Clinical trial NCT05858086: Is Physical Therapy Clearance Before Arthroplasty Home Discharge Necessary?
Official title: Is Postoperative Physical Therapy Clearance Necessary for Safe Home Discharge After Total Joint Arthroplasty?
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Physical Therapy
Total Joint Arthroplasty
Same-day Discharge
Lead sponsor: University of Maryland, Baltimore
Sponsor class: OTHER
Collaborators: name: Rothman Institute Orthopaedics
First posted: 2023-05-15
Enrollment: 210
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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.


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.

Primary outcomes:
measure: Number of postoperative falls per patient
timeFrame: 6 weeks postoperatively
Secondary outcomes:
measure: Number of emergency room visits per patient
timeFrame: 90 days postoperatively
measure: Number of hospital readmissions per patient
timeFrame: 90 days postoperatively
measure: Patient satisfaction scores
timeFrame: 6 weeks postoperatively
measure: Patient reported outcome measure
timeFrame: 6 weeks postoperatively
measure: Patient reported outcome measure
timeFrame: 6 weeks postoperatively
measure: Patient reported outcome measure
timeFrame: 6 weeks postoperatively
Other outcomes:
Locations:
city: Baltimore
country: United States
facility: University of Maryland
state: Maryland
city: New York
country: United States
facility: Hospital for Special Surgery
state: New York
Study officials:
References: