Multi-modal physiotherapy classes following total knee arthroplasty v1

• Research type

  Research Study

• Full title

  Multi-modal physiotherapy versus conventional physiotherapy following total knee arthroplasty – A prospective randomised controlled trial.

• IRAS ID

  123043

• Contact name

  Fares S Haddad

• Sponsor organisation

  University College London

• Research summary

  In patients with intractable pain and functional impairment failing conservative management, total knee replacement (TKR) is a successful treatment for reducing pain and improving function and quality of life. According the National Joint Registry, 50 000 TKRs were performed in NHS hospitals in 2011. However, functional deficits do remain post-operatively when these patients are compared to age- and gender- matched peers with no history of knee abnormalities. This is particularly noticeable when performing activities of increasing demand. Intensive physiotherapy after surgery is currently recommended in order to maximise benefit from TKR. Physiotherapy aims to increase joint range of movement, muscle strength, flexibility, as well as restoring normal walking patterns. This improves quality of life and reduces post-operative complications. It is thus imperative that the most effective method of rehabilitation – both in terms of clinical outcome and cost to the healthcare system – is being provided by orthopaedic units.

  Multi-modal group physiotherapy classes yield excellent results in improving patient outcomes for those suffering from osteoarthritis. However, a study in Finland showed that a 10-day multi-disciplinary rehabilitation programme carried out on TKR patients post-operatively had no effect on functional outcome or quality of life. Some argue that despite little difference in patient outcome measures, class-based rehabilitation is an efficient method of delivering physiotherapy. The advantages of group classes include peer support, modest program costs, supervision, and encouragement from the exercise leader. To date, no study has looked at the benefits of longer duration multi-modal physiotherapy classes in the TKR population.

  Our institution has been offering multi-modal physiotherapy classes - a safe and effective 6-week programme for treatment of chronic knee pain. It comprises of a combination of circuit exercise regimens with patient education. Our hypothesis is that patients who have undergone primary TKR achieve better functional outcome attending multi-modal physiotherapy compared to those undergoing conventional treatment.

• REC name

  London - City & East Research Ethics Committee

• REC reference

  13/LO/1165

• Date of REC Opinion

  24 Jul 2013

• REC opinion

  Favourable Opinion