Nurse-led rehabilitation after total hip or knee arthroplasty: a systematic review and meta-analysis of functional recovery, self-efficacy, and quality of life
TL;DR
Nurse-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.
Abstract
Background Nurse-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. Objective The 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. Methods PubMed, 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). Results Eleven 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. Conclusions Nurse-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 Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261425216, PROSPERO CRD420261425216.