In-home physical therapy care for knee replacement patients leads to better recovery

A team of physical therapy researchers from the University of Colorado School of Medicine have conducted one of the first full-scale studies to assess the effectiveness of in-home physical therapy care for patients who have had knee replacement surgery.

The study analyzes Medicare home health care claims for patients treated with total knee arthroplasty in 2012 who received home health care services for their post-operation rehabilitation.

Generally, patients who received more physical therapy visits at home were able to recover better from the surgery. The optimal number of home-care visits by physical therapists was six to nine. Researchers also found that patients living in a rural area or having other complex medical conditions were associated with fewer, not more, home health care visits.

Full story at news-medical.net

From PTJ: Getting at the Risk Factors for Falls Post-TKA

Up to a third of patients with total knee arthroplasty (TKA) experience a fall within 6 months to a year after surgery, but a new study suggests that physical therapists (PTs) can reduce this risk by targeting specific deficits for intervention.

Researchers followed 134 individuals at a Hong Kong hospital for 6 months after TKA to determine falls frequency, circumstances, and risk factors. All patients had been referred for outpatient rehabilitation. The individuals were all between the ages of 50 and 85 with a primary diagnosis of knee osteoarthritis (OA). Results were published in the September issue of PTJ(Physical Therapy).

Participants attended physical therapy 1-2 times per week for 8-10 weeks, beginning 2 weeks after surgery. Sessions included electrotherapy, mobilizing and strengthening exercises, and gait and balance training. At 4 weeks postsurgery, PTs evaluated knee proprioception, balance, knee pain, knee extension and flexion muscle strength, range of motion, and balance confidence. Patients also were given a log book to record any falls. After the evaluation, authors followed up monthly to ask participants about any falls they may have experienced.

Full story at APTA

What’s the Best Post-TKA Intervention in the Acute Care Setting? There’s No Easy Answer, Say Researchers

For patients who undergo total knee arthroplasty (TKA), this much is known: physical therapy in the acute care setting is a key component in successful rehabilitation. What’s not so easy to pinpoint are the individual interventions associated with the best outcomes, according to authors of a new systematic review. Their investigation into 20 years’ worth of clinical trials and other studies revealed no clear standout interventions but did find “very low” evidence for the use of cryotherapy, accelerated rehabilitation, and neurostimulation within the first 7 postoperative days (PODs).

The study, published in the Journal of Acute Care Physical Therapy, involved extensive reviews of research published between 1996 and 2016 on various physical therapy-related interventions used in the acute care setting post-TKA. Authors were on the lookout for evidence of effectiveness of a particular approach, because, they write, “despite seemingly routine use of physical therapy and its potential importance in reducing complications after [total joint replacement] in the acute hospital setting, no approach to rehabilitation in this setting appears to be standard.”

Full story at APTA

Study: Progressive Strengthening Program Shows Promise Over ‘Standard of Care’ Rehab for Patients Post-TKA

Adults 50 and older who undergo TKA may never fully achieve the same function as older adults without knee pain, but a progressive strengthening exercise program may bring them closer to those levels than would the variable approaches considered “standard-of-care,” according to authors of a recent study.

The study compared self-reported function and test performance for 3 groups: 88 adults aged 50 and older without knee or joint pain (and no TKA); 40 adults aged 50 and older who underwent TKA and participated in “standard-of-care” rehabilitation; and 165 adults aged 50 and over who underwent TKA and participated in what authors describe as an outpatient clinic program that “included progressive strengthening exercises that targeted muscle groups in the lower extremity.” Results were published in Physiotherapy Theory and Practice.

The strengthening program was conducted at a University of Delaware physical therapy clinic beginning 3 weeks after TKA, and consisted of at least 12 outpatient visits 2–3 times a week. The visits themselves focused on strengthening exercises that were progressively adjusted to maintain maximal effort for 3 sets of 10 repetitions for all exercises. The “standard of care” group participated in outpatient rehabilitation elsewhere for an average of 23 sessions that mostly focused on range of motion (ROM), stationary cycling, and “various straight-leg raising exercises without weights,” according to the study’s authors.

Full story at APTA

Flex: New CEU Courses

TOTAL KNEE ARTHROPLASTY REHABILITATION CONSIDERATIONS

The major objectives of rehabilitation after total knee arthroplasty (TKA) are the early regain of range of motion (ROM) and mobilization of the patient.  The goals of this CEU course are to investigate the effect of the knee position during wound closure on early knee function recovery after TKA and the validity and effectiveness of rehabilitation techniques and physical therapies before and after TKA.

