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Recruiting NCT05858086

Is Physical Therapy Clearance Before Arthroplasty Home Discharge Necessary?

No phase Interventional Physical Therapy Total Joint Arthroplasty Same-day Discharge

For patients and families

In plain language

An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.

What is being studied
The protocol lists: Novel same-day discharge protocol after total joint arthroplasty, Conventional postoperative physical therapy clearance.
Who it may be relevant to
Registry conditions: Physical Therapy, Total Joint Arthroplasty, Same-day Discharge. Basic parameters: 18 years — 90 years · All.
What needs checking
Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
Where it takes place
United States
Next step
Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →

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Official title

Is Postoperative Physical Therapy Clearance Necessary for Safe Home Discharge After Total Joint Arthroplasty?

Overview

Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge in patients having surgery late in the day. Failed same-day discharge in eligible TJA patients results in unnecessary hospital bed occupancy, which increases costs, limits operating room throughput for patients requiring inpatient admission, and introduces risks associated with longer length-of-stay. In collaboration with an institutional PT department, the investigators developed a protocol for discharging same-day TJA patients without postoperative PT clearance. Immediately preoperatively, PT administers gait training. Patients are then discharged home after ambulating with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization. This allows for the maximum number of patients discharged home, including the last patient of the day, PT staffing limitations notwithstanding. Single-institution pilot data demonstrates no increased risk of falls, emergency room (ER) visits, or readmissions with this process. The investigators propose a prospective, controlled, multicenter study to expand on pilot data. The study aim is to assess safety of day-of-surgery preoperative PT and postoperative ambulation with PACU nursing before TJA discharge. The primary endpoint is postoperative falls, while secondary endpoints include 90-day ER visits, 90-day hospital readmissions, patient-reported outcome measures, and patient satisfaction scores.

Interventions

  • Other Novel same-day discharge protocol after total joint arthroplasty
    Preoperative gait/stair training with physical therapy, then postoperative ambulation with nursing after total joint arthroplasty
  • Other Conventional postoperative physical therapy clearance
    Physical therapy evaluation and clearance after total joint arthroplasty

Primary outcome measures

  • Number of postoperative falls per patient [Time frame: 6 weeks postoperatively]
Secondary outcome measures (6)
  • Number of emergency room visits per patient [Time frame: 90 days postoperatively]
  • Number of hospital readmissions per patient [Time frame: 90 days postoperatively]
  • Patient satisfaction scores [Time frame: 6 weeks postoperatively]
  • Patient reported outcome measure [Time frame: 6 weeks postoperatively]
  • Patient reported outcome measure [Time frame: 6 weeks postoperatively]
  • Patient reported outcome measure [Time frame: 6 weeks postoperatively]

Eligibility criteria

Inclusion criteria

  • are 18 years of age or older
  • undergo primary THA or TKA
  • are eligible for same-day home discharge (friends or family available to stay at home with the patient for one week postoperatively and medically stable for discharge from PACU per anesthesia).

Exclusion criteria

  • 90 years of age or older
  • have sleep apnea (not eligible for same-day discharge)
  • require overnight stay for any reason
  • undergo revision THA or TKA.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation
Non-randomized
Model
Parallel assignment
Masking
Single blind
Primary purpose
Health services research

Study locations

United States · 2 centers
  • University of Maryland — Baltimore
  • Hospital for Special Surgery — New York

Identifiers

NCT: NCT05858086 · 12

Primary sources (government registries)

View this study on ClinicalTrials.gov ↗