Literature Review: Comparison of Home-Based Versus Supervised Physical Therapy After ACL Reconstruction
Home based and supervised physical therapy in Medicine and health service
Physical therapy can be carried out in different programmes depending on the patient’s interest. Mostly, these programmes are chosen depending on their efficiency, resource constraints, time consumption and cost effectiveness. In that case, there is a huge comparison between the home based programme and supervised clinical therapy. There are specific limitations which show how these programmes are different from each other.
Basically, they do not show any significant difference in terms of recovery. The only difference is in terms of cost and time consumption. The home based programme is more effective than the clinical supervised therapy. It is relatively cheaper in terms of transport and it cuts off unnecessary movements. This centralises the patients’ mind hence giving them confidence for quick recovery. The two programmes are studied in details where researches and the data obtained from both fields help to differentiate the both programmes. The research shows a slight difference in the two programmes where the home based programme is more effective in terms of time consumption and cost effectiveness.
In a broad spectrum, home based therapy programme takes place in the client’s home rather than in the rapist clinic. Most of these programmes are provided by the community health organisation as well as private therapists who are requested to provide services at one’s home. The programme is considered by many people as it reduces expenses like transport cost in such clinics when bringing services to those in extreme illness, childcare, personal crises or even lack of finance.
Standard clinical therapy is a programme that provides its services from a specific office, clinic or hospital. It is conducted by therapists themselves. This programme is costly in terms of transport, time consumption and even resource utilization. The two programmes have almost the same treatment strategy to the patients with unnoticeable difference in service delivery and recovery rate. Patients choose a programme that one feels is better to satisfy his or her needs. As a matter of fact, these two programmes are both effective in their service delivery. The only difference is that the home based programme seems to be more effective in terms of cost effectiveness and time consumption as compared to the supervised clinical programme.
Home based therapy programme is exercised and carried out at one’s home to speed up recovery rate where the place acts as a rehabilitation centre for the patient. It enables the patient to be independent and familiarise with their own daily duties reliable in the new environment. Basically, it involves the family members in the rehabilitation process. According to the Journal of International Medical Research (2008), patient suffering from ACL injuries not more than three months old who is ranging 18-35 years were selected.
Similarly, those who were involved in sport injuries, motor and vehicle accident that are able to give personal conclusion were selected. In post-operative rehabilitation, patients were sorted randomly either to attend home based or clinic.
Irrespective of the therapy programme chosen it shows the patient respondent well to both programs. However, the home based therapy programme patient give promising results in terms of time consumption and efficiency. The patients recover faster than the supervised therapy program. Similarly, they are able to carry on their standard chores within their locality.
Pros and cons
Comparatively, the home based programme is less expensive as the patients are not paying for the upkeep charges. By reducing the post operation activities it implies that the cost is greatly reduced. This is only possible in home based programme as the patient’s controls on how they are attended to. According to Knee Surg Sports Traumatol Arthros(2011), home based programme have clinical attendance after every three months of operation implying that the home based programme is cost effective and time conserving (John Grant et al, 2005).
In a broad spectrum, patients who participated in the home clinics cut off travel expense since every activity was carried out within their home places. Eventually, they travel to the hospital by the patient and relatives avoiding hence cutting off the expenses. Similarly, employee supervision was provided by the patient after the (ACL).
This implies that the patient is able to involve in the simple activities at home under family rehabilitation hence home based programme is more economical. Similarly, results of the study indicate that patients who are rehabilitee by therapist receive vocational training to help them develop confidence in their state as compared to those at home. Those who depend on their therapist for confidence take longer time to recover from (ACL) (Ugutmen et al, 2008).
Those involved in planning short term and long term goals in their life and free from therapist develop confidence independently hence takes less time to recover. This empowers personal confidence, hence they are able to appreciate their role in rehabilitative programme and empower personal efficiency. In the post-operative rehabilitation, Radom selection was done to the patient and assigned to the home based programme. They were guided to carry activities aimed at regaining their state of motion, improving their moving speed and retaining their strength. These were aimed to restore their initial motion state and reduce oedema and retain the ability and strength of the extensor muscle.
Phase two of the post-operative was aimed at gaining full muscle extension probably 900 through close chain exercise. In the third phase, patients returned into their normal exercise to retain their initial state of motion. Fourth phase patients were encouraged to get involved in sporting activities. The patients returned into the sporting activities and finally in contact sports. The first three stages were used to evaluate patient’s condition provided with complete home exercise manual aided by diagrams to carry on the exercise in the right manner.
Those who were categorised to attend the supervised program were excluded from the activities as to come up with a significant difference to quantify the results. Surprisingly, successful outcomes of the state of motion, strength and sagittal plane laxity and functional outcome showed closely results to those of standard based programme. The study validates short term outcomes that indicates that many of the home based programme were able to regain clinical acceptance state of motion and goals by the third month of post-operative time which is accompanied by cost-effective analysis that is performed together with the randomized clinical trial.
It demonstrates that home based program is time effective as compared to supervised programme. A strong pre-operative efficiency linked to the resulting surgery and rehabilitation results into the preinjured state. Specific outcome measures incorporates these variation directed toward sports and recreation (Ugutmen et al, 2008).
Results from the two programmes was analysed and compared using two tales t-test. After performance of arthroscopic minscetomy, sixteen patients in other clinics had meniscal tears ten hard lateral meniscal tears while the rest had both menial and lateral tears. Half of the patients were allocated to the home based programme while the other half were allocated to the supervised therapy programme. All of the patients from any of the group were lost to follow up and none of them was excluded from the study. After analysing the results, there was no significant difference between the results obtained from the two programmes. Both groups showed that there was reduction in their ability to move with improvement after the fourth week. Thigh atrophy was not so unique between the two groups.
