Jump to content

Knee Arthroplasty Home-Based Rehabilitation Evaluation

Original Editor - Stacy Schiurring

Top Contributors - Stacy Schiurring and Jess Bell  

What is Home-Based Rehabilitation?

Home-based rehabilitation is a form of therapy provided to patients in their own home. Rehabilitation professionals who can provide home-based rehabilitation care include physiotherapists, occupational therapists, and speech and language therapists (also called speech-language pathologists). Other services provided as part of home-based rehabilitation can include nursing care for ongoing medical assessment and medication management, social work / case management, and home-based aide services. Home-based aide service providers are non-licensed healthcare workers who focus on non-medical services and may assist with activities of daily living (ADLs), light housekeeping, meal preparation, and transportation.

Patients may be referred for home-based rehabilitation services for a wide variety of reasons, including but not limited to: (1) postoperative care, (2) following a hospital admission, (3) generalised deconditioning, (4) medical fragility, and (5) medical management of chronic underlying conditions, such as cancer, advanced chronic obstructive pulmonary disease (COPD), or high-level spinal cord injury. In many countries, patients must "qualify" for home-based rehabilitation services. For instance, they must have a documented medical need and be functioning at a "homebound" status. Being homebound means that a person has difficulty leaving their home without significant assistance or that leaving their home would negatively impact or endanger their health.[1]

Home-based rehabilitation services are available in multiple countries such as Australia,[2] Ireland,[3] Italy,[4] New Zealand,[5] the Netherlands,[4] South Africa,[6] Sweden,[4] the United Kingdom (UK),[7] and the United States (US).[4] Other countries like Mexico and South American nations are also expanding their rehabilitation services to include home- or community-based services.[8] Different countries refer to home-based rehabilitation services using different terms, such as "Community Allied Health Services" in Australia,[2] "domiciliary care" in Ireland,[3] "home visits" in South Africa,[6] "community care" in the UK,[7] and "home health rehabilitation" in the US.[4] This article uses the term "home-based rehabilitation" to describe this type of care.

Home-Based Rehabilitation and Knee Arthroplasty

Patients are increasingly returning directly home after knee arthroplasty and have, on average, shorter stays in hospital, with some returning home on day one post-surgery. As well as shorter hospital stays, patients undergoing knee arthroplasty may have more medical comorbidities.[9] [10]Home-based rehabilitation is a way to provide care to these individuals.

Research shows that home-based rehabilitation can improve patient outcomes when provided pre and/or postoperatively,[11] with home-based rehabilitation producing similar outcomes as clinic or in-patient-based therapy. Patients see improvements in functional ability and pain after both low and high frequency home-based rehabilitation visits.[12] Furthermore, a 2018 meta-analysis of nearly 6,000 patients determined that outcomes improved when people had access to more home visits: individuals who received 6 to 9 physiotherapy home visits experienced 25% greater improvement, those with 10 to 13 visits had a 40% improvement, and those with 14 or more visits had a 50% greater improvement, all with strong statistical significance (p < 0.0001). These associations remained even after accounting for medical complexity, baseline function, and duration of care.[13]

Home-Based Rehabilitation Evaluation

The home-based rehabilitation evaluation is a multi-faceted assessment of a patient's health and functional status. It focuses on a person's physical, emotional, and environmental well-being and should include typical evaluation procedures, such as collecting the patient's medical history, a physical assessment, an evaluation of functional ability, and family and / or care provider education and training.

A unique aspect of the home-based rehabilitation evaluation is the home safety evaluation, where a nurse or rehabilitation professional (typically a physiotherapist or occupational therapist) assesses a patient's safety within and when accessing the home. The goal of the home-based rehabilitation evaluation is to identify a patient's needs and develop a holistic care plan to support their recovery in a safe and accessible environment.[14]

Like all rehabilitation programmes, home-based rehabilitation is goal-driven. Some patients have the goal of returning to their prior level of function after a surgery or hospitalisation while others want to maintain a certain level of ability to maximise their independence in the home. Other programmes focus on care provider training and patient safety.

Components of a Home-Based Rehabilitation Evaluation

The full home-based rehabilitation evaluation is often completed by a multidisciplinary team, including nurses, physiotherapists, occupational therapists, speech and language therapists and social workers, with each discipline focusing on their area of practice.

Medical and social history: this part of the evaluation focuses on reviewing the patient's past medical history and current health status, including any recent hospitalisations, surgeries, or illnesses. Information on the patient's current medication list, allergies, and family medical background will also be collected. Social history can include the patient's current employment and / or student status, their normal mode of transportation, previous interests and enjoyed activities, and available family and friend support. Medication management will also be assessed to ensure that the patient is taking their medication correctly and effectively. An emotional assessment can also be completed to assess the patient's emotional well-being following a major life change, such as illness or hospitalisation, availability of a social support network, and overall quality of life.[14] Rehabilitation professionals should also review any changes in mobility or mobility limitations with the patient (e.g. weight-bearing status, use of assistive devices or orthotics, positioning needs).

