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Publication - Professor Rachael Gooberman-Hill

    Effect of group-based outpatient physiotherapy on function after total knee replacement

    The ARENA randomised controlled trial


    Lenguerrand, E, Artz, N, Marques, E, Sanderson, E, Lewis, K, Murray, JRD, Parwez, T, Bertram, W, Beswick, A, Burston, A, Gooberman-Hill, R, Blom, A & Wylde, V, 2019, ‘Effect of group-based outpatient physiotherapy on function after total knee replacement: The ARENA randomised controlled trial’. Arthritis Care and Research.



    To evaluate the long‐term clinical effectiveness of a novel group‐based outpatient physiotherapy following total knee replacement (TKR).


    In this two centre, unblinded, superiority, randomised controlled trial, 180 patients on a waiting list for primary TKR due to osteoarthritis were randomised to a 6 session group‐based outpatient physiotherapy intervention and usual care (n=89) or usual care alone (n=91).

    The primary outcome was patient‐reported functional ability measured by the Lower Extremity Functional Scale at 12 months post‐operative. Secondary outcomes included knee symptoms, depression, anxiety and satisfaction. Questionnaires were completed pre‐operatively and 3, 6 and 12 months post‐operatively.


    The mean difference in function between groups was 4.47 (95% CI 0.20 to 8.75; p=0.04) at 12 months post‐operative, favouring the intervention.. The mean difference in function between groups decreased over time; from 8.1 points at 3 months (95% CI 3.8 to 12.4; p<0.001) to 5.4 (95% CI 1.1 to 9.8; p=0.015) at 6 months post‐operative. There were no clinically relevant differences in any secondary outcomes between groups, although patients in the intervention group were more likely to be satisfied with their physiotherapy. No serious adverse events related to the intervention were reported.


    Supplementing usual care with this group‐based outpatient physiotherapy intervention led to improvements in function at 12 months after TKR, although the magnitude of the difference was below the minimal clinically important different of 9 points. However, patient satisfaction was higher in the intervention group and there was some evidence of clinically relevant improvements in function at 3 months.

    Full details in the University publications repository