Home-based rehabilitation programme compared with traditional physiotherapy for patients at risk of poor outcome after knee arthroplasty: the CORKA randomised controlled trial.

Objectives: To evaluate whether a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty offers superior outcomes to traditional outpatient physiotherapy.
Design: A prospective, single-blind, two-arm randomised controlled superiority trial.
Setting: 14 National Health Service physiotherapy departments in the UK.
Participants: 621 participants identified at high risk of a poor outcome after knee arthroplasty using a bespoke screening tool.
Interventions: A multicomponent home-based rehabilitation programme delivered by rehabilitation assistants with supervision from qualified therapists versus usual care outpatient physiotherapy.
Main Outcome Measures: The primary outcome was the Late-Life Function and Disability Instrument (LLFDI) at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function), Knee injury and Osteoarthritis Outcome Score Quality of Life subscale, Physical Activity Scale for the Elderly, 5 dimension, 5 level version of Euroqol (EQ-5D-5L) and physical function assessed using the Figure of 8 Walk test, 30 s Chair Stand Test and Single Leg Stance.
Results: 621 participants were randomised between March 2015 and January 2018. 309 were assigned to CORKA (Community Rehabilitation after Knee Arthroplasty) home-based rehabilitation, receiving a median five treatment sessions (IQR 4-7). 312 were assigned to usual care, receiving a median 4 sessions (IQR 2-6). The primary outcome, LLFDI function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference=0.49 points; 95% CI -0.89 to 1.88; p=0.48). There were no statistically significant differences between the groups on any of the patient-reported or physical secondary outcome measures at 6 or 12 months.There were 18 participants in the intervention group reporting a serious adverse event (5.8%), only one directly related to the intervention, all other adverse events recorded throughout the trial related to underlying chronic medical conditions.
Conclusions: The CORKA intervention was not superior to usual care. The trial detected no significant differences, clinical or statistical, between the two groups on either primary or secondary outcomes. CORKA offers an evaluation of an intervention utilising a different service delivery model for this patient group.
Trial Registration Number: ISRCTN13517704.
Competing Interests: Competing interests: GC is a member of the HTA Commissioning Board. A Price has a consultancy with Zimmer Biomet, outside the submitted work. MU has grants from NIHR, during the conduct of the study; grants from NIHR, Personal fees from NIHR, Personal fees from NICE, non financial support from Stryker PLC, grants from SERCO. SL has grants from NIHR Health Technology Assessment Programme during the conduct of the study and is a member of the following Boards: HTA Additional Capacity Funding Board 2010-2015, HTA Clinical Trials Board 2010-2015, HTA End of Life Care and Add on Studies 2015-2015, HTA Funding Boards Policy Group (Formally CSG) 2010–2015, HTA MNCH Methods Group 2013–2015, HTA Post-board funding teleconference (PG members to attend) 2010–2015, HTA Primary Care Themed Call board 2013–2014, HTA Prioritisation Group 2014–2015, NIHR CTU Standing Advisory Committee 2012–2016.
(© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)