Rehabilitation after total joint replacement: a scoping study.
The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research.



We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement. We reviewed this work in the context of outcomes described from previously published research.



Thirty individual studies and seven systematic reviews were included, with most research examining the effectiveness of physiotherapy-based exercise rehabilitation after total knee replacement using randomized control trial methods. Rehabilitation after hip and knee replacement whether carried out at the clinic or monitored at home, appears beneficial but type, intensity and duration of interventions were not consistently associated with outcomes. The burden of comorbidities rather than specific rehabilitation approach may better predict rehabilitation outcome. Monitoring of recovery and therapeutic attention appear important but little is known about optimal levels and methods required to maximize outcomes.



More work exploring the role of comorbidities and key components of therapeutic attention and the therapy relationship, using a wider range of study methods may help to advance the field. Implications for Rehabilitation Physiotherapy-based exercise rehabilitation after total hip replacement and total knee replacement, whether carried out at the clinic or monitored at home, appears beneficial. Type, intensity, and duration of interventions do not appear consistently associated with outcomes. Monitoring a patient's recovery appears to be an important component. The available research provides limited guidance regarding optimal levels of monitoring needed to achieve gains following hip and knee replacement and more work is required to clarify these aspects. The burden of comorbidities appears to better predict outcomes regardless of rehabilitation approach.
a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.|b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand.
Deborah
D
L Snell
a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.
Julia
J
Hipango
b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand.
K Anne
KA
Sinnott
a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.
Jennifer A
JA
Dunn
a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.
Alastair
A
Rothwell
c MedStar Health Research Institute , Washington , DC , USA.|d MedStar National Rehabilitation Hospital , Washington , DC , USA.
C Jean
CJ
Hsieh
d MedStar National Rehabilitation Hospital , Washington , DC , USA.|e Department of Rehabilitation Medicine , Georgetown University School of Medicine , Washington , DC , USA.
Gerben
G
DeJong
a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.
Gary
G
Hooper
D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D015897:Comorbidity; D006801:Humans; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities
Total hip replacement; exercise-based physiotherapy; home-based exercise programs; rehabilitation; therapeutic attention; therapy alliance; total knee replacement