Nurse-led rehabilitation after total hip or knee arthroplasty: a systematic review and meta-analysis of functional recovery, self-efficacy, and quality of life.
- 1Department of Rehabilitation, Taixing People's Hospital, Taixing, Jiangsu, China.
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 I ² 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; I ² = 94.5%), self-efficacy (five trials; g = 1.10, 0.00-2.20; I ² = 93.8%), and quality of life (four trials; g = 0.77, 0.08-1.46; I ² = 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, I ² = 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.
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BibTeX
@article{xu2026nurseled,
title = {{Nurse-led rehabilitation after total hip or knee arthroplasty: a systematic review and meta-analysis of functional recovery, self-efficacy, and quality of life.}},
author = {Ying Xu and Yan Chen and Yuan Yin and Mengxia Tang and Qin Luo},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1911533},
url = {https://europepmc.org/article/MED/42898140},
note = {CC BY},
}
RIS
TY - JOUR
TI - Nurse-led rehabilitation after total hip or knee arthroplasty: a systematic review and meta-analysis of functional recovery, self-efficacy, and quality of life.
AU - Ying Xu
AU - Yan Chen
AU - Yuan Yin
AU - Mengxia Tang
AU - Qin Luo
PY - 2026
DA - 2026/10/05
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1911533
UR - https://europepmc.org/article/MED/42898140
AB - 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 I ² 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; I ² = 94.5%), self-efficacy (five trials; g = 1.10, 0.00-2.20; I ² = 93.8%), and quality of life (four trials; g = 0.77, 0.08-1.46; I ² = 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, I ² = 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.
SN - 2296-858X
ER -