None listed
Conditions
Brief summary
Total knee arthroplasty (TKA) surgery is considered the gold standard procedure for symptomatic knee osteoarthritis, and in line with increasing osteoarthritis rates, TKA surgery is also projected to rise. Traditionally, TKA was associated with a long and extensive physical recovery, and supervised physiotherapy was considered routine. Recent peri-operative advancements and rapid recovery protocols have meant that TKA patients regain functional independence much sooner and are less reliant on formal rehabilitation. However, despite this progress, some patients still have suboptimal functional outcomes or self-reported dissatisfaction when their rehabilitation is self-directed, and are then subsequently referred by their orthopaedic specialist, or self-seek, supervised physiotherapy. The aim of the Knee Arthroplasty Physiotherapy Pathways (KAPPA) trial is to determine which patient variables are associated with poor physical or self-reported outcomes after undergoing self-directed physiotherapy. If patients at higher risk of suboptimal outcomes can be identified, then early referral to supervised physiotherapy can be implemented.
Interventions
Supervised Physiotherapy Intervention
Patients will be referred to one-to-one supervised physiotherapy if:
• They are dissatisfied with the progress of their rehabilitation.
• Are assessed to have a knee flexion range of motion of less than 90 degrees.
• Are assessed to have an extension range of motion lacking 10 degrees or more.
Patients all consent to starting the trial in the self-directed group (100% allocation to self-directed) and will be referred to the one-to-one Supervised Physiothera
Supervised Physiotherapy Intervention Patients will be referred to one-to-one supervised physiotherapy if: • They are dissatisfied with the progress of their rehabilitation. • Are assessed to have a knee flexion range of motion of less than 90 degrees. • Are assessed to have an extension range of motion lacking 10 degrees or more. Patients all consent to starting the trial in the self-directed group (100% allocation to self-directed) and will be referred to the one-to-one Supervised Physiotherapy intervention if any of the above criterions are met when assessed at 2 weeks, 6 weeks, and 4 months after total knee replacement surgery. Due to the patient-centred approach of the Supervised Physiotherapy Intervention, the exercise protocol, duration, and frequency for individuals in the intervention group will be at the discretion of the treating physiotherapist. However, It is expected that all individuals undergoing supervised physiotherapy will receive a combination of manual therapy and exercise prescription from a registered physiotherapist as standard practice. Exercises and manual therapy techniques from a physiotherapist would include those targeting knee range of movement, lower limb strength and gait retraining. Patients will keep a record of the number of Supervised Physiotherapy sessions they attend. As the first assessment timepoint is 2 weeks post operative and the final assessment time point is 4 months (16 weeks) post operative, the maximum duration for supervised physiotherapy as assessed in this trial is 14 weeks. There is no minimum, however, as stated above participants in the supervised physiotherapy group will be asked to keep a record of attendance.
Sponsors
Bond University
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients undergoing primary total knee arthroplasty for a diagnoses of knee osteoarthritis.
Exclusion criteria
Discharge from hospital destination other than home, i.e. those who discharge to inpatient rehabilitation are not eligible. Due to the "intention to treat" model applied to this trial, participants were initially included who met the inclusion criteria, however, if they underwent contralateral total knee arthroplasty during the trial period they were excluded,
Outcome results
None listed