Physical assessment: this part of the evaluation includes an assessment of vital signs, strength, sensation, reflexes, wounds or incision lines, skin integrity, and any other relevant health indicators. A pain assessment should also be completed to establish a baseline for the presence and severity of pain, as well as any interventions that might be needed. Rehabilitation professionals also complete a functional assessment,[14] which covers range of motion (ROM), strength, reflexes, sensation, balance, current level of mobility, gait and stairs negotiation, wheelchair management, and ability to perform ADLs (e.g. bathing, dressing, eating, cooking). Because home-based rehabilitation assessments are completed in the patient's home, the therapist can assess toilet and shower / bath transfers, bed mobility, and sit to stand transfers in the patient's real-world environment. Gait and / or wheelchair management can be assessed over surfaces the patient encounters every day. This provides rehabilitation professionals with insight into which strategies will be needed for transitions between surface types (e.g. natural, concrete, tile, carpet, rugs, wood floors), over doorway thresholds, and through tight spaces.

Environmental assessment: this often compliments or is completed at the same time as the functional assessment. The environmental assessment (also known as the home safety evaluation) includes checking the home for hazards (e.g. fall risks, poor lighting, tight spaces, fire hazards). It is a time for recommendations on home setup and / or modifications to improve safety and help the patient better navigate mobility limitations.[14] The entire home, from the entry to the bathroom and bedroom, is assessed for safety and moveability. Some countries have specific home accessibility requirements that should be assessed (e.g. door widths, countertop heights, and information on architectural barriers). Equipment recommendations and management are also part of the environmental assessment. This aspect of the assessment considers mobility devices (e.g. walkers, canes, wheelchairs), durable medical equipment (e.g. bedside commode, elevated toilet seat, bath / tub transfer bench, hospital beds, patient lifts, oxygen tubing and tanks), adaptive equipment (e.g. sock aids, dressing sticks, reachers, button aids, built up utensils), or home modifications (e.g. grab bars, ramps, removing doors for ease of access, bed height). This portion of the home-based evaluation aims to create an optimal environment to support patient recovery and independence.

Care provider assessment: this part of the evaluation focuses on the care provider's experience, emotional state, and ability to provide care.[14] Care provider education is completed as indicated. Details from the care provider assessment, functional assessment, and environmental assessment are all taken into account when determining if a patient requires a home-based aide worker to assist with ADLs outside of therapy. The amount of home-based aid provided per week is dependent on the patient's needs and the care provider's ability.

Care preferences and goals: this part of the assessment provides insight into the patient's preferences for care (e.g. timing therapy sessions with medications, morning versus afternoon appointments, gender of care provider) and setting realistic, patient-centred, and measurable goals for their recovery. This also includes coordinating care between all services and professionals involved in the patient's care.[14] For rehabilitation professionals, this often includes coordinating treatments around other provider visits, setting up co-treatments with other rehabilitation disciplines, and timing sessions to take the most advantage of medication windows.

Knee Arthroplasty Rehabilitation Goal Examples

When writing rehabilitation goals, make sure each goal is (1) measurable, (2) functional, and (3) and have a timeframe for completion.

Short-Term Goal Examples:

  1. Knee Flexion Range of Motion: Patient will demonstrate active knee flexion of 75-80 degrees within 14 days post-surgery as measured by goniometer in supine position, sufficient for basic ADLs and step negotiation.
  2. Quadriceps Strength: Patient will demonstrate quadriceps strength of 3/5 on manual muscle testing in sitting position within 14 days post-surgery, sufficient to perform straight leg raise and assist with functional mobility tasks.
  3. Bathroom Safety: Patient will enter/exit bathtub or shower with standby assistance using prescribed adaptive equipment (shower chair, tub transfer bench, grab bars) within 14 days post-surgery.
  4. Ambulation: Patient will ambulate 45-metres (150-feet) continuously on level surfaces using a rolling walker with standby assistance for safety within 10 days post-surgery, maintaining proper step-through gait sequence.

Long-Term Goal Examples:

  1. Knee Range of Motion: Patient will demonstrate active knee range of motion of 0-115+ degrees within 6 weeks post-surgery as measured by goniometer, sufficient for normal gait progression, stair negotiation, and all functional activities.
  2. Scar Management: Patient will independently perform scar mobilisation techniques within 4-8 weeks post-surgery as demonstrated by return demonstration, promoting optimal tissue healing and mobility.
  3. Activities of Daily Living: Patient will perform all ADLs including bathing, lower extremity dressing with modified independence, using adaptive equipment as needed, and basic meal preparation within 6 weeks post-surgery, demonstrating safe techniques and energy conservation strategies.
  4. Ambulation: Patient will ambulate greater than 122-metres (400-feet) continuously on indoor and outdoor surfaces with modified independence, using least restrictive assistive device, within 6 weeks post-surgery, demonstrating minimal gait deviations and endurance sufficient forcommunity distances.

