The HIHO Study: Hospital Inpatient vs Home Rehabilitation After Total Knee Replacement

Mark Buhagiar

Status

Completed

Conditions

Osteoarthritis

Treatments

Other: Hybrid Home Programme (HO)

Other: Hospital Inpatient Rehabilitation

Study type

Interventional

Funder types

Other

Identifiers

NCT01583153

HIHO-1042554

Details and patient eligibility

About

Total knee replacement (TKR) surgery is a common and highly effective treatment option for alleviating the pain and disability caused by chronic arthritis. The associated rehabilitation costs, however, impose a significant burden on the health system. In particular, inpatient rehabilitation - utilised by approximately 43% of private TKR recipients in NSW and 29% Australia-wide is of greatest concern, costing, on average, $7000 (AU) per inpatient episode.

The overarching aim of this study is to establish whether inpatient rehabilitation is necessary after TKR for patients with osteoarthritis (OA) who could otherwise be discharged directly home.

The main hypothesis to be tested by the proposed study is that TKR recipients who receive inpatient rehabilitation in addition to participating in a home programme, compared to patients who participate in a home programme only, will achieve a superior level of mobility. If superiority is shown, a cost-effectiveness analysis will be undertaken.

Secondary hypotheses to be tested relate to patient-reported knee pain and function, health-related quality of life, functional ambulation, and knee joint mobility.

Superiority in these outcomes will be evident at six months after surgery.

Full description

As preferences for therapy can be a confounder in RCTs, patients will be asked their preference for rehabilitation post TKR, prior to randomisation.

Patients will be randomised once a hospital bed is available.

Enrollment

165 patients

Sex

All

Volunteers

No Healthy Volunteers

Inclusion criteria

Consecutive patients presenting for elective, primary, unilateral TKR at the Whitlam Joint Replacement Centre (Fairfield Hospital) will be screened for eligibility at the pre-admission clinic by the study Project Manager (PM).
primary diagnosis of OA

Exclusion criteria

predisposition for requiring prolonged inpatient supervision (eg requiring assistance with at least one personal activity of daily living or lack of social support)
inability to comprehend the study protocol.
catastrophic complication arising post-surgery which precludes rehabilitation commencing within 2-3 weeks of surgery