The Group Experience: Remodelling Outpatient Physiotherapy after Knee Replacement Surgery

Ambulation milestones in post-operative physical therapy after total knee arthroplasty: how can we improve short-term outcomes?

Introduction: Post-operative day (POD) 0 physical therapy (PT) after total knee arthroplasty (TKA) has been associated with improved outcomes such as shorter hospital length of stay (LOS), though patient performance is variable. The purpose of this study was to evaluate PT performance and determine whether this affected LOS or discharge to home.Methods: Retrospective review including 412 patients who underwent TKA over 1 year. Specific data assessed included details about demographics, surgery/recovery, PT, LOS, and discharge destination.Results: Overall, 88.8% (366/412) of patients received POD 0 PT. About 73.9% of patients who did not receive POD 0 PT were prevented from doing so by reasons that kept them off of the orthopedic inpatient floor. Patients who walked greater than 10 feet on POD 0 or 100 feet on POD 1 were significantly more likely to have a shorter LOS and more likely to be discharged to home.Discussion: Objective milestones of walking 10 feet on POD 0 and 100 feet on POD 1 were associated with improved short-term outcomes. These performance markers may be useful for stratifying which patients are meeting milestones for early discharge. Late arrival to inpatient floor had the strongest associations with inability to perform PT.

A retrospective analysis of postrehabilitation outcomes following total knee arthroplasty

BACKGROUND AND PURPOSE

Total knee arthroplasty (TKA) is one of the most frequently performed orthopaedic procedures in Canada. Despite the frequency at which TKAs are performed, few studies have examined the association between postoperative outcomes and long-term functional outcomes following group-based rehabilitation in Canada. The primary objective of the present study was to examine changes in flexion and extension from intake to discharge from rehabilitation in patients in Saskatchewan, Canada. A secondary objective was to explore the demographic and medical predictors of range of motion in TKA patients, and treatment duration.

METHODS

A retrospective chart review from an outpatient rehabilitation clinical database was conducted between September 2014 and December 2016, and assessed demographic and medical variables.

RESULTS

A total of 672 patient charts were included in the study. Significant improvements (p < 0.001) were noted from intake to discharge from rehabilitation for flexion and extension. Right-side TKA, flexion at intake and the length of treatment predicted flexion at discharge from rehabilitation (R²  = 0.23). Gender, right side TKA, extension at intake and the length of treatment predicted extension at discharge from rehabilitation (R²  = 0.23). Lastly, age, flexion at intake and extension at intake predicted length of treatment in the rehabilitation programme (R²  = 0.21).

CONCLUSIONS

Patients who participated in rehabilitation following TKA experienced improvements in flexion and extension. Those with decreased flexion and extension after TKA may be less likely to experience a desirable range of motion, indicating a need for more intensive targeted rehabilitation in this group, and adjustments in hospital and community care.

Physical activity levels after hip and knee joint replacement surgery: an observational study

Usual care after hip or knee joint replacement does not adequately address the problem of low physical activity levels. We aimed to determine whether exercise delivered in a group setting in the early stage of outpatient rehabilitation influenced self-reported physical activity levels after hip or knee joint replacement. A case series of 79 participants referred to a 6-week outpatient orthopaedic exercise group after total hip or knee replacement were evaluated using the International Physical Activity Questionnaire (IPAQ) short form. Physical function was evaluated using Osteoarthritis Research Society International (OARSI) recommended performance-based tests (30 s Chair Stand Test, 40 m Fast Pace Walk Test, Stair Climb Test, Timed Up and Go Test, 6 Minute Walk Test). Measures were assessed at admission, discharge and 6 weeks after group discharge. Non-parametric analysis was conducted for IPAQ scores. Analysis of functional measures was conducted with linear mixed models with time modelled as a repeated measure. Standard multiple regression and correlation analysis were conducted. Fifty-four participants completed the study. Self-reported activity levels improved significantly at program discharge but not at 6-week follow-up. All performance-based measures improved significantly at program discharge. Fast-paced walking and 6 Minute Walk Test measures continued to improve at 6-week follow-up. Group dynamics present in an outpatient rehabilitation exercise program may increase physical activity levels during group participation but not after group cessation. Performance in all functional measures improved at group discharge.

Does physical activity change following hip and knee replacement? Matched case-control study evaluating Physical Activity Scale for the Elderly data from the Osteoarthritis Initiative

OBJECTIVES

To determine whether physical activity measured using the Physical Activity Scale for the Elderly (PASE), changes during the initial 24 months post-total hip (THR) or knee replacement (TKR), and how this compares to a matched non-arthroplasty cohort.

DESIGN

Case-controlled study analysis of a prospectively collected dataset.

SETTING

USA community-based.

PARTICIPANTS

116 people post-THR, 105 people post-TKR compared to 663 people who had not undergone THR or TKR, or had hip or knee osteoarthritis. Cohorts were age-, gender- and BMI-matched.

MAIN OUTCOME MEASURES

Physical activity assessed using the 12-item PASE at 12 and 24 months post operatively.

RESULTS

There was no significant difference in total PASE score between pre-operative to 12 months (mean: 136 vs 135 points; p=0.860) or 24 months following THR (mean: 136 vs 132 points; p=0.950). Whilst there was no significant difference in total PASE score from pre-operative to 12 months post-TKR (126 vs 121 points; p=0.930), by 24 months people following TKR reported significantly greater physical activity (126 vs 142 points; p=0.040). There was no statistically significant difference in physical activity between the normative matched and THR (p≥0.140) or TKR (p≥0.060) cohorts at 12 or 24 months post joint replacement.

CONCLUSIONS

Physical activity is not appreciably different to pre-operative levels at 12 or 24 months post-THR, but was greater at 24 months following TKR. Health promotion strategies are needed to encourage greater physical activity participation following joint replacement, and particularly targeting those who undergo THR.