Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: A randomized clinical trial involving 87 patients with 3 months of follow-up

Figures & data

Figure 1. Flow chart of patients in the randomized clinical trial.

Table 1.  Baseline data for 87 patients in the current intervention and accelerated intervention groups, Denmark 2005–2006

Group	Accelerated intervention	Current intervention
All (n)	45	42
Female/male ratio	25/20	19/23
Age, mean (SD)	64(10.8)	66 (9.2)
Mean QOL^a (SD)	0.46 (0.28)	0.53 (0.22)
THA (n)	28	28
Female/male ratio	15/13	11/17
Age, mean (SD)	62(11.3)	65 (9.5)
Arthrosis coxae/other	27/1	28/0
Implant cemented/uncemented ratio	8/20	12/16
Mobility, level 1/2/3^b	2/25/1	1/27/0
Self-care, level 1/2/3	13/14/1	16/12/0
Usual Activities, level 1/2/3	3/20/5	1/23/4
Pain/Discomfort, level 1/2/3	0/13/15	0/14/14
Anxiety/Depression, level 1/2/3	20/7/1	22/6/0
Mean QOL (SD)	0.45 (0.30)	0.49 (0.22)
TKA(n)	15	12
Female/male ratio	9/6	7/5
Age, mean (SD)	68(9.1)	67(10.2)
Arthrosis genus/other	15/0	11/1
Mobility, level 1/2/3	1/14/0	0/12/0
Self-care, level 1/2/3	10/5/0	11/1/0
Usual Activities, level 1/2/3	2/8/5	2/7/3
Pain/Discomfort, level 1/2/3	0/6/9	0/8/4
Anxiety/Depression, level 1/2/3	8/7/0	11/1/0
Mean QOL (SD)	0.44 (0.24)	0.60 (0.22)
UKA(n)	2	2
Female/male ratio	1/1	1/1
Age, mean (SD)	60(13.4)	61 (6.4)
Arthrosis genus/other	2/0	2/0
Mobility, level 1/2/3	0/2/0	1/1/0
Self-care, level 1/2/3	1/1/0	1/1/0
Usual Activities, level 1/2/3	0/2/0	0/1/1
Pain/Discomfort, level 1/2/3	0/2/0	0/2/0
Anxiety/Depression, level 1/2/3	0/2/0	1/1/0
Mean QOL (SD)	0.67 (0.05)	0.66 (0.22)

^a Quality of life from EQ-5D.

^b Statement from EQ-5D:

Level 1: no problems;

Level 2: some/moderate problems;

Level 3: unable to perform task/extreme problems.

Table 2.  Patient characteristics at baseline for two groups not included in randomized study: a concurrent control and a historical control group of 412 patients, Denmark 2004–2006

Group	Eligible for randomized study		Non-randomized study
	Not included in study
	On criteria	Refused participation	Concurrent	Historical
All (n)	4	23	96	289
Female/male ratio	2/2	14/9	45/51	153/136
Age, mean (SD)	69 (5.5)	67(10)	67 (9.6)	65(12)
THA (n)	3	10	53	179
Female/male ratio	1/2	4/6	35/25	88/91
Age, mean (SD)	71 (5.8)	65(8.1)	66(10)	64(12)
Diagnosis coxarthrosis/other	3/0	10/0	49/4	151/28
Implant ratio cemented/uncemented	2/1	2/8	26/26	88/89
TKA (n)	1	12	43	110
Female/male ratio	1/0	9/3	20/23	65/45
Age, mean (SD)	65	70(12)	68 (9.0)	67(10)
Diagnosis gonarthrosis/other	1/0	10/3	43/0	106/4
UKA (n)		1
Female/male ratio		1/0
Age, mean (SD)		64
Diagnosis gonarthrosis/other		1/0

Table 3.  Unadjusted, crude and stratified mean length of stay (LOS) with standard deviation, in the accelerated intervention group, the current intervention group, and four other groups receiving the current procedure (499 patients). Median and median difference with 95% confidence limits between the accelerated and the current intervention group. Adjusted mean difference in length of stay, Denmark 2004–2006

