Study designs of evaluations included in the review
Prospective and retrospective studies were eligible for inclusion. All of the included studies compared the results of clinical pathways with a control group. Some of the included studies used historical controls, some concurrent controls, or a mixture.
Specific interventions included in the review
Studies that compared the outcomes for patients whose TKA and THA care was managed with and without the use of clinical pathways were eligible for inclusion.
Participants included in the review
Patients undergoing TKA or THA were considered; further information was not reported.
Outcomes assessed in the review
The following outcomes were considered: length of acute hospitalisation, hospital cost, complications and functional status. The studies had to provide data on at least one of these to be eligible for the review.
In the included studies, the length of hospitalisation was measured from admission or surgery until discharge from the primary hospital. Complications were counted when they required readmission or variation from the clinical pathway. Functional status was assessed using a standardised physician-administered scoring system (Knee Society Clinical Rating System for TKA; Harris Hip Score for THA) or a patient-reported questionnaire.
How were decisions on the relevance of primary studies made?
Two reviewers independently screened the titles and abstracts of articles identified from the searches, and also reviewed retrieved articles.