Web-Based, Self-Directed Physical Therapy After Total Knee Arthroplasty Is Safe and Effective for Most, but Not All, Patients

Published:December 03, 2018DOI:https://doi.org/10.1016/j.arth.2018.11.040

      Abstract

      Background

      Recently, self-directed physical therapy (SDPT) programs have gained popularity following total knee arthroplasty (TKA). This study evaluated the safety and efficacy of the routine use of an SDPT program in a nonselect patient population.

      Methods

      This is a single-surgeon, retrospective study of 296 consecutive patients from August 2016 to October 2017 discharged home after primary, unilateral TKA and enrolled in a web-based SDPT program. Patients were seen 2 weeks after surgery and outpatient physical therapy (OPPT) was prescribed if flexion was less than 90°, upon patient request, or inability to use the web-based platform.

      Results

      Overall, 195 of 296 (65.9%) patients did not require OPPT (SDPT-only) while 101 of 296 were prescribed OPPT (34.1%, SDPT + OPPT). In SDPT + OPPT, 66.3% were for flexion <90°, 27.7% by patient request, 5.0% received a prescription but did not attend OPPT, and 1.0% due to inability to use the web-based platform. The rate of manipulation under anesthesia was 2.36% overall (SDPT + OPPT, 6.93%; SDPT-only, 0.0%). Multivariate analysis identified elevated Charlson comorbidity index, elevated body mass index, higher preoperative SF12 mental score, and loss of flexion at 2 weeks as independent predictors associated with the need for OPPT.

