title: Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes: a systematic review and meta-analysis examining allied health service models.
abstract: Temporal and dose-response relationships between allied health (AH) and recovery in the acute phase following lower limb (LL) arthroplasty are unclear. This systematic review investigates whether early commencement, additional therapy and/or weekend AH affects length of stay (LOS) and patient outcomes in the acute phase following LL arthroplasty.
  
  
  
  Electronic databases were searched in February 2015. Studies were included if they evaluated any of the following aspects of AH for adults following LL arthroplasty in the acute phase: Early compared to later therapy commencement; Additional therapy; or a 6- or 7-day service compared to a lesser service.
  
  
  
  Twenty-four studies met the inclusion criteria, of which 19 investigated effects of physical therapy (PT) alone. Earlier PT reduced LOS (WMD = -1.23 days; 95% CI, -2.16 to -0.30) and resulted in higher probability of discharge directly home (relative risk = 1.45; 95% CI, 1.26-1.67). Addition of weekend PT reduced LOS (WMD = -1.04 days; 95% CI, -1.66 to -0.41) and improved function (SMD = 0.37; 95% CI, 0.02-0.73). Increasing PT from once to twice daily did not affect LOS (WMD = -0.35 days; 95% CI, -0.96-0.26) or function (SMD = 0.31; 95% CI, -0.06-0.71).
  
  
  
  Early PT commencement and a weekend service may produce favorable outcomes following LL arthroplasty when baseline LOS is 4 days or more. Redistributing PT resources to commence as early as day of surgery regardless of weekday may accelerate postoperative recovery. Current, high quality research is needed to confirm these findings.
authors.affiliation: Monash University, Physiotherapy Department and Monash Health Allied Health Research Unit, Australia. Electronic address: romi.haas@monash.edu.
authors.forename: R
authors.initials: R
authors.lastname: Haas
authors.affiliation: Monash University, Physiotherapy Department and Monash Health Allied Health Research Unit, Australia. Electronic address: mnsar2@student.monash.edu.
authors.forename: M
authors.initials: M
authors.lastname: Sarkies
authors.affiliation: Monash University, Physiotherapy Department and Monash Health Allied Health Research Unit, Australia. Electronic address: Kelly-ann.bowles@monash.edu.
authors.forename: K-A
authors.initials: KA
authors.lastname: Bowles
authors.affiliation: Monash University, Occupational Therapy Department and Monash Health Allied Health Research Unit, Australia. Electronic address: lisa.o'brien@monash.edu.
authors.forename: L
authors.initials: L
authors.lastname: O'Brien
authors.affiliation: Monash University, Physiotherapy Department and Monash Health Allied Health Research Unit, Australia. Electronic address: Terrence.haines@monash.edu.
authors.forename: T
authors.initials: T
authors.lastname: Haines
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity; D010351:Patient Discharge; D026741:Physical Therapy Modalities
keywords: Allied health; Arthroplasty; Early commencement; Joint replacement; Length of stay; Physical therapy