Evidence map›Paper›PMID 33051212›Full record

Trial reportBMJ (Clinical research ed.)2020

Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial.

David F Hamilton, David J Beard, Karen L Barker, Gary J Macfarlane, Christopher E Tuck, Andrew Stoddart, Timothy Wilton, James D Hutchinson, Gordon D Murray, A Hamish R W Simpson and 1 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01849445 (Targeted Rehabilitation to Improve Outcome After Knee Replacement- A Physiotherapy Study), which is not on this map. Cited by 35 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01849445 nacompletednot on this map

Targeted Rehabilitation to Improve Outcome After Knee Replacement- A Physiotherapy Study (TRIO-Physio)

TypeinterventionalSponsorUniversity of EdinburghRan2013 to 2017Enrolled334ConditionsOsteoarthritis of the KneeArmsIntensive physiotherapy, Home physiotherapy exercises
3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

David F HamiltonDepartment of Orthopaedics and Trauma, University of Edinburgh, Edinburgh EH16 4SB, UK d.f.hamilton@ed.ac.uk.ORCID 0000-0001-9060-9255
David J BeardNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Karen L BarkerNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Gary J MacfarlaneAberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology) Group, University of Aberdeen, Aberdeen, UK.
Christopher E TuckUsher Institute of Population Health, University of Edinburgh, Edinburgh, UK.
Andrew StoddartUsher Institute of Population Health, University of Edinburgh, Edinburgh, UK.
Timothy WiltonDepartment of Orthopaedics, Royal Derby Hospital, Derby, UK.
James D HutchinsonDepartment of Orthopaedic Surgery, University of Aberdeen, Aberdeen, UK.
Gordon D MurrayUsher Institute of Population Health, University of Edinburgh, Edinburgh, UK.
A Hamish R W SimpsonDepartment of Orthopaedics and Trauma, University of Edinburgh, Edinburgh EH16 4SB, UK.
TRIO investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor outcome after total knee arthroplasty.

designParallel group randomised controlled trial.

setting13 secondary and tertiary care centres in the UK providing postoperative physiotherapy.

participants334 participants with knee osteoarthritis who were defined as at risk of a poor outcome after total knee arthroplasty, based on the Oxford knee score, at six weeks postoperatively. 163 were allocated to therapist led outpatient rehabilitation and 171 to a home exercise based protocol.

interventionsAll participants were reviewed by a physiotherapist and commenced 18 sessions of rehabilitation over six weeks, either as therapist led outpatient rehabilitation (progressive goal oriented functional rehabilitation protocol, modified weekly in one-one contact sessions) or as physiotherapy review followed by a home exercise based regimen (without progressive input from a physiotherapist).

main outcome measuresPrimary outcome was Oxford knee score at 52 weeks, with a 4 point difference between groups considered to be clinically meaningful. Secondary outcomes included additional patient reported outcome measures of pain and function at 14, 26, and 52 weeks post-surgery.

results334 patients were randomised. Eight were lost to follow-up. Intervention compliance was more than 85%. The between group difference in Oxford knee score at 52 weeks was 1.91 (95% confidence interval -0.18 to 3.99) points, favouring the outpatient rehabilitation arm (P=0.07). When all time point data were analysed, the between group difference in Oxford knee score was a non-clinically meaningful 2.25 points (0.61 to 3.90, P=0.01). No between group differences were found for secondary outcomes of average pain (0.25 points, -0.78 to 0.28, P=0.36) or worst pain (0.22 points, -0.71 to 0.41, P=0.50) at 52 weeks or earlier time points, or of satisfaction with outcome (odds ratio 1.07, 95% confidence interval 0.71 to 1.62, P=0.75) or post-intervention function (4.64 seconds, 95% confidence interval -14.25 to 4.96, P=0.34).

conclusionsOutpatient therapist led rehabilitation was not superior to a single physiotherapist review and home exercise based regimen in patients at risk of poor outcomes after total knee arthroplasty. No clinically relevant differences were observed across primary or secondary outcome measures. TRIALS REGISTRATION: Current Controlled Trials ISRCTN23357609 and ClinicalTrials.gov NCT01849445.

Indexed as

Physical Therapy ModalitiesAgedArthroplasty, Replacement, KneeClinical ProtocolsExercise TherapyFemaleHumansKnee JointMaleMiddle AgedOsteoarthritis, KneePain MeasurementPatient CompliancePatient Reported Outcome MeasuresPostoperative PainTreatment Outcome

Identifiers

PMID33051212
PMCPMC7551789

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.