title: Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Effectiveness of physiotherapy after meniscectomy Cost-effectiveness study of outpatient physiotherapy after medial meniscectomy A prospective outcome study of rehabilitation programs and anterior cruciate ligament reconstruction. Comparison of Clinic- and Home-Based Rehabilitation Programs After Total Knee Arthroplasty Reliability of the PEDro scale for rating quality of randomized controlled trials. Independent home versus supervised rehabilitation following arthroscopic knee surgery--a prospective randomized trial. No need for outpatient physiotherapy following total knee arthroplastyA randomized trial of 120 patients Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study. Comparison of Home versus Physical Therapy-Supervised Rehabilitation Programs after Anterior Cruciate Ligament Reconstruction
abstract: BACKGROUND AND PURPOSE Controversy exists about the effectiveness of physical therapy after arthroscopic partial meniscectomy . This r and omized controlled trial evaluated the effectiveness of supervised physical therapy with a home program versus a home program alone . SUBJECTS Eighty-four patients ( 86 % males ; overall mean age=39 years , SD=9 , range=21 - 58 ; female mean age=39 years , SD=9 , range=24 - 58 ; male mean age=40 , SD=9 , range=21 - 58 ) who underwent an uncomplicated arthroscopic partial meniscectomy participated . METHODS Subjects were r and omly assigned to either a group who received 6 weeks of supervised physical therapy with a home program or a group who received only a home program . Blinded test sessions were conducted 5 and 50 days after surgery . Outcome measures were : ( 1 ) Hughston Clinic question naire , ( 2 ) Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and EuroQol EQ-5D ( EQ-5D ) question naires , ( 3 ) number of days to return to work after surgery divided by the Factor Occupational Rating System score , ( 4 ) kinematic analysis of knee function during level walking and stair use , and ( 5 ) horizontal and vertical hops . RESULTS No differences between groups were found for any of the outcomes measured . DISCUSSION AND CONCLUSION The results indicate that the supervised physical therapy used in this study is not beneficial for patients in the early period after uncomplicated arthroscopic partial meniscectomy Abstract To evaluate the effect of physiotherapy after partial arthroscopic meniscectomy , we performed a prospect i ve , r and omised and partially blinded study . This pilot study was performed from October 1996 to June 1997 . The control group received the st and ard treatment , consisting of verbal and written advice and exercises . The physiotherapy group performed exercises according to a dynamic protocol under the supervision of a physiotherapist . During a 3-week period , nine treatment sessions were given of 30 min each . Twenty patients , who had undergone arthroscopic meniscectomy without any other pathology of the knee , were r and omised into two groups of ten patients each . The effects of therapy were evaluated by a blinded observer . We measured the distance and height of one-leg jumps ( hops ) , the VAS pain scale , the Tegner and Lysholm scores and the SARS/FORS score . Recovery and satisfaction with the treatment were also evaluated . The effect measurements were performed at 7 ( T1 ) , 14 ( T2 ) , 21 ( T3 ) and 28 days ( T4 ) following surgery . Statistical analysis was performed with the Student ’s t-test . The physiotherapy group showed significantly better results than the control group regarding the SARS score , the hop test and the distance jumps . Moreover , the measurements showed clear progression in favour of the physiotherapy group . In conclusion , exercising under the supervision of a physiotherapist led to high patient satisfaction and good functional rehabilitation after partial arthroscopic meniscectomy In a r and omised controlled trial comparing the outcome of two groups of men aged 16 - 45 one group received outpatient physiotherapy after medial meniscectomy and the other did not .  In clinical aspects of knee function there was no significant difference between the test group and control group measured at specified intervals up to 26 weeks postoperatively . Similarly , there was no significant difference between the groups in the time taken to return to work or in the mean fall in take-home pay as a result of meniscectomy . The mean cost per patient of providing outpatient physiotherapy  in the test group was 23 pounds at 1976 prices . Thus the least costly way of returning male patients aged 16 - 45 to activity is by not providing routine outpatient physiotherapy after medial meniscectomy . Further r and omised controlled trials are , however , required to determine the value of physiotherapy in other age groups and other conditions We evaluated the outcome of and compared two rehabilitation programs ( clinic-based versus home ) after a mid-third patellar autograft reconstruction of