Outcomes of group exercise following hip or knee arthroplasty in an inpatient rehabilitation setting: a non-inferiority trial

Submission note: This thesis is submitted in total of the requirements for the Master of Applied Science (Research) to the School of Allied Health, La Trobe University, Victoria, Australia.

Delivering exercise therapy in a group format is a common strategy in the management of post-operative hip and knee arthroplasty rehabilitation. However, it is not clear whether patients may expect outcomes from rehabilitation inclusive of group exercise that are similar to those of exercise that is delivered only on an individual basis. The aim of this thesis was to evaluate whether replacing one of two daily one-to-one exercise sessions with group exercise is not inferior to two one-to-one exercise sessions in inpatient rehabilitation setting for patients with hip or knee arthroplasty. Chapter two outlines a systematic review that investigates whether exercise therapy that is delivered to a group of patients with hip or knee osteoarthritis or arthroplasty provides similar outcomes as exercise that is delivered one-to-one. Evidence of the effectiveness of group exercise therapy is limited in these populations but suggests that outcomes are similar for each delivery mode. In the main study of this thesis, 88 participants were allocated by block randomization to receive either two daily sessions of one-to-one exercise (IndEx) or replacement of one of these sessions with group-based exercise (GpEx) on admission to an inpatient rehabilitation facility following hip or knee arthroplasty. The primary outcome of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to determine non-inferiority of the group exercise; secondary outcomes included quadriceps strength, Timed Up and Go, 10 Meter Walk Test, Six Minute Walk Test, cadence, velocity, stride length, hospital length of stay and patients’ satisfaction. Outcomes were assessed on admission, at discharge and at six months. Outcomes for GpEx participants were not inferior to IndEx on all outcomes. Replacing one of two daily one-to-one exercise sessions to group exercise does not lead to inferior clinical outcomes for patients at inpatient hospital discharge.