Improving the physical therapy model of care after total joint arthroplasty
Date
2018
Authors
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Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
The incidence of total joint arthroplasties has increased in the past decade and that age-range of patients has widened. This greater range of ages introduces new challenges for surgeons and clinicians when determining interventions that meet patients’ needs and goals. Currently, there is limited research on how or if expectations and goals have changed with a younger patient demographic. There is also no current research that has evaluated how age affects the rate of recovery of patients after joint arthroplasty. Identifying these differences in expectations and recovery are foundational steps to ultimately improve post-operative management and rehabilitation protocols after TJA. Improvements to the current model of care are necessary as functional deficits, muscle weakness, activity limitations, and biomechanical moments/symmetries, do not always resolve after surgery. While these impairments may not substantially reduce the quality of life for older individuals, possible younger more active patients would be unprepared or unable to safely return to higher levels of recreational and vocational activities after surgery. ☐ To address these limitations, this dissertation improves the measurement and understanding of patient expectations and satisfaction, evaluates how age may be a factor in treatment outcomes, and tests a novel rehabilitation model that would be ideally suited for patients with higher expectations and an earlier recovery after joint replacement. ☐ Chapter 1 provides pertinent background information regarding and explains the significance, innovations and specific aims of the defense. Chapter 2 describes a reliable expectation questionnaire designed for patients after total knee arthroplasty (TKA) and the relationship of age, BMI and Six-minute walk (6MW) tests to scores. Results from this chapter found age was not related to patient expectations, but BMI and the 6MW were. Function and weight may be more appropriate variables when discussing and evaluating expectations. Chapter 3 introduces a reliable satisfaction questionnaire that mirrors the expectation questionnaire from Chapter 2. In this chapter the relationship of age, BMI and 6MW were also evaluated, as well as the correlation between expectations before surgery to satisfaction 6 months after surgery. Similarly, to Chapter 1 age was not a significant variable when predicting satisfaction scores, but BMI and 6MW were. Higher expectations also correlated to higher satisfaction scores. In Chapter 4, we found that pre-operative demographics and functional variables were not significant predictors of early recovery of ROM and early mobility after TKA. In Chapter 5, we discuss the results from a novel rehabilitation protocol that we developed to return patients to higher level activities. This protocol was safe, feasible and effective at improving function and biomechanics after surgery. ☐ The findings of this defense suggest age is not a strong predictor of expectations, satisfaction or recovery which is contrary to previous thinking. Our work has shown that younger patients can present with lower function and worse pain than an older cohort. We also found that pre-operative assessments may not be useful in trying to predict patients with “early recovery” from TKA surgery. However, we did find that a rehabilitation protocol with a delayed treatment timing is successful and feasible. When determining patient interventions less focus should be placed on age, and a greater focus on function. Future work is still necessary to identify what variables can best identify patients with higher expectations and earlier recovery, that would be best suited for the rehabilitation protocol evaluated in this defense. Overall, the results of these studies impact the current understanding of recovery, expectations, and satisfaction after TKA and introduce a potential new model of care after THA.
Description
Keywords
Biological sciences, Health and environmental sciences, Biomechanics, Osteoarthritis, Physical therapy, Rehabilitation, Total joint replacement