Wong 1990.

Methods	A multi‐centre (3 sites) randomised controlled trial evaluating the effects of an experimental program on post‐hospital adjustment of early discharged patients after THA.
Participants	N: 146 participants, 146 THA.  Gender: early discharge and enhanced recovery: males 24, females 26; conventional discharge and enhanced recovery males 12, females 35; conventional discharge and traditional recovery: males 19, females 29  Mean age: early discharge and enhanced recovery 63.3 years; conventional discharge and enhanced recovery: 71.1 years; conventional discharge and traditional recovery: 64.8 years.  BMI: not documented  Concurrent medical condition (yes): early discharge and enhanced recovery: 46 (92%); conventional discharge and enhanced recovery: 42 (87.5%); conventional discharge and traditional recovery: 42 (87.4%). Inclusion criteria: all participants listed for THA in the three participating hospitals; if they were English‐speaking; did not experience severe postoperative complications during hospitalisation; and met the following medical discharge criteria: satisfactory range of motion of the operated hip and satisfactory ambulation ability.  Exclusion criteria: abnormality of mental state; people who suffered from apparent visual or auditory impairment, or both; and people with severe diseases such as peripheral vascular diseases of the lower extremities and advanced rheumatoid arthritis.
Interventions	Conventional discharge and enhanced recovery (N = 50): the study authors did not provide any information as to what constituted a ‘conventional’ discharge. The experimental enhanced recovery programme included the following: provision of a pamphlet and videotape and regular posthospital visits by a community health nurse on information: performance of selected ADL e.g. safe method of carrying out activities to promote participants’ self‐care without risk of prosthesis dislocation; required postdischarge exercises for muscle strength and movement; warning signs and symptoms of common complications post‐total hip replacement including deep infection; safe and proper use of different walking aids, bathing, dressing and toileting; expected stages of recovery during the first 6 months; potential impact of operation on participant’s psychological welfare to prevent unrealistic expectations postoperatively; list of all available community resources for people to use. The videotape was shown to these participants between the 5th and 6th postoperative day and the day before discharge. Posthospital visits were made at 1 week, 3 months and 6 months posthospital discharge to assess the ability to cope, planning and implementing the interventions and strategies such as procurement of aids, counselling and reinforcing teaching initiated at hospital. The study authors did not provide information as to what constituted an ‘early’ discharge.  Conventional discharge and traditional rehabilitation programme control (N = 48): the study did not provide information as to what constituted a ‘conventional’ discharge. Participants received a “yoked attention‐placebo” visits from the research assistant at 1 week, 3 months and 6 months postdischarge, which consisted of advice on seeking medical and rehabilitation assistance if required regarding surgery‐related problems. Early discharge with the enhanced recovery programme (N = 48): participants allocated to this group received the same enhanced recovery programme as those in the early discharge and enhanced recovery programme. The study did not provide information as to what constituted an ‘early’ discharge. Given the lack of information regarding what constituted 'early' discharge, we included only the comparison between enhanced recovery and traditional rehabilitation as these were the interventions of interest. Therefore, we did not extract or include data from this specific treatment arm in the analysis.
Outcomes	Follow‐up intervals: 1 week, 3 months and 6 months.  Outcome measures: the Objective Functional Capability Index (OFCI); the Subjective Functional Capability Index (SFCI); the Subjective Psychosocial Capability Index (SPSCI); the Knowledge Test Post Hip Arthroplasty Complications (KTPHAC); the Perceived Preparedness For Discharge Scale (PPFDS); the Patient Compliant Scale (PCS) consisted of two subsets: the Compliant Behavior Index (CBI) and the Exercise Compliance Scores (ECS) (outcomes included in this review were OFCI and SFCI). The study authors did not present data on outcomes of interest including: pain, HRQOL; global assessment of treatment success; hip dislocation; reoperation rate; total adverse events; limitations in personal ADL; restrictions in EADL; societal reintegration; length of hospital stay; and cost‐analysis.
Notes	The study authors did not present a power calculation to base sample size on. There was limited information on the study interventions, particularly on the discharge (early versus conventional) criteria. We requested data from the study authors, including mean and SD values and sample size in each group, at each follow‐up interval, for data on: the OFCI and SFCI. The study authors did not respond to this request.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	The study authors did not provide information regarding sequence generation.
Allocation concealment (selection bias)	High risk	The study authors did not provide information on whether allocation was concealed or not.
Blinding of participants and personnel (performance bias) All outcomes	High risk	This would have been logistically difficult to achieve for the participant and personnel.
Blinding of outcome assessment (detection bias) All outcomes	High risk	The study employed assessors blinded to group allocation (“impartial observers”) to collect data on all follow‐up points (Data Collection Procedure, Page 13). However as the participant is the assessor in this case, there was a high risk for the subjective outcome, the SFCI.
Incomplete outcome data (attrition bias) All outcomes	Low risk	There appears to be sufficient evidence that the study authors accounted for all participants in the analyses (Results, Page 13).
Selective reporting (reporting bias)	High risk	The study authors only presented P values and no mean/median or SD/interquartile range data (Results, Page 13 to 15).
Other bias	Low risk	There were no apparent other sources of bias.

Abbreviations: ADL ‐ activities of daily living; CBI ‐ Compliant Behavior Index; EADL ‐ extended activities of daily living; ECS ‐ Exercise Compliance Scores; HRQOL ‐ health‐related quality of life; kg/m² ‐ kilograms per meter squared; KTPHA ‐ Knowledge Test Post Hip Arthroplasty Complications; BMI ‐ body mass index; N ‐ number of participants; OFCI ‐ Objective Functional Capability Index; PPFDS ‐ Perceived Preparedness For Discharge Scale; SD ‐ standard deviation; SF‐12 ‐ Short‐Form 12; SFCI ‐ Subjective Functional Capability Index; THA ‐ total hip arthroplasty