Mitchell Caroline, Walker Jane, Walters Stephen, Morgan Anne B, Binns Teena, Mathers Nigel
University of Sheffield, School of Health & Related Research (ScHARR), Institute of General Practice and Primary Care, Community Sciences Centre, Northern General Hospital, Sheffield, UK.
J Eval Clin Pract. 2005 Jun;11(3):283-92. doi: 10.1111/j.1365-2753.2005.00535.x.
To assess the effectiveness of pre- and post-operative physiotherapy at home for unilateral total knee replacement (TKR).
In this pragmatic randomized controlled trial set in participants' homes (four primary care trust areas) and physiotherapy outpatients in a South Yorkshire teaching hospital trust, 160 osteoarthritis patients waiting for unilateral TKR were randomly allocated to intervention (home) group (n=80) or control (hospital outpatient) group (n=80). The intervention group had pre- and post-operative home visits for assessment and treatment by a community physiotherapist. Outcome measures were health-related quality of life (HRQoL), measured by the Western Ontario McMaster Osteoarthritis index (WOMAC) and the Short Form 36 health survey (SF-36) pre-operatively and at 12 weeks post-TKR operation; patient satisfaction; and NHS resource use.
No significant differences were observed between the two treatment groups in the primary outcome measure, the WOMAC pain score, or any other HRQoL score. The home group had a significantly greater mean number of physiotherapy sessions than the hospital group [mean difference 5.2 sessions, 95% confidence interval (CI)=-6.3 to -4.1; P=0.001]. There was no significant difference in the total NHS costs per patient between groups. However, home physiotherapy for TKR was significantly more expensive (mean difference-pound136.5, 95% CI=- pound160 to-pound113; P=0.001). Patients were equally satisfied with physiotherapy at home or in hospital; however, more of the home group would choose their location for physiotherapy again.
Although home physiotherapy was as effective and as acceptable to patients as hospital outpatient physiotherapy for unilateral TKR, it was more expensive. Additional pre-operative home physiotherapy did not improve patient-perceived health outcomes.
评估单侧全膝关节置换术（TKR）术前及术后在家中进行物理治疗的效果。
在一项实用的随机对照试验中，研究地点为参与者家中（四个初级保健信托区）以及南约克郡一家教学医院信托机构的物理治疗门诊。160名等待单侧TKR的骨关节炎患者被随机分配至干预（在家）组（n = 80）或对照组（医院门诊）组（n = 80）。干预组在术前及术后接受社区物理治疗师的家访评估与治疗。结局指标包括健康相关生活质量（HRQoL），通过术前及TKR术后12周时的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及简明健康调查36项量表（SF - 36）进行测量；患者满意度；以及国民保健服务（NHS）资源利用情况。
在主要结局指标WOMAC疼痛评分或任何其他HRQoL评分方面，两个治疗组之间未观察到显著差异。在家组接受的物理治疗疗程平均数量显著多于医院组[平均差异5.2个疗程，95%置信区间（CI）= - 6.3至 - 4.1；P = 0.001]。两组间每位患者的NHS总费用无显著差异。然而TKR在家中进行物理治疗的费用显著更高（平均差异 - 136.5英镑，95% CI = - 160至 - 113；P = 0.001）。患者对在家或在医院进行物理治疗的满意度相同；然而，更多在家组的患者会再次选择其进行物理治疗的地点。
尽管对于单侧TKR，在家中进行物理治疗与医院门诊物理治疗对患者而言同样有效且可接受，但费用更高。额外的术前在家物理治疗并未改善患者感知的健康结局。
