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  • What a Difference a Day Makes: Researchers Say That for TKA, Post-Op Same-Day Physical Therapy Reduces Opioid Use and Shortens Length of Stay

    In this review: Same-Day Physical Therapy Following Total Knee Arthroplasty Leads to Improved Inpatient Physical Therapy Performance and Decreased Inpatient Opioid Consumption
    (The Journal of Arthroplasty, August 2019)

    The message
    Total knee arthroplasty (TKA) patients who received physical therapy on the same day as their surgeries were able to walk more while in the hospital and had lower rates of opioid consumption during their stay compared with patients who didn't receive physical therapy until the day after their surgeries. The same-day patients also tended to have shorter lengths of stay and higher rates of discharge to home.

    The study
    Researchers at the New York-based Columbia University Medical Center tracked 687 patients with knee osteoarthritis (OA) who received TKA at the facility between July 2016 and December 2017. A total of 295 "PT0" patients received postoperative physical therapy on the same day as their surgeries (POD0), consisting of a 30-minute session that included information, education, knee exercises, and activities-of-daily-life training. The remaining 392 "PT1" patients received the same session, but not until the day after surgery (POD1). Patients weren't randomized into the groups; instead the "PT0" and "PT1" groups fell into place, depending on whether factors such as patient motivation, fatigue, or pain during physical therapy prevented same-day physical therapy.

    All patients were asked to participate in 2 physical therapy sessions on postoperative day 1 if willing and able. Researchers evaluated ambulation distance, morphine equivalents consumed, pain levels, length of stay, and discharge disposition among the PT0 and PT1 groups. They also analyzed demographics, treatment details such as length of surgery, and preoperative function and outcome measures using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Society Score (KSS).

    Findings

    • The PT0 group experienced an average 76% increase in "physical therapy performance" (number of steps taken) compared with the PT1 group. Authors of the study think the difference may be attributable to the idea that "early interaction with the physical therapist (PT) motivates and affirms patients that they can ambulate with full weight-bearing immediately postoperatively." That confidence-building, they write, paves the way for better progress in subsequent sessions.
    • While self-reported pain levels between the groups were similar, the PT0 group consumed about 25% less opioids than the PT1 group while in the hospital.
    • Average length of stay for the PT0 group was less than for the PT1 group—2.7 days compared with 3.2 days for the PT1 patients. The PT0 patients also tended to be discharged to home at a greater rate than the PT1 group, with 81.7% of the PT0 cohort sent home, compared with 54.8% of the PT1 patients.
    • Factors including gender, pain scores, preoperative KSS and KOOS, and age-influenced results, but did so similarly between the 2 groups. The groups showed no major differences in baseline characteristics.

    Why it matters
    TKA is an ever-increasing procedure predicted to rise to a rate of 1.3 million surgeries a year by 2030. Expenditures are high, with hospital length of stay and postacute care figuring heavily into costs—2 factors that seem to be positively affected by starting physical therapy the same day as surgery. Additionally, as authors point out, "any intervention that can demonstrate decreased opioid consumption is beneficial."

    Related APTA resources
    The association offers a TKA clinical summary, the Knee Outcome Survey-Activities of Daily Living test, and the Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement through the PTNow resource area, and individuals considering TKA can find a consumer-friendly guide at MoveForwardPT.com, the American Physical Therapy Association’s official consumer website. APTA's highly successful #ChoosePT campaign is helping to spread the word about effective nonopioid approaches to pain management, while the association continues to work for increased patient access to physical therapy for pain through direct advocacy and publications, such as its white paper on physical therapy's role in pain management. And be on the lookout: APTA's own clinical practice guideline on TKA is coming soon.

    Keep in mind…
    The research didn't employ a formal randomization process.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • We tried Same day physical therapy after TKA Problem 1) Most of the TKA with comorbidities which affect their Blood pressure, back pain , dizziness 2) Some patient react with anasthetic agent . They become combactiv, delusional 3) starting next day physical therapy does not affect recoverry time or more use of pain killer

      Posted by deepak on 8/29/2019 2:49 PM

    • As a PT why would you even comment something that devalues the implementation of our skills and the very hallmark of our jobs? A research study was conducted and under the conditions they clearly state there was a difference in starting PT the same day that resulted in reduced use of opioids and increase in walking more among other things you can read in their research.

      Posted by Toni Robinson on 9/1/2019 11:17 AM

    • Great information

      Posted by Mary on 9/1/2019 5:02 PM

    • This is just another study that supports early mobilization for all hospitalizations - when the patient is medically stable. In response to Deepak - I think that you need to have a meeting with your orthopods and anesthesia. Our hospital system has patients stand in the recovery room, and amb into their room from the hallway. How did we accomplish this? Orthopods and anesthesia working on the correct combination of global and local medications to not snow the patient and maintain motor control of the LE.

      Posted by Scott Sinick -> BHP^?J on 9/3/2019 7:51 AM

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