Knee Replacement, Total
Conditions
Keywords
knee replacement, knee arthroplasty
Brief summary
Previous research has shown that use of rehabilitation (including physical therapy) and the recovery of function after knee replacement surgery may differ depending on patients' race, sex, income or insurance, and geographic location. In this study, the investigators will develop and test a new care pathway for knee replacement rehabilitation that is designed to maximize functional recovery for all patients and reduce differences between different groups of patients. Findings from this project will lead to improved rehabilitation quality after knee replacement surgery.
Detailed description
In previous work, the investigators used quantitative and qualitative data to identify sociodemographic disparities in physical function and use of rehabilitation following total knee arthroplasty (TKA), or knee replacement surgery. The investigators also identified patient and provider impressions regarding areas of the post-TKA rehabilitation pathway and recommendations for improvements. Based on all of this information, the investigative team has developed a newly-optimized rehabilitation care pathway and will pilot test this approach in this study.
Interventions
BEHAVIORALTKA Journey - patient education
The investigators' team developed a new patient education booklet containing information that walks the patient through their TKA journey, from pre-operative to hospital-based rehabilitation prior to discharge, to outpatient physical therapy, and after discharge from formal physical therapy services. All patients in the intervention arm will receive this booklet from their surgeon's office and will receive a phone call from study personnel to review it and answer any questions.
OTHEROptimized Rehab Scheduling
For all patients in the 'intervention' practice, the home health referral will include instructions for the home health physical therapist to assist the patient with scheduling their first outpatient physical therapy session, to avoid unnecessary gaps in care between home health discharge and outpatient physical therapy evaluation.
BEHAVIORALUsual Rehab
Participants in the usual rehab group will continue to follow the current standard-of-care rehabilitation pathway for patients post-TKA.
Sponsors
University of Pittsburgh
National Institute on Minority Health and Health Disparities (NIMHD)
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
The new care pathways will be implemented from the practice level and downward, meaning that all patients receiving TKA from the "intervention" surgical practice within the three-month study period will be guided by surgical and rehabilitation staff to follow the new pathways. In the 'control' practice, the investigators will simply obtain information regarding patients' rehabilitation utilization and functional outcomes during the 3-month study period from an institutional data warehouse. The 'control' practice is located in a similarly-sized hospital less than 2 miles from the 'intervention" practice, and internal data indicate that patient demographics are very similar between the two.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* scheduled to receive unilateral TKA surgery at a University of Pittsburgh Medical Center hospital * plans to utilize UPMC Home Health and/or UPMC Rehab Institute for home health and/or outpatient rehabilitation post-operatively
Exclusion criteria
* does not undergo planned surgery * does not receive any post-TKA rehabilitation at UPMC facilities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient Satisfaction | 3 months post-TKA surgery | A patient satisfaction survey will be collected at 3 months post-operative, to query all patients' satisfaction with pre-operative education, ease of scheduling of post-TKA rehabilitation, and perceptions of the overall post-TKA rehab pathway. A modified version of the PSQ-III patient satisfaction survey will be used, in which each construct is rated by the patient on a 1-5 scale, with higher scores indicating greater satisfaction with care. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rehab timing | For most patients, this will occur approximately 2 weeks post-operatively. | In days, the investigators will calculate the time between the patient's last home health visit and their first outpatient physical therapy visit. This enables the quantitative assessment of gaps in care. The investigators will obtain this information from the electronic health record. |
| Completion of in-depth, semi-structured focus group interviews (study participants) | 3 months post-operatively | The investigators will conduct focus groups with patients who followed the optimized post-TKA rehab pathway to learn in-depth about their impressions of the pathway. The focus group interview guide will include questions about patient perception of their post-TKA rehab, transitions between home health and outpatient physical therapy, the completeness of educational information they received from their surgical care team and physical therapists, and any difficulties they may have encountered during any phase of post-TKA rehabilitation. These focus groups will be recorded, transcribed verbatim, and then coded by two independent trained coders using a codebook created iteratively by the coders and the investigators. Themes will be identified and summarized by the investigators. |
| Completion of in-depth, semi-structured 1-on-1 interviews (physical therapists who treat patients post-total knee arthroplasty) | 4 months after enrollment of the first participant in the study | The investigators will conduct 1-on-1 semi-structured interviews to assess home health and outpatient physical therapist perceptions of the optimized post-TKA rehab pathway. The interview guide will include questions about physical therapist perception of the optimized post-TKA rehabilitation pathway, transitions between home health and outpatient physical therapy, the completeness of educational information patients received from their surgical care team and physical therapists, and any difficulties they may have experienced while implementing the new optimized care pathway. These interviews will be recorded, transcribed verbatim, and then coded by two independent trained coders using a codebook created iteratively by the coders and the investigators. Themes will be identified and summarized by the investigators. |
Countries
United States
Contacts
CONTACTAllyn M Bove, DPT, PhD
PRINCIPAL_INVESTIGATORAllyn M Bove, DPT, PhD
University of Pittsburgh
Outcome results
None listed