Is there a role for rehabilitation streaming following total knee arthroplasty? Preliminary insights from a randomized controlled trial

To determine whether total knee arthroplasty recipients demonstrating comparatively poor mobility at entry to rehabilitation and who received supervised therapy, had better rehabilitation outcomes than those who received less supervision. Retrospective analysis of randomized trial data. Total knee arthroplasty participants randomized to supervised (n = 159) or home-based therapy (n = 74). Participants were dichotomized based on mean target 6-min walk test (6MWT) pre-therapy (second post-surgical week). Absolute and change in 6MWT and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function subscales amongst low performers in the supervised (n = 89) and unsupervised (n = 36) groups were compared, as were high performers in the supervised (n = 70) and unsupervised (n = 38) groups. Low performers in the unsupervised compared with the supervised group demonstrated significantly poorer 6MWT scores (absolute δ = 8.5%, p = 0.003; change δ = 8.1%, p = 0.007) when therapy ceased (10 weeks post-surgery). No differences in 6MWT were observed between the high performing subgroups or in the recovery of WOMAC subscales between any subgroups. Individuals manifesting comparatively poor mobility at the commencement of physiotherapy may recover their mobility, but not perceived function, more quickly if streamed to supervised therapy.