Effect of group-based outpatient physiotherapy on function after total knee replacement: The ARENA randomised controlled trial

Erik Lenguerrand, Neil Artz, Elsa Marques, Emily Sanderson, Kristina Lewis, James Murray, Tarique Parwez, Wendy Bertram, Andrew D. Beswick, Amanda Burston, Rachael Gooberman-Hill, Ashley W. Blom, Vikki Wylde

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
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ObjectiveTo evaluate the long‐term clinical effectiveness of a novel group‐based outpatient physiotherapy following total knee replacement (TKR).
MethodsIn this two centre, unblinded, superiority, randomised controlled trial, 180 patients on a waiting list for primary TKR due to osteoarthritis were randomised to a 6 session group‐based outpatient physiotherapy intervention and usual care (n=89) or usual care alone (n=91).The primary outcome was patient‐reported functional ability measured by the Lower Extremity Functional Scale at 12 months post‐operative. Secondary outcomes included knee symptoms, depression, anxiety and satisfaction. Questionnaires were completed pre‐operatively and 3, 6 and 12 months post‐operatively.
ResultsThe mean difference in function between groups was 4.47 (95% CI 0.20 to 8.75; p=0.04) at 12 months post‐operative, favouring the intervention.. The mean difference in function between groups decreased over time; from 8.1 points at 3 months (95% CI 3.8 to 12.4; p<0.001) to 5.4 (95% CI 1.1 to 9.8; p=0.015) at 6 months post‐operative. There were no clinically relevant differences in any secondary outcomes between groups, although patients in the intervention group were more likely to be satisfied with their physiotherapy. No serious adverse events related to the intervention were reported.
ConclusionSupplementing usual care with this group‐based outpatient physiotherapy intervention led to improvements in function at 12 months after TKR, although the magnitude of the difference was below the minimal clinically important different of 9 points. However, patient satisfaction was higher in the intervention group and there was some evidence of clinically relevant improvements in function at 3 months.
Original languageEnglish
JournalArthritis Care and Research
Publication statusPublished - 29 Apr 2019

Structured keywords

  • Centre for Surgical Research


  • Knee replacement
  • physiotherapy
  • function
  • pain
  • satisfaction


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