the anterior cruciate ligament . Thirty-seven patients ( 28 male , 9 female ; average age , 24.1 years ) completed the study . Fifteen of these patients received clinic-based rehabilitation ( three visits per week for 6 weeks prescribed ) , and 22 patients received home-based physical therapy ( number of visits determined by patient response ) . Knee ROM , Lysholm , Visual Analogy Scale , ( VAS ) pain rating , hop test , KT-1000 , and Sickness Impact Profile ( SIP ) were evaluated preoperatively and postoperatively . All patients reported good satisfaction with the function of their knee at average follow-up of 21.6 months ( range , 12 to 48 ) . Patients managed by home rehabilitation averaged 2.85 visits as compared with 14.2 for clinic-centered patient ( P < .05 ) . There were no differences in functional or subjective outcomes in the different postoperative rehabilitation regimens , with both groups reporting high satisfaction and improved quality of life . Cost savings in the home rehabilitation group were significant One hundred sixty patients ( mean age , 68 ± 8 years ) having primary total knee arthroplasty were assigned r and omly to two rehabilitation programs : ( 1 ) clinic-based rehabilitation provided by outpatient physical therapists ; or ( 2 ) home-based rehabilitation monitored by periodic telephone calls from a physical therapist . Both rehabilitation programs emphasized a common home exercise program . Before surgery , and at 12 and 52 weeks after surgery , no statistically significant differences were observed between the clinic- and the home-based groups on any of the following measures : ( 1 ) total score on the Knee Society clinical rating scale ; ( 2 ) total score on the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 3 ) total score on the Medical Outcomes Study Short Form ; ( 4 ) pain scale of the Knee Society clinical rating scale ; ( 5 ) pain scale of the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 6 ) functional scale of the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 7 ) distance walked in 6 minutes ; ( 8) number of stairs ascended and descended in 30 seconds ; and ( 9 ) knee flexion range of motion , on either the per protocol or the intent-to-treat or the analyses . After primary total knee arthroplasty , patients who completed a home exercise program ( home-based rehabilitation ) performed similarly to patients who completed regular outpatient clinic sessions in addition to the home exercises ( clinic-based rehabilitation ) . Additional studies need to determine which patients are likely to benefit most from clinic-based rehabilitation programs BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . This prospect i ve study compared 30 patients r and omly assigned to either a home exercise program or supervised outpatient physical therapy following arthroscopic partial medial meniscectomy . Their knee functions were assessed at 2 , 4 , and 8 weeks postoperatively using isokinetic analysis and subjective question naires . At each evaluation , the home exercise group performed as well or better than the supervised physical therapy group . There were no statistically significant differences between the two groups . At 4 weeks postoperation , the mean percent deficit in torque ( strength ) between the affected and unaffected limbs was 22.1 % in the supervised rehabilitation group and 22.0 % in the home exercise . The percent deficit in terms of endurance was 7.7 % in the supervised group and 3.6 % in the home group . Similar results were noted with regard to the patients ' subjective evaluations of their knee function and ability to resume work and recreational activities . We conclude that a well-planned , unsupervised home exercise knee rehabilitation program can produce equally good postoperative recovery as compared to a supervised outpatient physical therapy regimen in properly selected patients following arthroscopic partial meniscectomy of the knee BACKGROUND We have not found any reports on the effect of physiotherapy after knee replacement . PATIENTS AND METHODS In a prospect i ve r and omized controlled trial , we r and omized two groups to receive or not receive outpatient physiotherapy  following total knee arthroplasty . 120 patients were recruited over 2 years , each followed up for 1 year . Inclusion criteria were age between 55 - 90 years , less than 40 degrees of fixed flexion contracture and the ability to walk at least 10 meters unaided preoperatively with monoarticular arthrosis . RESULTS We found no statistically significant benefit of outpatient physiotherapy  at any of the three times measured . After adjusting for baseline differences between the two treatment groups , the mean difference in knee flexion 1 year postoperatively was only 2.9 degrees . This mean difference is of no clinical significance . INTERPRETATION We concluded that in a preselected group of patients following primary total knee arthroplasty , inpatient physiotherapy with good instructions