Group Therapy Best for TKA

You’ve had a knee replaced. Now which is better—home-based one-to-one therapy or physical therapy with a group? An Australian study has found “very strong evidence that one-to-one therapy does not provide superior outcomes to group-based therapy or monitored home programs in the short and longer term after total knee arthroplasty.”

Victoria Ko and colleagues analyzed 249 total knee arthroplasty patients who, at two weeks after surgery, went to a six-week treatment program. Ko randomly assigned the patients to 12 one-to-one therapy sessions, 12 group-based therapy sessions or a monitored home program.

At 10 weeks, the one-to-one therapy group had a median Oxford Knee score of 32 points compared with 36 points in the group-based therapy and 34 points in the home-based therapy groups. Ko and colleagues noted no significant differences across any of the therapy groups regarding secondary outcomes measures. There were also none among the 233 patients who remained available for the one-year follow-up.

Ko noted in her study that providers of one-to-one therapy do so at greater cost without securing significantly better outcomes for their patients. “This revelation is particularly relevant in light of the growing numbers of total knee arthroplasties undertaken annually in the absence of enhanced rehabilitation resources, ” she wrote.