key: cord-0781427-oua29mkc
authors: Nutarelli, Sebastiano; Delahunt, Eamonn; Cuzzolin, Marco; Delcogliano, Marco; Candrian, Christian; Filardo, Giuseppe
title: Home-Based vs Supervised Inpatient and/or Outpatient Rehabilitation Following Knee Meniscectomy: A Systematic Review and Meta-analysis
date: 2021-05-26
journal: JAMA Netw Open
DOI: 10.1001/jamanetworkopen.2021.11582
sha: 365a8197d01369268ec83e5c9b7dee586d3fff81
doc_id: 781427
cord_uid: oua29mkc

IMPORTANCE: Arthroscopic meniscectomy is one of the most common orthopedic procedures. The optimal postoperative approach remains debated. OBJECTIVE: To compare outcomes associated with home-based rehabilitation programs (HBP) vs standard inpatient and/or outpatient supervised physical therapy (IOP) following arthroscopic isolated meniscectomy (AM). DATA SOURCES: A systematic literature search was conducted on PubMed, Web of Science, Cochrane Library, and Scopus databases on March 15, 2021. The included studies were published from 1982 to 2019. STUDY SELECTION: Randomized clinical trials of patients treated with HBP vs IOP after AM were included. DATA EXTRACTION AND SYNTHESIS: Data were independently screened and extracted by 2 authors according to the Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guideline. The meta-analysis was performed using a random-effect model; when an I(2) < 25% was observed, the fixed-effect model was used. The Hartung-Knapp correction was applied. MAIN OUTCOMES AND MEASURES: The primary outcome was the Lysholm score (scale of 0-100 with higher scores indicating better knee function) and secondary outcomes were subjective International Knee Documentation Committee (IKDC) score, knee extension and flexion, thigh girth, horizontal and vertical hop test, and days to return to work, as indicated in the PROSPERO registration. Outcomes were measured in the short-term (ranging from 28 to 50 days) and the midterm (6 months). RESULTS: In this meta-analysis of 8 RCTs including 434 patients, IOP was associated with a greater short-term improvement in Lysholm score compared with HBP, with a mean difference of −8.64 points (95% CI, −15.14 to −2.13 points; P = .02) between the 2 approached, but the sensitivity analysis showed no difference. Similarly, no statistically significant difference was detected at midterm for Lysholm score, with a mean difference between groups of −4.78 points (95% CI, −9.98 to 0.42 points; P = .07). HBP was associated with a greater short-term improvement in thigh girth, with a mean difference between groups of 1.38 cm (95% CI, 0.27 to 2.48 cm; P = .01), whereas IOP was associated with a better short-term vertical hop score, with a mean difference between groups of −3.25 cm (95% CI, −6.20 to −0.29 cm; P = .03). No differences were found for all the other secondary outcomes. CONCLUSIONS AND RELEVANCE: No intervention was found to be superior in terms of physical and functional outcomes as well as work-related and patient-reported outcomes, both at short-term and midterm follow-up. Overall, these results suggest that HBP may be an effective management approach after AM in the general population.

eFigure. The robvis visual summary of the performed risk of bias assessment Note: RoB assessment differs across outcomes. Because the assessors were aware of intervention in all the included studies, the per outcome RoB should be rated higher for those outcomes rated by an assessor, such as the physical and functional outcomes. This does not affect the RoB of the PROs and work-related outcomes. The only included study providing outcomes not rated by an assessor (PROs) was the Moffet et al. (1994) 

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