Table 1 Characteristics of included studies

Bruun-Olsen et al. 2013 [29] Norway 2008-2010

Primary TKA

Walking skills

On completion of intervention and 9 months after intervention

Osteoarthritis

Outpatient physiotherapy department

KOOS, 6 minute walk test, performance tests, ROM, self-efficacy in activities

N = 57 (29:28)

Physiotherapist-led walking-skills programme with emphasis on weight-bearing exercises. Commenced 6 weeks after surgery

28/29 completed programme (97%)

6 (2:4) not followed up

69 (56.1%)

6–8 weeks

Usual physiotherapy

Evgeniadis et al. 2008 [19] Greece 2006

Primary TKA

Strengthening

6, 10 and 14 weeks after surgery

Osteoarthritis

Home

SF-36, Iowa Level of Assistance Scale, active ROM

N = 48 (24:24)

Supervised exercise programme with emphasis on strengthening lower extremities

20/24 completed programme (83%)

69 (56.3%)

Commenced after hospital discharge

13 (9:4) not followed up

8 weeks

Control received standard preoperative and postoperative care

Frost et al. 2002 [17] UK 1995-1996

Primary unilateral TKA

Functional exercise

3, 6 and 12 months

Osteoarthritis

Home

VAS pain, ROM, leg extensor power, walking speed, gait speed

N = 47 (23:24)

Warm up exercise, chair rise, walking, and leg lifts. Commenced after hospital discharge

16/23 completed programme (70%)

71.3 (48.9%)

Number of visits and duration not specified

20 (7:13) not followed up

Controls given instructions to continue exercises taught in hospital

Fung et al. 2012 [27] Canada 2009-2010

TKA

Balance and posture control additional to outpatient physiotherapy

Discharge from physiotherapy, estimate about 3 months

Not specified

Outpatient department in rehabilitation hospital

ROM, 2-minute walk test, NRS pain, LEFS, Activity-specific Balance Confidence Scale, length of rehabilitation, satisfaction

N = 50 (27:23)

Wii Fit gaming activities focused on multidirectional balance, and static and dynamic postural control

27/27 completed programme (100%)

68.1 (66%)

Commenced a mean of 38–47 days after surgery

0 lost to follow up

Twice weekly for mean of about 8 weeks

All patients received twice-weekly outpatient physiotherapy. Control patients also received 15 minutes of lower extremity strengthening and balance training exercises

Harmer et al. 2009 [30] Australia 2005-2006

Primary TKA

Hydrotherapy compared with gym-based therapy

8 and 26 weeks

Not specified

Community pool

WOMAC, VAS, 6 minute walk test, stair ascent, ROM, knee oedema

N = 102 (53:49)

Supervised classes in pool with walking forward and backward, stepping sideways, step-ups, jogging, jumping, kicking, knee ROM exercises, lunges, and combined squats and upper extremity exercises.

81% of patients attended at least 8/12 sessions 3 (2:1) lost to 26 week follow up

68.3 (57%)

Commenced 2 weeks after surgery

Twice a week, 60 min duration for 6 weeks

Control patients received gym-based rehabilitation with ergometer cycling; walking on a treadmill; stair climbing; standing isometric, balance and knee ROM exercises at a bar; and sit to stand exercises

Kauppila et al. 2010 [13] Finland 2002-2005

Primary unilateral TKA

Multidisciplinary rehabilitation programme

2 months, 6 months, 12 months

Osteoarthritis

University hospital outpatient department

WOMAC, 15 min walk test, stair ascent/ descent test, isometric strength, ROM

N = 86 (44:42)

Week 1: physiotherapist assessment; 3 group sessions (45 minutes) with lower limb strengthening exercises; 2 pool gymnastic sessions (30 minutes) with lower limb stretching and mobility, and functional exercises focused on walking; lectures by social worker (60 minutes) and nutritionist (90 minutes)

44/44 attended multidisciplinary rehabilitation programme (100%)

70.6 (75.6%)

Week 2: 2 lower limb strengthening exercise group sessions (45 minutes); 3 pool gymnastic sessions (45 minutes); orthopaedic surgeon lecture (45 minutes) and clinical assessment (15 minutes).

11 (8:3) lost to 6 and 12 month follow up

Included 60–80 years

Daily supervised group stretching exercises (30 minutes)

Twice weekly supervised group Nordic walking (30 minutes)

4 group rehearsals of relaxation strategies (30 minutes)

Individualised exercise recommendations (40 minutes).

2 group sessions on coping strategies (90 minutes) and individual visit with psychologist

Total 10 days at 2–4 months after surgery

Control received an exercise programme to complete at home from 2 months after surgery.

