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Nurse-led rehabilitation improves functional recovery and quality of life after hip and knee arthroplastyNurse Led Rehabilitation Improves Recovery After Hip and Knee Surgery

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Key Takeaway
Note that nurse-led rehabilitation may improve recovery outcomes, but evidence certainty is low due to high heterogeneity.

This systematic review and meta-analysis evaluated the impact of nurse-led rehabilitation compared to usual care for patients undergoing total hip or knee arthroplasty. The analysis included 11 trials with a total of 1,107 participants. The primary outcomes analyzed were functional recovery, self-efficacy, and quality of life.

The meta-analysis reported significant improvements in functional recovery (g = 1.11; 95% CI 0.42 to 1.81) and self-efficacy (g = 1.10; 95% CI 0.00 to 2.20) for patients receiving nurse-led care. Quality of life also showed improvement (g = 0.77; 95% CI 0.08 to 1.46), with a homogeneous benefit specifically noted for knee replacement patients (g = 1.12; I2 = 0%).

Several limitations were noted, including low certainty of evidence (GRADE) for all primary outcomes and substantial between-study heterogeneity (I2 values ranging from 81.7% to 94.5%). Additionally, prediction intervals crossed the null, and the finding for self-efficacy was described as statistically fragile. Due to these factors, the clinical magnitude of benefit remains uncertain despite the observed improvements.

How this fits prior evidence

This meta-analysis addresses a gap in postoperative rehabilitation protocols following hip and knee arthroplasty. While prior evidence has established specific analgesic regimens for pain management after these procedures, this study focuses on the role of nurse-led rehabilitation in improving functional outcomes and quality of life. The findings do not directly relate to the previously reported differences in femoral stem designs or specific local anesthetic cocktails.

A review of 11 trials involving 1,107 patients looked at how nurse led rehabilitation affects recovery after hip and knee replacements. The study compared these programs to usual care to see if they helped patients move better and feel more confident in their abilities.

The analysis found that patients who received nurse led care showed improvements in functional recovery, self-efficacy, and overall quality of life. These results were consistent across both hip and knee replacement patients. However, the researchers noted that the evidence is not very certain because the studies varied significantly in how they were conducted.

Because the data is limited and the results are not consistent across all types of studies, it is hard to say exactly how much better these programs are compared to standard care. Patients should talk to their doctors to see if a nurse led program is a suitable option for their specific recovery needs.

What this means for you:
Nurse led rehabilitation shows a link to better recovery and quality of life after hip and knee surgeries.

Common questions

Does nurse led rehabilitation help after hip or knee surgery?

The study found that nurse led rehabilitation was associated with improved functional recovery and quality of life for patients who had hip or knee replacements. While the results were positive, the overall certainty of this evidence is low because the studies included in the review were very different from one another.

How does it affect a patient's confidence during recovery?

Patients in the study who received nurse led care showed improvements in self-efficacy, which is the confidence to perform daily tasks. However, researchers noted that this specific finding was statistically fragile, meaning the results were less certain than other outcomes measured.

Is nurse led care better than standard care for joint replacement?

The analysis showed that nurse led care was associated with better outcomes than usual care. However, because the study had high heterogeneity and low certainty, the exact size of the benefit is still uncertain. You should discuss these options with your medical team.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BackgroundNurse-led rehabilitation is increasingly embedded in postdischarge care after total hip or knee arthroplasty, but its effect on patient-reported recovery has not been quantified through meta-analysis.ObjectiveThe aim of this study was to evaluate the effects of nurse-led rehabilitation versus usual care on functional recovery, self-efficacy, and quality of life after total hip or knee arthroplasty.MethodsPubMed, Scopus, Web of Science, and ClinicalTrials.gov were searched (2010–2026; English only) for randomized controlled trials comparing nurse-led rehabilitation with usual care. Standardized mean differences (Hedges g) were pooled using random-effects models with Hartung–Knapp confidence intervals. Heterogeneity was assessed with I2 and prediction intervals, robustness with leave-one-out and subgroup analyses, and certainty with Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsEleven trials (1,107 participants) were included. Nurse-led rehabilitation improved functional recovery (10 trials; g = 1.11, 95% confidence interval 0.42–1.81; I2 = 94.5%), self-efficacy (five trials; g = 1.10, 0.00–2.20; I2 = 93.8%), and quality of life (four trials; g = 0.77, 0.08–1.46; I2 = 81.7%). The certainty of evidence (GRADE) was rated low for all three primary outcomes. Secondary outcomes were directionally favorable but imprecise. The functional recovery effect was robust to leave-one-out analysis, whereas self-efficacy was statistically fragile. Quality of life showed a homogeneous benefit after knee replacement (g = 1.12, I2 = 0%) but not hip (between-subgroup p = 0.032), and functional recovery differed by delivery model (p = 0.012, largest for digital). Heterogeneity was substantial throughout, all prediction intervals crossed the null, and funnel plot asymmetry suggested possible small-study effects.ConclusionsNurse-led rehabilitation after hip or knee arthroplasty was associated with improved function, self-efficacy, and quality of life, consistently favoring nurse-led care in direction but with evidence of low certainty, substantial between-study heterogeneity, prediction intervals that crossed the null, and possible small-study effects. Therefore, the magnitude of benefit remains uncertain. Adequately powered, outcome-blinded trials are needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261425216, PROSPERO CRD420261425216.
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