Group exercise following hip or knee arthroplasty in inpatient rehabilitation

Ms Angel Ching1, Dr Jodie McClelland1, Dr Kate Webster1

1La Trobe University, Bundoora, Australia

Aim: To evaluate whether group exercise does not lead to inferior self-reported, impairments and functional outcomes compared to one-to-one exercise in an inpatient rehabilitation setting for patients with hip or knee arthroplasty.

Method: Eighty-eight patients were allocated to either group-based exercise (n=48) or one-to-one exercise (n=40) during their inpatient rehabilitation.  Participants in the one-to-one exercise group received two sessions of one-to-one exercise whilst participants in the group-based exercise group received one session of one-to-one exercise and one session of group exercise. The primary outcome of Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to determine non-inferiority of the study. Non-inferiority margin was set at 10 for WOMAC. Other measures included quadriceps strength, the Time Up and Go, 10 Meter Walk Test , Six Minute Walk Test, cadence, velocity, stride length, hospital length of stay and patients’ satisfaction were used as secondary outcomes. Outcomes were assessed on admission, at hospital discharge and at six months.

Results: Group exercise was shown to be non-inferior to one-to-one exercise in WOMAC. The upper limit of 95% confidence interval of the mean change between admission and discharge (p= 0.23), and between admission and at six month (p=0.97) lied between zero and the non-inferiority margin.  Group exercise was also shown to be non-inferior to one-to-one exercise in secondary outcomes both at hospital discharge and at six month post-operatively.

Significance of the findings to allied health: Rehabilitation service providers may consider implementing more group exercise programs to improve the efficiency of the services and without compromising patients’ clinical outcomes at hospital discharge.