Group	Eligible for randomized study				Non-randomized Concurrent
	Included in study		Excluded from study
	Accelerated intervention	Current intervention	Criteria	Refused	Concurrent	Historical
Unadjusted
Crude (n)	45	42	4	23	96	289
Mean (SD)	4.9 (2.4)	7.8(2.1)	8.3(1.7)	7.2(1.8)	8.7 (2.8)	9.3 (3.9)
Median	4	7
Difference^a, CI		3 (3–4)^b
P-value		< 0.001 ^c
Stratified
THA, (n)	28	28	3	10	53	179
Mean (SD)	4.4(1.3)	7.3(1.5)	9.0(1.0)	7.6(1.4)	7.8 (2.8)	9.2 (4.3)
Median	4	7
Difference, CI		3 (2–4)
P-value		< 0.001
TKA, (n)	15	12	1	12	43	110
Mean (SD)	6.1 (3.5)	9.3 (2.5)	6.0	7.2(1.8)	9.9 (2.5)	9.6 (3.3)
Median	4	8.5
Difference, CI		4 (2–5)
P-value		0.04
UKA, (n)	2	2		1
Mean (SD)	3.0 (0)	6.0(1.4)		3.0
Median	3	6
Difference, CI		3 (2–4)
P-value		0.3
Adjusted
Difference, CI		3.1 (2.3–4.0)^d
P-value		< 0.001

^aDifference: Median LOS current intervention – median LOS accelerated intervention.

^bHodges-Lehman median differences with 95% confidence interval.

^cDifference between groups tested with nonparametric equality-of-medians test.

^dMean difference with 95% confidence interval from multivariate linear regression including randomization group, QOL at baseline, gender, age, diagnosis, implant type, and randomization stratification.

Table 4.  Unadjusted, crude, and stratified mean quality of life (QOL) with standard deviation. Mean and median difference with 95% confidence interval between the accelerated and the current intervention group at 3-month follow-up, and gain from baseline to follow-up. Adjusted mean difference in quality of life at 3-month follow-up, for 87 hip and knee patients, Denmark 2005–2006

Group	Accelerated intervention	Current intervention	Difference^a	P-value
Unadjusted
Crude (n)	45	42
Follow-up	0.87 (0.15)^b	0.79 (0.20)	0.08 (0–0.16)^c	0.003^d
Gain	0.42(0.31)	0.26(0.31)	0.16 (0.02–0.29)^e	0.02^f
Stratified
THA (n)	28	28
Follow-up	0.88(0.17)	0.76 (0.23)	0.13(0–0.19)	0.001
Gain	0.44 (0.33)	0.27 (0.34)	0.16(0.2–0.35)	0.07
TKA (n)	15	12
Follow-up	0.86(0.11)	0.86 (0.09)	0 (−0.07–0.08)	0.1
Gain	0.42 (0.28)	0.26 (0.25)	0.16 (−0.06–0.37)	0.1
UKA (n)	2	2
Follow-up	0.85(0.21)	0.80 (0.06)	0.05 (−0.13–0.25)	0.3
Gain	0.18(0.17)	0.13(0.16)	0.05 (−0.75–0.65)	0.8
Adjusted
Follow-up			0.08(0.01–0.16)^g	0.03^h

^aDifference: QOL accelerated group – QOL current group.

^bMean (Standard deviation).

^cHodges-Lehman median differences with 95% confidence interval.

^dDifference between groups tested with nonparametric equality-of-medians test.

^eMean difference with 95% confidence interval.

^fDifference between groups tested with two-sample t-test.

^gMean difference with 95% nonparametric confidence interval based on 1,000 bias-corrected and accelerated bootstrap replicates.

^hMultivariate linear regression including randomization group, QOL at baseline, gender, age, diagnosis, implant type, and randomization stratification.