None listed
Conditions
Brief summary
Within Gold Coast Health all patients who have their knee joint replaced (total knee arthroplasty) are referred for supervised outpatient physiotherapy after their surgery. This is in contrast to growing evidence that indicates that some patients who are having their knee joint replaced can achieve good post-surgery outcomes without the need for supervised outpatient physiotherapy, offering convenience and potential savings. The KAPPA criteria, previously established in a private sector cohort trial, demonstrated that simple and reproducible outcome measures assessed by a physiotherapist at two weeks post-surgery could determine which individuals could successfully continue with unsupervised rehabilitation versus those who would benefit from supervised outpatient physiotherapy. This project will validate these findings in a public health setting in patients who are undergoing knee joint replacement with the primary aim to compare the effectiveness and cost-efficiency of stratified physiotherapy using the KAPPA criteria with existing care through randomised methodology.
Interventions
Those who meet the KAPPA criteria at 2 weeks post-surgery to continue self-directed rehabilitation, will be recommended to complete 3 exercises, 3 times daily, until their next KAPPA physiotherapy review at 6 weeks and 12 weeks (maximum duration of intervention 10 weeks).
The exercises are low level intensity and are commonly prescribed as independent home-exercises after total knee arthroplasty:
Knee flexion exercises in sitting (heel slides or floor bike pedals) - 5 minutes
Knee extension exer
Those who meet the KAPPA criteria at 2 weeks post-surgery to continue self-directed rehabilitation, will be recommended to complete 3 exercises, 3 times daily, until their next KAPPA physiotherapy review at 6 weeks and 12 weeks (maximum duration of intervention 10 weeks). The exercises are low level intensity and are commonly prescribed as independent home-exercises after total knee arthroplasty: Knee flexion exercises in sitting (heel slides or floor bike pedals) - 5 minutes Knee extension exercises on the bed or flat surface (sitting towel-assisted calf stretch) - 5 minutes Walking with heel-toe gait practice - 10 minutes A Senior Orthopaedic Physiotherapist will explain and demonstrate the self-directed exercise protocol with the participant and a instructional handout will also be provided along with a diary to record daily participation in the self-directed intervention. Those participants who do not meet the above criteria will continue with Supervised Outpatient Physiotherapy.
Sponsors
Gold Coast Hospital and Health Service
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Caregiver, Investigator)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients scheduled for primary unilateral TKA for a primary diagnosis of osteoarthritis at Robina Hospital. Within the Stratified Physiotherapy Intervention group, those participants who meet the KAPPA criteria (below) will be advised to continue with a self-directed rehabilitation pathway and will not receive Supervised Physiotherapy (usual care): • Knee flexion range of motion equal to or greater than 90 degrees. • Knee extension range of motion not lacking in equal to or less than 10 degrees. • Satisfied with the progress of their rehabilitation.
Exclusion criteria
Patients will be excluded if they: o Decline or unable to provide informed consent. o Are scheduled for contralateral TKA in <3 months. o Are unable or unwilling to travel to physiotherapy appointments. o Discharge to an inpatient rehabilitation facility o Experience a peri-operative or post-operative complication or hospital readmission.
Outcome results
None listed