After Knee Replacement, PT Is Under-Utilized

Individuals who underwent total knee replacement surgery (TKR) are not receiving enough physical therapy (PT), according to results from a retrospective review.

This suggests that PT interventions may be insufficiently applied in clinical practice.

IF YOU LIKE THIS, READ MORE...

Total Knee Replacement in the Very Elderly

4 Questions About Exercise Before Joint Replacement

Previous research has reported that exercise interventions are associated with better outcomes after TKR. However, studies have not determined whether the evidence has been rendered into clinical practice.

For this study, the researchers evaluated 112 records to measure content, dosage, and progression of usual post-acute PT services following TKR from 30 PT sites. Of the records analyzed, 91 records were from 27 outpatient facilities, and 21 records were from 3 home care facilities. 

Descriptive statistics and linear regression models were used to define PT treatment factors and actuate associations of care with patient functional outcomes at 6 months.

Overall, content and dosage of specific exercises, as well as incidence of progression, varied widely. 

A total of 34 different interventions—16 closed-chain, 14 open-chain, and 4 passive exercises—were identified in the analyses.

Over the course of acute care, patients had an average 14.5 PT visits and 12.8 different exercise interventions, including 4.5 closed-chain exercises, 5.1 open-chain exercises, and 1.8 passive interventions.

Open-chain exercises were used more intermittently than closed-chain exercises (median, 21 vs 13). 

The median incidence of progression was 0 for closed-chain exercise and 1 for open-chain exercise. Stair climb recorded at a shorter interval was associated with higher total number of PT interventions, and was associated with use and progression of closed-chain exercises.

“Additional research is needed…to identify ‘best practice’ adjusting for patient characteristics that lead to optimal functional outcomes following TKR surgery,” the researchers concluded.

—Melinda Stevens

Reference:
Oatis CA, Johnson JK, DeWan T, Donahue K, Li W, Franklin PD. Characteristics of usual physical therapy post‐total knee replacement and their associations with functional outcomes [published online October 3, 2018]. Arthritis Care Res. 
https://doi.org/10.1002/acr.23761.