Kramer et al. 2003 [25] Canada Not specified

Primary unilateral TKA

Basic and advanced ROM and strengthening exercises.

12, 26 and 52 weeks

Osteoarthritis

Home- and clinic- based groups

WOMAC, SF-36, KSS, stair ascent and descent, 6 minute walk test

N = 160 (80:80)

Attended outpatient physical therapy. Therapists able to modify or add exercises, use therapeutic modalities, joint mobilisations or other measures as appropriate

154/160 complete programmes (96%)

68.4 (56.9%)

Between 2 to 12 weeks after surgery, two sessions per week for 1 hour per session

26 (11:15) medical issues, withdrawn consent

Home-base group received a telephone call once in week 2 to 6 and once in weeks 7–12 reminding them of the importance of exercise and to give advice

Liebs et al. 2010 [28] Germany 2005-2006

Primary unilateral TKA

Ergometer cycling (additional to standard programme)

3, 6, 12 and 24 months

Osteoarthritis or osteonecrosis

Multiple hospitals

WOMAC, SF-36 PCS, patient satisfaction

N = 159 (85:74)

Cycling with minimal resistance under guidance of a physical therapist. Aim was to improve muscle coordination, proprioception and ROM.

No information on patient adherence reported

69.8 (71.7%)

Three times a week for at least three weeks, starting after the second postoperative week

24 (10:14) lost to follow up at 3 months

Controls received standard physiotherapy programme only

Madsen et al. 2013 [24] Denmark 2010-2011

Fast-track primary TKA

Group-based programme compared with home-based programme

3 and 6 months

Osteoarthritis

Physiotherapist led strength endurance training, education, patient discussion. Home exercises twice weekly with strength training, endurance training on exercise bike, walking, balance, training and muscle strength training.

OKS, SF-36 physical function, EQ-5D, ROM, peak Leg Extensor Power, balance test, 10 m walk test, sit-to-stand tests, VAS pain during Leg Extensor Power test.

N = 80 (40:40)

2 sessions per week for 6 weeks starting 4–8 weeks after surgery. Average 10.5 sessions (range 4–12)

Patients in group-based programme attended mean 10.5 sessions (range 4–12). Adherence to home-based programme not reported

66.6 (41%)

Home exercises with 1–2 planned visits by a local physiotherapist

10 (4:8) lost to follow up

Minns Lowe et al. 2012 [20] UK 2006-2009

Primary TKA

Home-based functional rehabilitation

3, 6 and 12 months

Osteoarthritis

Home

OKS, KOOS, leg extensor power, timed sit to stand test, 10 metre timed walk

N = 107 (56:51) received surgery

2 physiotherapist home visits within 2 weeks and at 6–8 weeks after discharge. Assessment of function and rehabilitation progress on gait re-education, and use of walking aids. Twice daily exercise for 3 months: weight, partial knee bends/quarter squats, standing knee flexion and extension wall sits, heel and knee raises, step-overs, and stretches. Task training: getting in and out of a car, getting up from a chair at a table, walking outside and stairs.

46/47 home-based group received 2 visits (98%)

69.2 (58%)

Controls received usual physiotherapy treatment provided at the hospital without additional home visits

1 (1:0) lost to follow up

Mitchell et al. 2005 [21] UK 1999-2000

Primary unilateral TKR

Home physiotherapy compared with outpatient group provision

12 weeks

Osteoarthritis

Up to 6 post-discharge home visits by community physiotherapist. Commenced 3–19 days after discharge. Patient assessment and individualised therapy relating to pain relief, knee flexion and extension, gait re-education, home and functional adaptations, reduction of swelling and mobilisation of soft tissues. Before surgery patients received 3 visits.

WOMAC, SF-36, resource use and cost

N = 115 (57:58)

Controls received exercises and individual treatment 1–2 times a week

Home-based group had a mean of 8.4 sessions. Outpatient group had a mean of 3.5 sessions

70.3 (57.9%)

1 (0:1) lost to ITT analysis (45 patients withdrawn mainly pre-surgery)

Mockford et al. 2008 [14] Northern Ireland Not specified

Primary TKA

Outpatient physiotherapy

3 months and 1 year

Osteoarthritis, rheumatoid arthritis

Outpatient department

Oxford Knee Score, SF-12, Bartlett Patella Score, ROM, Walking distance

N = 143 (71:72)

6 weeks starting within 3 weeks of hospital discharge

Intervention group attended mean 7.3 sessions (range 0–9). 43/71 attended all sessions (61%)

70.2 (61.5%)