Factors affecting ACL recovery
Clinical rehabilitation is one of the main factors affecting the ACL recovery. Different rehabilitation programmes can be put into place to aid in ACL reconstruction, but should aim at healing the wound first, gaining full extension, controlling leg sweating and having leg control before starting to tackle increased flexion, mounting a functional pace, tackling daily living activities and then joining competitive sports. The most important components of the home based rehabilitation activities are descriptive manual aided with pictures for a particular activity, scrutinised assortment of the accommodating patients and consisted follow-up with the physical therapist.
These combinations of events give the patient confidence in themselves and even a strong bondage between the assistive group and the patient, something that is very important to the patient for quick recovery. The patient is also given the ability to make his own choice and judgement on the activities to be carrient out something that is not in the standard clinical programme. This makes the home based programme more reliable in resource utilization.
The patients should be given proper education on the importance of physical therapy before undergoing whether home or clinical based rehabilitation for the ACL reconstructive surgery. Based on the results, home based rehabilitative programme is as reliable as the clinical based and time and cost effective. This is because most of the actions are done within the patient premises and no transport charges to be incurred.
Most importantly, ACL reconstruction with the home based rehabilitation programme for a patella-bone with tendon-bone outograft continued for a period of more than two years of the surgery. The study clearly indicates that home based group reported disease specific quality of life as compare to the clinical based one. Although in the statistics, the difference is so insignificant, because it was less than clinically relevance. Despite the ignorance of the difference, home based programmes seems to look it on the save side as compared to the clinical programme.
There is no significance difference between the groups for the secondary outcomes for knee extension and flexion range of motion, sagittal plane laxity, and quadriceps strength ratio or hamstring strength ratio. The limitation in the current study needs to be acknowledged. According to Advances in Physiotherapy (2009), the reaction rate is 68%, with only 51% of the patients accessible for full clinical follow-up. The specific activity level or proportion of patients returning to preinjured sports is not included. The disease-specific consequence measure incorporates these variables and is preferentially weighted toward the sport and recreation domain. The difference in scores between the two groups is statistically significant in analysing the resorts of the two studies (Ravena et al, 2009).
Despite being statistically significant, the mean scores at follow-up do not meet the priority definition of a clinically relevant ACL reconstruction. Importantly, the minimal clinical difference is difficult to achieve in a subjective patient-based outcome measure, and there is a general lack of agreement on how to correctly calculate this value. Given the co-author’s experience with the development and clinical use of the score over the past 10 years, a 15-point difference is considered conservative and clinically relevant. Distribution-based methods to determine the value have also been published and normally reported as the edge of essentiality.
Change is consistently close to a wide range of disease-specific and global patient-oriented rating scales. Previously, the identified SD of the ACL would be the mean difference between the groups in this study. Falling between the priorities opinion-based on the distribution based value. It is feasible that the current study may demonstrate a clinical difference in the rehabilitation groups. Furthermore, the work is clearly required to determine the questionnaire.
Patient’s comments regarding their feelings about the pros and cons of participating in a limited administered post-operative rehabilitation program had been a beneficial tally to this study. There are main areas for future work which include exploring the psychological issues of self-efficacy and motivation. This plays an important role in the success of the supervised rehabilitation program and the delineation (Erik, 2011).
An anterior cruciate ligament injury is the over-stretching, partial tearing, or complete tearing of the anterior cruciate ligament (ACL) in the knee. Surgical reconstruction of the ACL to repair the tear, and proper physical rehabilitation to strengthen the injured knee are used to bring the patient’s knee back to its pre-injured state.
Several research studies were done in order to determine if a home-based physical therapy program after anterior cruciate ligament reconstruction would be just as successful as a standard physical therapy program. These findings have concluded that there is no significant difference between the home-based program and the supervised physical therapy program, suggesting that a home-based approach can be a viable option in terms of time constraints cost-effectiveness and effective resource utilization.
ASA Revena S, Annchristin Johansson2 & Jerzy Leppert. (2009). A randomized study of two physiotherapeutic approaches after knee ligament reconstruction. Advances in Physiotherapy; 11: 30_41.
Erik Hohmann, Kevin Tetsworth, Adam Bryant (2011). Physiotherapy-guided versus home- based, unsupervised rehabilitation in isolated anterior cruciate injuries following surgical reconstruction. Knee Surg Sports Traumatol Arthrosc. 19:1158–1167.DOI 10.1007/s00167-010-1386-8.
E Ugutmen1, K Ozkan1, V Kilincoglu2, Fu Ozkan3, S Toker4, E Eceviz1 and F Altintas1. (2008). Anterior Cruciate Ligament Reconstruction by using Otogeneous Hamstring Tendons with Home-based Rehabilitation. The Journal of International Medical Research; 36: 253 – 259.
John A. Grant, Nicholas G.H. Mohtadi, Murray E. Maitland and Ronald F Zernicke. (2005).Comparison of Home versus physical Therapy-Supervised rehabilitation Programs after Anterior cruciate ligament Reconstruction. The American Journal of Sports Medicine.Vol. 33. No. 9.
John A. Grant and Nicholas G. H. Mohtadi. (2010). Two- to 4-Year Follow-up to a Comparison of Home versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction. The Amerians Journal of Sport Medicine. DOI: 10.1177/0363546509359763.