Group Physiotherapy Provides Similar Outcomes for Participants After Joint Replacement Surgery as 1-to-1 Physiotherapy: A Sequential Cohort Study

Objectives: To compare effectiveness and time efficiency of physiotherapy rehabilitation provided within a group with an individualized program provided at home for improving participants' outcomes after total joint replacement surgery. Design: Quasiexperimental sequential cohort trial with 12-week follow-up. Setting: A tertiary acute care hospital. Participants: Consecutive patients (N=51) having hip or knee replacement surgery in an 8-month period and who were able to weight-bear postoperatively. Interventions: The first group admitted to the study entered the exercise group, and patients in the following 4 months entered the home physiotherapy group. Main Outcome Measures: Primary outcome measures included the Western Ontario McMaster's University Osteoarthritis Index (WOMAC), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Timed Up & Go (TUG) test, and knee range of motion (ROM). Secondary measures included the 6-m walk test and a patient evaluation questionnaire. Staff time costs were recorded. Outcomes were recorded preoperatively or at hospital discharge, and 5 and 12 weeks postoperatively. Results: There was no difference between the 2 groups for either the WOMAC or SF-36 scores, 6-m walk test, TUG test, or ROM measures at 12 weeks (P>.05), although both groups of patients improved between hospital discharge and 12 weeks. The class group accessed more frequent physiotherapy than the home group (mean, 7.5 and 3.96 visits, respectively). The physiotherapist's time was less per patient per visit for the class group (mean, 27min direct and 10min indirect) than for the home visits (mean, 38min direct and 26min indirect). Conclusions: This trial suggests that the class-based exercise rehabilitation was the most efficient method of delivery of the physiotherapy service, without cost to patient outcomes.