Why the committee made the recommendations
The committee agreed that outpatient rehabilitation after hip, knee or shoulder replacement is essential. Evidence suggested that, for people who have had hip or knee replacement, self-directed rehabilitation and supervised rehabilitation are similarly effective. Compared with self-directed rehabilitation, supervised rehabilitation is very costly. The committee agreed that, in their experience, self-directed rehabilitation is effective for most people after hip or knee replacement if undertaken with advice, and ongoing support if needed, from the physiotherapy or occupational therapy team.
There was no evidence to enable the committee to compare self-directed with supervised outpatient rehabilitation for people who have had shoulder replacement, so they recommended that advice may be given on either self-directed or supervised rehabilitation. They also made a recommendation for research.
The committee agreed, based on their experience, that provision needs to be made for people with additional needs that make self-directed outpatient rehabilitation difficult or who find that it is not meeting their rehabilitation goals, and who would benefit from supervised group or individual rehabilitation. They noted the lack of evidence in this area and made a recommendation for research on supporting rehabilitation for people with additional needs.
How the recommendations might affect practice
Although the proportions of people having self-directed or supervised rehabilitation after elective joint replacement are not known, it is likely that the recommendations will increase the proportion having self-directed rehabilitation and decrease rehabilitation costs.