POST-PARTUM COCCYDYNIA MUSCLE ENERGY TECHNIQUES

Coccydynia is a painful and incapacitating condition in the early post-partum period.  The goal of this CEU course is to determine the effect of Muscle Energy Technique (MET) in treating post-partum coccydynia. This course is based off of an open access article from the Journal of Physical Therapy and Rehabilitation.

For more on these new courses and many more, visit our CEU home page!

Outpatient total knee replacement surgery linked to higher rates of complications

Some complications are more common when total knee replacement surgery is done as an outpatient or same-day procedure, reports a study in the December 6, 2017 issue of The Journal of Bone & Joint Surgery. The journal is published in partnership with Wolters Kluwer.

Compared to conventional inpatient surgery, patients undergoing outpatient total knee arthroplasty (TKA) experience higher rates of certain complications, including infections, repeat surgery, and blood clots, according to the new research by Armin Arshi, MD, of the David Geffen School of Medicine at UCLA and colleagues.

Full story at news-medical.net

Patients with TKA Who Receive Outpatient Physical Therapy Soon After Surgery Recover More Quickly Than Patients Who Receive Home Physical Therapy First

In brief:

  • Retrospective cohort study focused on 109 TKA patients
  • One group (87) received outpatient physical therapy beginning within a week of discharge; a second group (22) received 2-3 weeks of home physical therapy before entering an outpatient physical therapy program
  • While 6MWT and KOOS outcomes were the same for both groups at completion of outpatient physical therapy, the home health group took average of 20 days longer to reach benchmarks
  • Authors believe results point to need for patient education and choice; potential cost savings of immediate outpatient physical therapy

A new study finds that when it comes to results, patients who undergo total knee arthroplasty (TKA) and engage in home physical therapy before participating in outpatient physical therapy ultimately wind up doing just about as well as patients who proceed directly to physical therapy sessions. The time it takes them to reach those outcomes, however, is another story.

Full story of outpatient PT after surgery wit TKA vs home PT at APTA

NYT: CMS Consideration of Outpatient TKA Sparks Debate

The New York Times (NYT) is reporting “deep discord in the medical world” over the possibility that the US Centers for Medicare and Medicaid Services (CMS) could allow total knee arthroplasty (TKA) to be performed as an outpatient service for its beneficiaries. While a final decision may be a year or 2 away, the Times reports that “many orthopedic doctors and hospitals” are lining up against free-standing surgery centers and outpatient facilities over the issue.

At the center of the debate is CMS’ ongoing consideration of reimbursing for outpatient TKA, and its recent efforts to solicit comments on the change. According to NYT, CMS documents state that an “overwhelming majority” of commenters were in favor of the outpatient option. APTA is on record as a supporter of the move, though the association cautioned that the change would need to be accompanied by updated payment methodologies.

Full story of CMS of outpatient TKA debate at APTA

Final OPPS Rule Eliminates Pain Management Questions From Patient Surveys; Changes Payment Source for Some Hospital-Owned Off-Campus Facilities

The Centers for Medicare and Medicaid Services (CMS) is sticking by its plan to eliminate questions about pain management from patient satisfaction surveys, in response to worry that the questions were pressuring providers to overprescribe opioids and other painkillers. That change, which CMS characterized as a shift made in “an abundance of caution,” is part of the final 2017 outpatient prospective payment system (OPPS), which also alters payment for hospital-owned off-campus facilities and begins a discussion around whether total knee arthroplasty (TKA) should be performed in outpatient settings for Medicare beneficiaries.

The final rule is mostly unchanged from the version proposed in July. APTA provided comments to CMS on the proposed rule and will publish a fact sheet on the final OPPS in the coming weeks.

Full story of OPPS rule eliminating pain management questions at APTA

In the News: Tech-Driven Approaches Improve TKA, THA Surgery and Recovery

Rehabilitation from total knee arthroplasty (TKA) or total hip arthroplasty (THA) may be a constant, but the time needed for rehab could be shortened, thanks to new ways of performing TKA, THA, and joint restoration surgeries.

In an April 21 article in the Miami Herald, reporter Caitlin Granfield writes about approaches to surgery that rely on technologies such as robotics and 3-D modeling to help create procedures that, among other recovery-enhancing qualities, minimize impact on surrounding muscles. Techniques include what Granfield describes as “quadriceps-sparing knee replacement, where surgeons lift the muscle and the knee-replacement surgery is performed from the side, with the incision much shorter than traditional knee replacement surgeries.”

“Over time, we’ve realized that certain muscles and tissues can simply be moved out of the way and don’t need to be detached,” one orthopedic surgeon says in the article.

Full story of tech-driven approaches to TKA and THA surgery/recovery at APTA