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Publication Date

10-29-2018

Keywords

physical therapy, total knee arthroplasty, preoperative, patient outcomes

Abstract

Background: Total knee arthroplasty (TKA), or total knee replacement, is an effective surgical approach used to treat osteoarthritis and knee trauma. Its utilization has grown, and the accompanying financial impact has resulted in an equal need to advance physical therapy practice. Historically, physical therapy is provided postoperatively as the standard of care for TKA. An emerging approach is the inclusion of a preoperative rehabilitation physical therapy program (prehab) focused on functional skill training and education; however, its effectiveness remains untested with TKA.

Purpose: In the current study, we examined the impact of standardized prehab in the health care setting, using a single visit to determine if it improved discharge disposition and length of inpatient hospital stay compared to controls.

Methods: We retrospectively reviewed 1043 adult patients at a single institution who underwent TKA and received physical therapy from September 2015 through March 2017. All categorical and numeric variables were described using appropriate descriptive statistics. The two groups (prehab and control) were compared using chi-squared/Fisher’s tests and t-test for independent samples. An alpha of 0.05 was used for all statistical tests, and all statistical analysis was done using SAS version 9.4 (SAS Institute Inc., Cary, NC).

Results: Preoperative physical therapy improved discharge disposition and decreased length of inpatient stay. We found a marked shift in the prehab group. On day 1, 37.1% of prehab patients left inpatient care compared to 27.0% of controls; on day 2, the two groups were nearly identical (48.9% and 48.8%, respectively); and on day 3, 14.0% of prehab patients left compared to 24.2% of controls (overall: P = 0.0008). Prehab also improved discharge disposition, which was the percentage of people who either returned home or required other arrangements such as an inpatient subacute rehabilitation facility. We found 41.6% of prehab patients returned home for self-care compared to 23.2% of controls (P < 0.001).

Conclusion: These data suggest a single preoperative physical therapy visit improves patient outcomes following TKA. Our findings highlight the need to explore the greater utilization of preoperative physical therapy to improve patient outcomes and address reimbursement changes with bundled care coverage.

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