Knee Replacement Rehabilitation Care Pathways

Official title

Development and Implementation of Optimal Rehabilitation Care Pathways to Reduce Disparities in Rehabilitation Outcomes After Joint Replacement

Overview

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.

Detailed description

In previous work, the investigators used quantitative and qualitative data to identify sociodemographic disparities in physical function and use of rehabilitation following total knee arthroplasty (TKA), or knee replacement surgery. The investigators also identified patient and provider impressions regarding areas of the post-TKA rehabilitation pathway and recommendations for improvements. Based on all of this information, the investigative team has developed a newly-optimized rehabilitation care pathway and will pilot test this approach in this study.

Interventions

• Behavioral TKA Journey - patient education
  The investigators' team developed a new patient education booklet containing information that walks the patient through their TKA journey, from pre-operative to hospital-based rehabilitation prior to discharge, to outpatient physical therapy, and after discharge from formal physical therapy services. All patients in the intervention arm will receive this booklet from their surgeon's office and will receive a phone call from study personnel to review it and answer any questions.
• Other Optimized Rehab Scheduling
  For all patients in the 'intervention' practice, the home health referral will include instructions for the home health physical therapist 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.
• Behavioral Usual Rehab
  Participants in the usual rehab group will continue to follow the current standard-of-care rehabilitation pathway for patients post-TKA.

Primary outcome measures

• Patient Satisfaction [Time frame: 3 months post-TKA surgery]

Secondary outcome measures (3)

• Rehab timing [Time frame: For most patients, this will occur approximately 2 weeks post-operatively.]
• Completion of in-depth, semi-structured focus group interviews (study participants) [Time frame: 3 months post-operatively]
• Completion of in-depth, semi-structured 1-on-1 interviews (physical therapists who treat patients post-total knee arthroplasty) [Time frame: 4 months after enrollment of the first participant in the study]

Eligibility criteria

Inclusion criteria

• 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

Exclusion criteria

• does not undergo planned surgery
• does not receive any post-TKA rehabilitation at UPMC facilities

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

Open label

Primary purpose

Health services research

Study locations

United States · 1 center

• University of Pittsburgh — Pittsburgh

Identifiers

NCT: NCT07598539 · K23MD018640 · K23MD018640

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