Pre-operative One-on-One Physical Therapy Education Improves Postoperative Function and Patient Satisfaction After Total Joint Arthroplasty

Study Overview
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Brief Summary
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The purpose of this study was to evaluate the efficacy of a one-time, preoperative physical therapy protocol on postoperative (1) discharge disposition, (2) pain, function and stiffness and (3) patient satisfaction.

Official Title
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One-on-One Physical Therapy Education Improves Postoperative Function and Patient Satisfaction After TJA

Conditions
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Arthroplasty

Intervention / Treatment
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* Behavioral: Preoperative Physical Therapy Session
* Behavioral: Group Preoperative Education Session (per the standard of care)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects will be required to meet the following inclusion criteria in order to participate: Unilateral Primary Knee OA or Hip OA Patients at least 18 years old up to 85. Undergoing surgery with one of the following study surgeons Able to independently ambulate ≥ half a block with or without assistive device Able to independently perform non-reciprocal stairs with or without assistive device/rails Patients that plan to D/C home post TKA / THA Patients that speak English only. Exclusion Criteria: Rheumatoid arthritis Psoriatic arthritis Juvenile rheumatoid arthritis Knee or Hip revisions Patients under 18 years of age Patients unwilling or unable to complete PRO instrument or study questionnaires at the specified study time points pre-operatively or post-operatively Bilateral TKA and THA Uni-condylar knee arthroplasty or Hip resurfacing Patellar reconstruction Patient on disability, workman's compensation Patients unwilling to participate in PEdPTWP and/or Patient education class and booklet. Patients that plan to D/C to rehabilitation center post TKA and THA Patients that do not speak English Patients that do not have access to computer

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental (Intervention): PreopPT Group<br>This group will undergo the group preoperative education session. Following this session (intervention) this group underwent a one-time, one-on-one preoperative PT session. They also were given access to a web-based microsite which was customized to surgeon | Behavioral: Preoperative Physical Therapy Session<br>* This was a one-on-one preoperative physical therapy session on preoperative education. These patients were also given access to a surgery specific web-based microsite<br>Behavioral: Group Preoperative Education Session (per the standard of care)<br> <br> |
| Placebo Comparator: Control (standard of care): No PreopPT Group<br>This group underwent the current of standard of care at our institution. This only includes the group preoperative education session. No further preoperative education was given. | Behavioral: Group Preoperative Education Session (per the standard of care)<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of In-patient Physical Therapy visits required to meet hospital discharge criteria PT | This included a review of the hospital database for hospital discharge time. At this institution PT discharge is defined as the ability to (1) independently transfer, (2) independently ambulate approximately 150 feet and (3) independently negotiate stairs (4) independent with home exercise program and activities of daily living. All of this data was recorded from hospital records | Through Study Completion, an average of 3 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) | This standard patient reported outcome was filled out preoperatively or at six weeks postoperatively | This standard patient reported outcome was filled out preoperatively or at six weeks postoperatively | 
| Patient Satisfaction Scores | Patient satisfaction was measured by a series of patient administered questionnaires at various stages of the study. All satisfaction questions, with the exception of the utilization of the microsites [Yes/No], were asked via a visual analogue scale to disagree or agree with given statements [0-5, where 0 was strongly disagree, 3 was neutral and 5 was strongly agree]. Patients unable to complete any forms at the time of the appointment completed the form over the phone with a co-investigator. | from two weeks prior to surgery until 6 weeks after surgery | 
| Time to meet Physical Therapy discharge criteria | At this institution PT discharge is defined as the ability to (1) independently transfer, (2) independently ambulate approximately 150 feet and (3) independently negotiate stairs (4) independent with home exercise program and activities of daily living. | Time from Surgery to meeting PT discharge criteria, an average of 3 days | 
| Hospital Length of Stay | collected from a hospital database | Time from Surgery until Hospital Discharge, an average of 2-3 days |