Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis

• Published in: PloS one Vol. 12; no. 6; p. e0178295
• Main Authors: Masaracchio, Michael, Hanney, William J, Liu, Xinliang, Kolber, Morey, Kirker, Kaitlin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.06.2017; Public Library of Science (PLoS)
• Subjects: Age; Analysis; Arthroplasty (knee); Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - economics; Arthroplasty, Replacement, Hip - rehabilitation; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - economics; Arthroplasty, Replacement, Knee - rehabilitation; Biology and Life Sciences; Biomedical materials; Clinical trials; Confidence intervals; Cost control; Criteria; Data bases; Data sources; Economic aspects; English language; Extraction; Health aspects; Health care costs; Hip; Hip joint; Hospital stays; Hospitals; Humans; Joint replacement; Joint surgery; Knee; Language; Length of Stay - economics; Libraries; Mathematical models; Medical research; Medicare; Medicine and Health Sciences; Meta-analysis; Pain; Patients; Physical therapy; Physical Therapy Modalities - economics; Physiological aspects; Population; Quality of life; Rehabilitation; Research and Analysis Methods; Rheumatoid arthritis; Scanning; Searching; Side effects; Studies; Surgery; Surgical implants; Therapy; Total hip arthroplasty; Treatment Outcome; Variance; Florida; New York; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0178295

To investigate the role of early initiation of rehabilitation on length of stay (LOS) and cost following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty. Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, and the Cochrane Library were searched in July 2016. Five additional trials were identified through reference list scanning. Eligible studies were published in English language peer-reviewed journals; included participants that had undergone total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty reported clearly defined timing of rehabilitation onset for at least two groups; and reported at least one measure of LOS or cost. Inclusion criteria were applied by 2 independent authors, with disagreements being determined by a third author. Searching identified 1,029 potential articles, of which 17 studies with 26,614 participants met the inclusion criteria. Data was extracted independently by 2 authors, with disagreements being determined by a third author. Methodological quality of each study was evaluated independently by 2 authors using the Downs and Black checklist. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate standardized mean differences (SMD) and 95% confidence intervals for LOS. When compared with standard care, early initiation of physical therapy demonstrated a decrease in length of stay for the 4 randomized clinical trials (SMD = -1.90; 95% CI -2.76 to -1.05; I2 = 93%) and for the quasi-experimental and 5 prospective studies (SMD = -1.47; 95% CI -1.85 to -1.10; I2 = 88%). Early initiation of rehabilitation following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty is associated with a shorter LOS, a lower overall cost, with no evidence of an increased number of adverse reactions. Additional high quality studies with standardized methodology are needed to further examine the impact of early initiation of physical therapy among patients with joint replacement procedures.