Abstract
The original RCT demonstrated that a limitedly-supervised post-ACL reconstruction rehabilitation program was both clinically more effective and less costly than the traditional physiotherapy-supervised program. This study contacted patients from the original RCT a minimum of two years post-surgery to evaluate whether or not the clinical findings of the RCT were upheld over the long term. This study of eighty-eight patients has upheld the original findings in that the patients who performed the limitedly-supervised (home-based) program had a significantly higher mean disease-specific quality of life score compared to the patients who performed the physiotherapy-supervised rehabilitation program.
To determine whether or not there were any differences in long-term outcome between those patients who performed a physiotherapy-supervised rehabilitation program (PT) and those who performed a primarily home-based rehabilitation program (H) in the first three months following ACL reconstruction.
Patients were originally randomized, before ACL reconstruction surgery, to either the physiotherapy-supervised (seventeen physiotherapy sessions) or home-based program (four physiotherapy sessions). Eighty-eight of the original patients were able to return two to four years following surgery to assess their long-term clinical outcomes. Primary outcome: the Mohtadi ACL disease-specific quality of life questionnaire (ACL QOL). Secondary outcomes: bilateral difference in knee extension and flexion range of motion, sagittal plane knee laxity, relative quadriceps and hamstrings strength, and IKDC score. Unpaired t-tests were used to compare the two groups across the continuous variables. A Chi square test was used for the categorical data.
The home-based group had a significantly higher (p = 0.02, 95% CI [18.4, 1.7]) mean ACL QOL score (80.0 ± 16.2) compared to the physiotherapy-supervised group (69.9 ± 22.0) a mean of forty months post-surgery. There were no significant differences between the two groups with respect to any of the secondary outcome measures.
This long-term study upholds the short-term findings of the original RCT in that the home-based rehabilitation program is more effective than a more physiotherapy-intensive program for patients in the first three months following ACL reconstruction.
Given the resource savings demonstrated in the original RCT, the home-based program is clearly economically-dominant (i.e., clinically more effective and less expensive).
FUNDING: Calgary Health Region
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
