIVENSS OF COMMUNITY BASED REHABILITATION PROGRAM FOR TOTAL KNEE REPLACEMENT PATIENTS: A SINGAPORE STUDY

E.C. Neoh¹, M.J.R. Chong¹, S.G. Lim¹, C.J. Lim², K.G. Tan³

¹Tan Tock Seng Hospital, Physiotherapy, Singapore, Singapore, ²Woodlands Health Campus, Orthopedic Surgery, Singapore, Singapore, ³Tan Tock Seng Hospital, Orthopedic Surgery, Singapore, Singapore

Background: With the aging population, the number of total knee replacement (TKR) surgery is steadily increasing worldwide. Rehabilitation after surgery is the standard practice of care as it improves pain, muscle strength and physical function. Due to the homogenous rehabilitation profile, majority of TKR patients have good long-term outcomes regardless of rehabilitation setting , duration or protocols. However, in Singapore, TKR patients usually receive individual rehabilitation sessions at an outpatient physiotherapy clinic situated within an Acute Hospital (AH) after they discharge home post surgery, and not at the community Day Rehab Center (DRC) due to the limitation of the referral system. According to the Singapore Ministry Of Health (MOH) One Rehab Framework, DRC is the recommended rehabilitation setting for TKR patients. Hence, there is a need to set up a TKR community rehabilitation program and evaluate its effectiveness.

Purpose: To compare the clinical effectiveness of the new TKR community rehabilitation model with the current acute hospital model. We hypothesize that both models are effective, and there is no outcome difference at the last session.

Methods: This is a controlled prospective study. All TKR patients who met inclusion criteria and were agreeable, were allocated to either intervention (DRC) or control group (AH) based on the patients’ preference. Subjects received 5 rehabilitation sessions, starting from week 2 until 3 months post-operative, based on harmonized rehabilitation protocol and discharge criteria. Subjects were discharge from the rehabilitation service earlier, if they achieved the discharge criteria before the 5^th session. Assessments were conducted at the first (baseline) and last session. The primary outcome is Timed up and Go (TUG) test. Secondary outcomes include pain intensity, knee flexion and extension Passive Range Of Motion (PROM), quadriceps strength and 30 seconds chair rise (30CR) test.

Results: 59 subjects were recruited (29 in DRC group; 30 in AH group) for the study. The demographic and baseline outcomes were similar between the two groups. Subjects in the DRC group utilized 4.48 sessions, whereas subjects in the AH group utilized 4.45 sessions in average. There was no significant difference between groups at the final assessments for all the outcomes [TUG test (p=0.853) ; Knee Flexion PROM (p=0.933); Knee Extension PROM (p=0.409); Quadriceps strength (p=0.064) and 30CR test (p=0.347)] , except for pain intensity (p=0.003). For pre-post difference within group, there was a statistically significant difference (p<0.05) for all the outcome measures in both groups.

Conclusions: Both DRC and AH rehabilitation models are effective for TKR patients. Patients who attended rehabilitation at DRC have lesser pain at last session.

Implications: Our study found that the new community rehabilitation model was clinically effective for TKR patients, hence, it should be offered to all TKR patients and to be adopted nationwide. This new model dovetails Singapore MOH strategy of “Beyond hospital to community” to ensure accessible, affordable and sustainable healthcare services for fellow Singaporeans.

Funding acknowledgements: Singapore Ministry of Health Healthcare Research Scholarship

Keywords:
Community Based Rehabilitation
Total Knee Replacement

Topics:
Community based rehabilitation
Orthopaedics
Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: National Healthcare Group (NHG)

Committee: NHG DSRB Ethics Committee

Ethics number: 2019/01135