Association between rehabilitation attendance and physical function following discharge after total knee arthroplasty: Prospective cohort study

Summary Background Rehabilitation is widely advocated and provided as a standard of care for patients with total knee arthroplasty (TKA) but its effects on intermediate-to longer-term physical function is unclear. Also unknown is the relationship between the number of rehabilitation sessions attended and functional outcomes. Methods We conducted a prospective cohort study of 1540 patients who had undergone TKA and were referred for rehabilitation. Physical function was indexed by the Short-Form 36 (SF-36) physical function score at 6 months post TKA. We used multivariable linear regression to assess the association between rehabilitation attendance and Month-6 physical function. Among patients who attended rehabilitation, multivariable linear regression was used to examine the dose-response association between the number of sessions attended and Month-6 physical function. Results Of the 1540 patients, 68 patients did not attend rehabilitation, 86 patients attended one session, and 1386 patients attended 2 or more sessions. Adjusted for the propensity to attend rehabilitation, rehabilitation attendance was independently associated with better Month-6 SF-36 physical function (point estimate, 5.0 points; 95% CI, 0.5 to 9.5; P =0.028 compared with patients with no rehabilitation). Among patients who attended rehabilitation, attending 5 sessions was associated with a 3.6-point increase in SF-36 scores (95% CI, 0.8 to 6.5; P =0.01) relative to patients who attended one session. Conclusions Rehabilitation attendance post TKA is associated with an increase in self-report physical function. Among patients who attended rehabilitation, a modest dose–response relationship was observed between the number of sessions and functional outcomes.