      Conclusion

      Web-based SDPT is safe and effective for most patients eligible for home discharge after TKA. It is difficult to preoperatively predict those patients who will require OPPT; therefore, we recommend close follow-up. It is critical to preserve these services for patients who require them after TKA as up to a third of patients required OPPT.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Inacio M.C.S.
        • Paxton E.W.
        • Graves S.E.
        • Namba R.S.
        • Nemes S.
        Projected increase in total knee arthroplasty in the United States - an alternative projection model.
        Osteoarthritis Cartil. 2017; 25: 1797-1803
        • Bozic K.J.
        • Ward L.
        • Vail T.P.
        • Maze M.
        Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction.
        Clin Orthopaedics Relat Res. 2014; 472: 188-193
        • Buhagiar M.A.
        • Naylor J.M.
        • Harris I.A.
        • Xuan W.
        • Kohler F.
        • Wright R.
        • et al.
        Effect of inpatient rehabilitation vs a monitored home-based program on mobility in patients with total knee arthroplasty: the HIHO randomized clinical trial.
        JAMA. 2017; 317: 1037-1046
        • Ko V.
        • Naylor J.
        • Harris I.
        • Crosbie J.
        • Yeo A.
        • Mittal R.
        One-to-one therapy is not superior to group or home-based therapy after total knee arthroplasty: a randomized, superiority trial.
        J Bone Jt Surg Am Vol. 2013; 95: 1942-1949
        • Kramer J.F.
        • Speechley M.
        • Bourne R.
        • Rorabeck C.
        • Vaz M.
        Comparison of clinic- and home-based rehabilitation programs after total knee arthroplasty.
        Clin Orthopaedics Relat Res. 2003; : 225-234
        • Mahomed N.N.
        • Davis A.M.
        • Hawker G.
        • Badley E.
        • Davey J.R.
        • Syed K.A.
        • et al.
        Inpatient compared with home-based rehabilitation following primary unilateral total hip or knee replacement: a randomized controlled trial.
        J Bone Jt Surg Am Vol. 2008; 90: 1673-1680
        • Jiang S.
        • Xiang J.
        • Gao X.
        • Guo K.
        • Liu B.
        The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: a systematic review and meta-analysis.
        J Telemed Telecare. 2018; 24: 257-262
        • Moffet H.
        • Tousignant M.
        • Nadeau S.
        • Merette C.
        • Boissy P.
        • Corriveau H.
        • et al.
        In-home telerehabilitation compared with face-to-face rehabilitation after total knee arthroplasty: a noninferiority randomized controlled trial.
        J Bone Jt Surg Am Vol. 2015; 97: 1129-1141
        • Russell T.G.
        • Buttrum P.
        • Wootton R.
        • Jull G.A.
        Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial.
        J Bone Jt Surg Am. 2011; 93: 113-120
        • Shukla H.
        • Nair S.R.
        • Thakker D.
        Role of telerehabilitation in patients following total knee arthroplasty: evidence from a systematic literature review and meta-analysis.
        J Telemed Telecare. 2017; 23: 339-346
        • Tousignant M.
        • Moffet H.
        • Boissy P.
        • Corriveau H.
        • Cabana F.
        • Marquis F.
        A randomized controlled trial of home telerehabilitation for post-knee arthroplasty.
        J Telemed Telecare. 2011; 17: 195-198
        • Tousignant M.
        • Boissy P.
        • Corriveau H.
        • Moffet H.
        • Cabana F.
        In-home telerehabilitation for post-knee arthroplasty: a pilot study.
        Int J Telerehabil. 2009; 1: 9-16
        • Tousignant M.
        • Moffet H.
        • Nadeau S.
        • Merette C.
        • Boissy P.
        • Corriveau H.
        • et al.
        Cost analysis of in-home telerehabilitation for post-knee arthroplasty.
        J Med Internet Res. 2015; 17: e83
        • Restrepo C.
        • Mortazavi S.M.
        • Brothers J.
        • Parvizi J.
        • Rothman R.H.
        Hip dislocation: are hip precautions necessary in anterior approaches?.
        Clin Orthopaedics Relat Res. 2011; 469: 417-422
        • Parvizi J.
        • Ceylan H.H.
        • Kucukdurmaz F.
        • Merli G.
        • Tuncay I.
        • Beverland D.
        Venous thromboembolism following hip and knee arthroplasty: the role of aspirin.
        J Bone Jt Surg Am Vol. 2017; 99: 961-972
        • Parvizi J.
        • Huang R.
        • Restrepo C.
        • Chen A.F.
        • Austin M.S.
        • Hozack W.J.
        • et al.
        Low-dose aspirin is effective chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty: a preliminary analysis.
        J Bone Jt Surg Am Vol. 2017; 99: 91-98
        • Austin M.S.
        • Urbani B.T.
        • Fleischman A.N.
        • Fernando N.D.
        • Purtill J.J.
        • Hozack W.J.
        • et al.
        Formal physical therapy after total hip arthroplasty is not required: a randomized controlled trial.
        J Bone Jt Surg Am Vol. 2017; 99: 648-655
        • Kornuijt A.
        • Das D.
        • Sijbesma T.
        • de Vries L.
        • van der Weegen W.
        Manipulation under anesthesia following total knee arthroplasty: a comprehensive review of literature.
        Musculoskelet Surg. 2018; 102: 223-230
        • Hung M.
        • Bounsanga J.
        • Voss M.W.
        • Saltzman C.L.
        Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis outcome score for joint reconstruction in orthopaedics.
        World J Orthopedics. 2018; 9: 41-49
        • Naylor J.M.
        • Hayen A.
        • Davidson E.
        • Hackett D.
        • Harris I.A.
        • Kamalasena G.
        • et al.
        Minimal detectable change for mobility and patient-reported tools in people with osteoarthritis awaiting arthroplasty.
        BMC Musculoskelet Disord. 2014; 15: 235
        • Rondon A.J.
        • Tan T.L.
        • Greenky M.R.
        • Goswami K.
        • Shohat N.
        • Phillips J.L.
        • et al.
        Who goes to inpatient rehabilitation or skilled nursing facilities unexpectedly following total knee arthroplasty?.
        J Arthroplasty. 2018; 33: 1348-13451.e1
        • Smith W.A.
        • Zucker-Levin A.
        • Mihalko W.M.
        • Williams M.
        • Loftin M.
        • Gurney J.G.
        Physical function and physical activity in obese adults after total knee arthroplasty.
        Orthop Clin North Am. 2017; 48: 117-125
        • Jarvenpaa J.
        • Kettunen J.
        • Kroger H.
        • Miettinen H.
        Obesity may impair the early outcome of total knee arthroplasty.
        Scand J Surg. 2010; 99: 45-49
        • Bonnefoy-Mazure A.
        • Martz P.
        • Armand S.
        • Sagawa Jr., Y.
        • Suva D.
        • Turcot K.
        • et al.
        Influence of body mass index on sagittal knee range of motion and gait speed recovery 1-year after total knee arthroplasty.
        J Arthroplasty. 2017; 32: 2404-2410

      Linked Article