UMMS Affiliation

Department of Quantitative Health Sciences, Division of Preventive and Behavioral Medicine; Department of Orthopedics and Physical Rehabilitation

Publication Date

2018-10-03

Document Type

Article Postprint

Disciplines

Musculoskeletal Diseases | Orthopedics | Rehabilitation and Therapy

Abstract

OBJECTIVE: Although total knee replacement surgery (TKR) is highly prevalent and generally successful, functional outcomes post-TKR vary widely. Most patients receive some physical therapy (PT) following TKR, but PT practice is variable and associations between specific content and dosage of PT interventions and functional outcomes are unknown. Research has identified exercise interventions associated with better outcomes but studies have not assessed whether such evidence has been translated into clinical practice. We characterized the content, dosage and progression of usual post-acute PT services following TKR, and examined associations of specific details of post-acute PT with patients' 6-month functional outcomes.

METHODS: Post-acute PT data were collected from patients undergoing primary unilateral TKR and participating in a clinical trial of a phone-based coaching intervention. PT records from the terminal episode of care were reviewed and utilization and exercise content data were extracted. Descriptive statistics and linear regression models characterized PT treatment factors and identified associations with 6-month outcomes.

RESULTS: We analyzed 112 records from 30 PT sites. Content and dosage of specific exercises and incidence of progression varied widely. Open chain exercises were utilized more frequently than closed chain (median and interquartile range (21(4,49) vs 13(4,28.5)). Median (interquartile range) occurrence of progression of closed and open chain exercise was 0 (0,2) and 1 (0,3) respectively. Shorter timed stair climb was associated with greater total number of PT interventions and use and progression of closed chain exercises.

DISCUSSION: Data suggest that evidence-based interventions are under-utilized and dosage may be insufficient to obtain optimal outcomes.

Keywords

Total Knee Replacement, outcomes, physical therapy

Rights and Permissions

This is the peer-reviewed version of the following article: Arthritis Care and Research. 2018 Oct 3. doi: 10.1002/acr.23761, which has been published in final form at https://doi.org/10.1002/acr.23761. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Authors' accepted peer-reviewed manuscript posted after 12 months as allowed by the publisher's author rights policy at https://authorservices.wiley.com/author-resources/Journal-Authors/licensing/self-archiving.html.

DOI of Published Version

10.1002/acr.23761

Source

Arthritis Care Res (Hoboken). 2018 Oct 3. doi: 10.1002/acr.23761. [Epub ahead of print] Link to article on publisher's website

Journal/Book/Conference Title

Arthritis Care and Research

Related Resources

Link to article in Pubmed

PubMed ID

30281207

Available for download on Thursday, October 03, 2019

Share

COinS