Author(s): MAU-MÖLLER, A., EL-AARID, N., BEHRENS, M., STÖCKEL, T., BERGSCHMIDT, P., BADER, R., TOHTZ, S., MITTELMEIER, W., JACKSTEIT, R., Institution: UNIVERSITY OF ROSTOCK, Country: GERMANY, Abstract-ID: 2202

INTRODUCTION:
Studies on the effectiveness of inpatient and outpatient orthopaedic rehabilitation have not yet differentiated their analyses with respect to certain orthopaedic diseases. This is the first study on the effectiveness of both rehabilitation programmes in a specific orthopaedic population (total knee arthroplasty [TKA] patients) with a focus on functional motor performance.
METHODS:
Forty-two patients were allocated to a 3-week inpatient (n = 26) or outpatient (n = 16) rehabilitation program. Measurements were performed 1 day before discharge from the hospital (pre-test) and 3 months after TKA (post-test). Outcome measures included physical activity over a period of 7 days, i.e. number of steps (primary outcome variable) and number of sit-to-stand transitions. Secondary outcomes included knee pain, knee joint swelling, active and passive maximal knee flexion and maximal knee extension range of motion, timed up and go performance, stair climbing performance, joint position sense at 30° and 50° of knee flexion, gait performance and long-term memory representation of the gait.
RESULTS:
The outpatient group performed a higher number of steps (mean difference: 14840; 95% CI: 6844 to 22835; P < 0.001) and sit-to-stand-transitions (74; -11 to 158; p = 0.086) during the first 7 days of rehabilitation. They also showed a lower error during the knee joint repositioning test at 30° (-7.7°; -12.4° to 3.2°; p < 0.001) and 50° (-5.5°; -10.0° to 1.0°; p < 0.010) of knee flexion and better stair climbing performance (-6.1s; -12.3s to 0.1s; p = 0.004) at post-test.
Correlation analyses between the functional outcome measures revealed moderate and strong positive relationships between the number of steps and sit-to-stand transitions (r = 0.48; p = 0.003) and between stair climbing and timed up and go performance (r = 0.68; p < 0.001).
CONCLUSION:
The outpatient rehabilitation group showed (i) significantly higher physical activity during the first 7 days of rehabilitation, (ii) better proprioceptive accuracy and stair climbing performance 3 months after TKA, (iii) no significant group-differences in pain, swelling, range of motion, timed up and go performance, gait performance or long-term memory representation of the gait and (iv) correlations between functional outcome measures.
The associations between functional measures are not surprising, but – together with the finding of higher physical activity and better motor performance during and following outpatient rehabilitation – the present study underlines the relevance of physical activity for regaining and/or retaining motor performance in the early postoperative phase following TKA. Our findings suggest that, besides standard physiotherapy, everyday physical activity should be promoted during inpatient rehabilitation. Thus, outpatient rehabilitation is a suitable alternative for patients who can be treated in either an inpatient or an outpatient setting.