| The purpose of this study was to determine the cost-effectiveness of a home-based rehabilitation program (H) relative to a standard physiotherapy-supervised rehabilitation program (PT) in patients three months following anterior cruciate ligament (ACL) reconstruction.; This randomized clinical trial recruited 145 recreationally active patients (16--59 years) booked for their first ACL reconstruction with a bone-patellar tendon-bone graft. WCB patients & elite athletes were excluded. All patients attended a pre-surgery education class. Patients were randomized to either the H or PT group before surgery. H patients attended structured physiotherapy sessions at 1, 3, 6 & 12 weeks post-surgery (total of 4). PT patients attended 17 physiotherapy sessions over the first 12 weeks following surgery. All patients followed the same standardized rehabilitation program. Study outcome measures included knee flexion & extension range of motion (ROM), knee range of motion during gait, KT computerized arthrometer (anterior-posterior knee laxity), isokinetic quadriceps and hamstrings strength and the cost of each program from the viewpoints of the health care system, the patient, employers and society. Clinically acceptable outcomes: knee flexion & extension ROM within 5° of the contralateral knee, ligament laxity within 5 mm side to side difference, affected quadriceps strength ≥50% of the contralateral and affected hamstrings strength ≥75% of the contralateral.; Fisher's exact tests were used to determine differences in the number of acceptable outcomes in each group. 129 patients were available for 12 week follow-up. The H group had a significantly higher percentage of patients with acceptable flexion and extension ROM (p = 0.03, p = 0.02 respectively). There were no significant differences between groups with respect to ROM during gait (flexion: p = 0.13, extension: p = 0.38), ligament laxity (p = 0.36) and strength (quadriceps: p = 0.27, hamstrings: p = 0.16). The mean difference in cost per patient favoured the H group from the viewpoints of the health care system ({dollar}303.69), patient ({dollar}81.45), employer ({dollar}546.55) and society ({dollar}729.79). The H program was therefore more effective and less costly than the PT program.; These data demonstrate that a highly structured, minimally-supervised rehabilitation program is economically dominant in the first three months following ACL reconstruction. |
