Can physical therapy optimize recovery following knee replacement surgery? A recent study of TKA patients offers new insights.
According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States. In fact, total knee arthroplasty (TKA) is the most commonly performed inpatient surgical procedure in the United States.
However, some studies have indicated that rehabilitation following knee replacement surgery may not be needed to optimize recovery. Setting out to examine this hypothesis, a team of researchers from the University of Colorado School of Medicine recently conducted a study with the objectives of (1) investigating whether PT utilization is associated with functional improvements for total knee arthroplasty (TKA) patients in home-health-care settings and (2) exploring which factors are related to PT utilization.
The 2018 study, which was published in The Journal of Bone and Joint Surgery, analyzes Medicare home-health-care claims from 2012 for TKA patients who received home-health-care services following surgery. In comparison to low home-health-care utilization, which was defined as ≤5 visits, utilization of 6 to 9 visits was associated with 25% greater improvement in activities of daily living (ADLs) over the home-health-care episode, and improvement increased from there, with 10 to 13 visits seeing 40% greater improvement and ≥14 visits being associated with 50% greater improvement. In addition, patients receiving home-health-care from rural agencies were observed to have lower PT utilization (10.7% fewer visits).
After controlling for medical complexity, baseline function, and home-health-care episode duration, low PT utilization was significantly associated with worse ADL recovery for study patients. Researchers also found that that low users of at-home physical therapy often had less social support and more complex medical conditions and that without adequate post-op care, these patients could require future hospitalization or institutionalization. The bottom line? According to lead researcher Dr. Jason Falvey, the risks of not providing the appropriate level of care post-surgery may result in higher overall healthcare costs in the long term.
More research is needed to develop specific evidence-based treatment strategies for TKA patients, but based on these findings, telerehab, which allows post-surgery treatment to be done in the home, may be a useful tool in promoting patient engagement and utilization for better outcomes after surgery.
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Falvey, J. R., Bade, M. J., Forster, J. E., Burke, R. E., Jennings, J. M., Nuccio, E., & Stevens-Lapsley, J. E. (2018). Home-Health-Care Physical Therapy Improves Early Functional Recovery of Medicare Beneficiaries After Total Knee Arthroplasty. JBJS, 100(20), 1728-1734.