OBJECTIVES: A systematic literature review was conducted to evaluate whether supervised rehabilitation after total knee arthroplasty (TKA) is safe and effective compared to unsupervised home-based rehabilitation.

METHODS: The literature search was performed using four international databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Physiotherapy Evidence Database) and two domestic databases (KoreaMed and KMbase). We selected only randomized clinical trials (RCT). Primary outcomes were: patient-reported functional outcome, patient-reported pain or discomfort and quality of life. Secondary outcomes were: evaluator-assessed functional outcomes and treatment-related complication or adverse events. Assessment for risk of bias was performed using Cochrane’s tool. Two researchers independently reviewed the literature and assessed the risk of bias. After data extraction, a meta-analysis was performed when appropriate.

RESULTS: A total of 11 RCTs were included. Patient-reported functional outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Function subscale, Knee Injury Osteoarthritis Outcomes Score (KOOS), Oxford Knee Score (OKS), Canadian Occupational Performance Measure (COPM) Performance subscale, Patient-Reported Outcomes Measurement Information System (PROMIS) Physical function subscale, and RAND 36 physical component score. Except for one study, no significant difference was found between supervised and unsupervised rehabilitation. Patient-reported pain or discomfort was evaluated with visual analog scale (VAS), WOMAC Pain subscale, and KOOS Pain subscale. In all cases, there was no significant difference between supervised and unsupervised rehabilitation. Quality of life was evaluated by EQ-5D, SF-36, SF-12, and KOOS Quality of life subscale. No study reported results using EQ-5D. In the studies that reported their results using other tools, there were no significant differences between the supervised and unsupervised rehabilitation.

CONCLUSIONS: The available evidence suggests that the improvement in outcomes did not clearly differ from supervised and unsupervised rehabilitation after TKA. Thus, home-based rehabilitation can be an adequate alternative for proper patients after TKA.