Control received no outpatient physiotherapy following discharge. All patients were given a home exercise regime to follow on discharge

7(4:3) not followed up

Moffet et al. 2004 [18] Canada 1997-1999

Primary TKA

Intensive functional rehabilitation

4, 6, 12 months

Osteoarthritis

Rehabilitation Institute

WOMAC, SF-36, 6 minute walk test

N = 77 (38:39)

12 physiotherapist supervised sessions from 2 months after-discharge with individualised home exercises. 60-90mins per week for 6–8 weeks

All intervention patients participated in the 12 sessions

67.7 (59.7%)

Each session included: warm-up, specific strengthening exercises, functional task-oriented exercises, endurance exercises, and cool-down. ROM, pain and effusion monitored to optimise intervention.

6 (0:6) not followed up at 12 months

Control group received usual care including possibility of supervised rehabilitation at home

All patients were taught a home exercise programme before hospital discharge.

Monticone et al. 2013 [16] Italy 2010

Primary TKR, osteoarthritis

Home-based functional exercise programme

6 and 12 months

N = 110 (55:55)

Home

Knee injury and Osteoarthritis Outcome Score (KOOS), Tampa Scale for Kinesiophobia, NRS pain, SF-36

67 (64%)

Continuation of functional exercises provided in hospital. Cognitive behavioural intervention with home exercise book about the fear-avoidance model and management of kinesiophobia. Monthly phone calls to reinforce adherence.

No patients dropped out of study but no information collected on patient adherence

Commenced after discharge from rehabilitation unit

0 losses to follow up

Twice-weekly 60-minute sessions for 6 months

No physiotherapy. Advice to stay active

Piqueras et al. 2013 [22] Spain 2008-2010

Primary TKR, able to walk and with no contra-indications for rehabilitation

Outpatient and home-based telerehabilitation

2 weeks after intervention and 3 months

Osteoarthritis

5 sessions under therapist supervision at rehabilitation department and 5 sessions at home

ROM, isometric hamstring and quadriceps strength, pain, WOMAC, timed up and go test

N = 142 (72:70). 181 randomised but 142 completed baseline measures

Commenced after 2 week rehabilitation programme after hospital discharge

18/72 home-based (25%) and 21/70 outpatient (30%) dropped out during first 5 sessions.

73.5 (72.4%)

Interactive virtual telerehabilitation. Patients received information needed to perform exercises and remote therapist monitoring. Therapy modified as rehabilitation evolved. System used wireless movement sensors, interactive software and a touch-screen computer, and a web-portal.

9 (4:5) lost to follow up

Daily 1 hour sessions for 10 days

Conventional out-patient physical therapy. All randomised patients received a 2 week rehabilitation programme immediately after hospital discharge

Piva et al. 2010 [26] USA 2007-2008

Unilateral TKR in the last 2-6months

Balance exercises (additional to supervised functional training programme)

2 months and 6 months

Not specified

Outpatient physical therapy department

WOMAC, Lower Extremity Functional Scale, timed chair rise test, self-selected gait speed over 4 m

N = 43 (21:22)

Additional balance exercises (agility and perturbation)

84% completed programmes. 64-67% of prescribed exercises completed

68.5 (71.4%)

Control group received a supervised functional training program without additional balance exercises

8 (3:5) not followed up

Commenced 2–6 months after surgery

All patients received 12 sessions of functional training over 6 weeks

Home exercises given to both groups at the end of the supervised programme

Rajan et al. 2004 et al. [15] UK 1998-1999

Primary TKA

Outpatient physiotherapy

3 months, 6 months and 1 year

Monoarticular arthrosis

Outpatient

ROM

N = 120 (59:61)

Average 4–6 physiotherapy sessions

No information on patient adherence

68.5 (62.9%)

Commenced after discharge from hospital

4 (3:1) not followed up

Control group did not receive outpatient physiotherapy

All patients given a home exercise regime on discharge

Tousignant et al. 2011 [23] Canada Not specified

TKA

Functional rehabilitation

4 months

Not specified

Home

Knee range of motion, Berg balance scale, 30 second chair-stand test, WOMAC, Timed up and go, Tinetti test, functional autonomy measu(SMAF), SF-36

N = 48 (24:24)

Intervention group received tele-rehabilitation through high speed internet. Progressive exercises to reduce disability and improve function in ADL. Family member or friend present to ensure safety

No information on adherence

66 (unreported)

2 sessions per week for 8 weeks

7 (3:4) not followed up

Commenced within 5 days of hospital discharge

Approx 1 hour duration

Control group received usual home care services and outpatient rehabilitation over 2 month period