and a well-structured home exercise regime can dispense with the need for outpatient physiotherapy The efficacy of an early , intensive , supervised rehabilitation program to accelerate knee strength recovery in the first 3 weeks postmeniscectomy by arthroscopy was evaluated using a r and omized controlled trial design . The maximal voluntary isokinetic strength of 31 men , r and omly allocated to either a  treatment ( EXP ) or a  control ( CTL ) group , was measured twice by a blind rater : preoperatively ( pretest ) and 3 weeks postsurgery ( posttest ) , using a computer-controlled Kin-Com dynamometer ( Chattecx Corporation , Chattanooga , TN ) . Strength deficits of the operated leg at the pretest and posttest were established in percent of the values obtained for the sound leg at the pretest . In the interval between the surgery and the posttest , the patients of the EXP group ( n = 15 ) received nine supervised treatments combined to home exercises whereas patients of the control group ( n = 16 ) had no specific physiotherapy treatment but were given instructions in postsurgical management and prescribed exercises by the orthopedic surgeons . Patients of the EXP group had better knee extensor strength recovery than patients of the CTL group ( ANCOVA , p < 0.001 ) . The size of the strength difference ( 3 weeks postsurgery ) between EXP and CTL subgroups ( n = 8) matched according to preoperative deficits was as large as 26 % and the residual deficits of the untreated patients were two to three times larger than those of the treated patients . The results of this study highlight the importance of instituting an early intensive and supervised rehabilitation program , especially for workers returning to a strenuous job requiring good knee extensor muscle function Background Because of health care funding and policy changes , there is a need to examine the effects of an evolution toward patient-directed ( ie , home-based ) rehabilitation programs on clinical outcomes of patients undergoing anterior cruciate ligament reconstruction . Hypothesis There will be no difference in the effectiveness of a home-based rehabilitation program and a st and ard physical therapy-supervised rehabilitation program in patients 3 months after nonacute anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts . Study Design R and omized controlled clinical trial ; Level of evidence , 1 . Methods There were 145 patients ( 16 - 59 years ) who attended a presurgery education class . Home-based patients attended 4 physical therapy sessions , and physical therapy-supervised patients attended 17 physical therapy sessions over the first 12 weeks after surgery . All patients followed the same st and ardized rehabilitation program . Study outcome measures included active-assisted knee flexion and passive knee extension range of motion , knee range of motion during walking , KT computerized arthrometer results , and isokinetic quadriceps and hamstrings strength . Patient outcomes were dichotomized as either clinical ly acceptable or unacceptable . Rehabilitation programs were compared by the proportion of acceptable patients in each group . Results The home-based group had a significantly higher percentage of patients with acceptable flexion and extension range of motion compared to the st and ard physical therapy group ( flexion , 67 % vs 47 % ; extension , 97 % vs 83 % ) . There were no significant differences between the groups in range of motion during walking , ligament laxity , and strength . Conclusion A structured , minimally supervised rehabilitation program was more effective in achieving acceptable knee range of motion in the first 3 months after anterior cruciate ligament reconstruction than a st and ard physical therapy-based program . Clinical Relevance Recreational athletes undergoing nonacute anterior cruciate ligament reconstruction can successfully reach acceptable rehabilitation goals in the first 3 months after surgery with a limited number of purpose ful physical therapy education sessions , allowing recreational athletes more flexibility when integrating the necessary postoperative rehabilitation into their daily activities
target: In select young and healthy population with few co morbidities  supervised physical therapy  is no more beneficial than a  home exercise program  following relatively simple knee surgical procedures ( arthroscopic meniscetomy ) .
background: Physical therapy is common following a knee surgery .
  With rising healthcare costs there is debate as to the appropriateness of outpatient physical therapy following such interventions .
  Many of the existing controlled trials have concluded that there is no benefit to subjects that receive supervised physical therapy when compared to subjects that perform their exercises at home .
  The purpose of this systematic review was to consider the existing evidence regarding benefit following  knee surgery  and evaluate the quality , internal and external validity of such evidence .