Knee Replacement Rehabilitation Care Pathways
ConditionKnee Replacement, Total
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversity of Pittsburgh
About this trial
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.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
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
Disqualifiers
does not undergo planned surgery
does not receive any post-TKA rehabilitation at UPMC facilities
Trial design
Design model
Parallel
Treatments tested in this trial
TKA Journey - patient education
BehavioralThe investigators' team are co-developing new patient education materials with patients and physical therapists, to be presented at the pre-operative "total joint class" that patients awaiting knee and hip replacement attend prior to their surgery. These new materials replace previous slides that were presented about rehabilitation post-knee replacement.
Optimized Rehab Scheduling
Other interventionFor all patients in the 'intervention' cohort, the home health physical therapist will receive instruction 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.
Usual Rehab
BehavioralParticipants in the usual rehab group will continue to follow the current standard-of-care rehabilitation pathway for patients post-TKA.
Physical Therapist reminders
BehavioralAlong with implementation of the new patient education materials, outpatient physical therapists will receive reminder materials regarding the preferred elements of the current standard-of-care "prehabilitation" visit --- a single outpatient physical therapy visit that patients awaiting total knee replacement are instructed to attend prior to their surgery. Instructions exist regarding the content of these visits, but physical therapists in the system have not received updated materials or reminders regarding the content of the visits in quite some time. This will serve as a reminder of "best practices" and re-education to the prehabilitation process.
Treatment groups
30 Participants
are divided into 2 treatment groupsGroup A: Control - Usual RehabActive comparator 1 intervention
Group B: Intervention - Optimized RehabExperimental treatment 3 interventions
Trial outcomes
Primary outcomes
1
Patient Satisfaction
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.
Time frame
3 months post-TKA surgerySecondary outcomes
1
Patient focus groups to assess implementation outcomes
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 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.
Time frame
Upon completion of all rehab post-total knee replacement (approximately 3 months post-operatively)2
Completion of in-depth, semi-structured 1-on-1 interviews (physical therapists who treat patients post-total knee arthroplasty)
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.
Time frame
4 months after enrollment of the first participant in the studySponsors and contacts
Click on the lead sponsor to view all of their trials.
University of Pittsburgh
Lead sponsor
National Institute on Minority Health and Health Disparities (NIMHD)
Collaborator
Source ClinicalTrials.gov