Home-Based Rehabilitation Services Status Post Knee Arthroplasty

Like evaluations in any practice setting, home-based rehabilitation evaluations should be individualised to capture an accurate functional picture of a patient. There are several areas of interest a therapist should take care to assess when performing a home-based rehabilitation evaluation for patients status post-knee arthroplasty, including: (1) knee range of motion, (2) positioning to prevent hamstring muscle shortening, (3) oedema management and its effect on quadriceps activation, and (4) specialised durable medical equipment, such as a continuous passive motion (CPM) machine or cryotherapy pumps. To learn more about these topics and other knee arthroplasty treatment options, please see these articles:

The following articles provide more in-depth information on the types of knee joint surgeries and greater insight into how to individualise your evaluation:

Outcome Measures Specific to the Knee

The use of evidence-based and standardised outcome measures helps ensure high-quality and consistent care for patients following knee arthroplasty. The following outcomes can be used:

For a comprehensive list of other outcome measures useful for total joint arthroplasty assessment, please see: Total Joint Arthroplasty and Outcome Measures (TJAOM) Toolkit. Please note this list contains outcome measures for both total knee and total hip arthroplasties.

Clinical Resources

References

  1. ↑ Medicare Interactive. The homebound requirement. Available from: https://www.medicareinteractive.org/understanding-medicare/medicare-covered-services/home-health-services/the-homebound-requirement (accessed 10/June/2025).
  2. ↑ 2.0 2.1 Cairns A, Barker R. Community Rehabilitation for Rural and Remote Australia: Measuring What Matters Based on the International Classification of Functioning, Disability and Health (ICF): A Scoping Review. Australian Journal of Rural Health. 2025 Apr;33(2):e70017.
  3. ↑ 3.0 3.1 Department of Health. Domiciliary care. Available from: https://www.health-ni.gov.uk/articles/domiciliary-care (accessed 10/June/2025).
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Papanicolas I, Figueroa JF. International comparison of patient care trajectories: Insights from the ICCONIC project. Health Services Research. 2021 Nov 10;56(Suppl 3):1295.
  5. ↑ Te Kōhao Health. Home Based Support Services. Available from: https://www.tekohaohealth.co.nz/home-based-support-services (accessed 10/June/2025).
  6. ↑ 6.0 6.1 Kawaya H. Home Visitation by Community Health Workers. InHealthcare Access-New Threats, New Approaches 2023 Mar 28. IntechOpen.
  7. ↑ 7.0 7.1 Department of Health. Community care. Available from: https://www.health-ni.gov.uk/articles/community-care (accessed 10/June/2025).
  8. ↑ Mills T, Marks E, Reynolds T, Cieza A. Rehabilitation: essential along the continuum of care. Disease control priorities: improving health and reducing poverty. 2017 Nov 27;3.
  9. ↑ DeMik DE, Carender CN, Glass NA, Callaghan JJ, Bedard NA. More patients are being discharged home after total knee arthroplasty, however rates vary between large databases. The Journal of arthroplasty. 2021 Jan 1;36(1):173-9.
  10. ↑ Lyndrup O, Kehlet H, Jørgensen CC, Lindberg-Larsen M, Jakobsen T, Gromov K, Andersen MR, Bieder M, Overgaard S, Varnum C. Discharge destination of patients in fast-track primary hip and knee arthroplasty: results from a prospective Danish cohort. The Journal of arthroplasty. 2024 Dec 7.
  11. ↑ De Klerk TC, Dounavi DM, Hamilton DF, Clement ND, Kaliarntas KT. Effects of home-based prehabilitation on pre-and postoperative outcomes following total hip and knee arthroplasty: a systematic review and meta-analysis. Bone & Joint Open. 2023 May 5;4(5):315-28.
  12. ↑ Pritchard KT, Baillargeon J, Westra J, Li CY, Mroz T, Reistetter TA, Lee WC, Raji MA, Kuo YF. The impact of High-versus Low-Dose home rehabilitation for functional independence after hip or knee replacement. Journal of the American Medical Directors Association. 2024 Jan 1;25(1):118-20.
  13. ↑ Falvey JR, Bade MJ, Forster JE, Burke RE, Jennings JM, Nuccio E, Stevens-Lapsley JE. Home-health-care physical therapy improves early functional recovery of Medicare beneficiaries after total knee arthroplasty. JBJS. 2018 Oct 17;100(20):1728-34.
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 Home Health Patient Education. 7 Key Elements of a Comprehensive Start of Care Assessment in Home Health Nursing. Available from: https://homehealthpatienteducation.com/7-key-elements-of-a-comprehensive-start-of-care-assessment-in-home-health-nursing/ (accessed 02/June/2025).
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Knee_Arthroplasty_Home-Based_Rehabilitation_Evaluation&oldid=372531"