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In brief:

  • Retrospective cohort study focused on 109 TKA patients
  • One group (87) received outpatient physical therapy beginning within a week of discharge; a second group (22) received 2-3 weeks of home physical therapy before entering an outpatient physical therapy program
  • While 6MWT and KOOS outcomes were the same for both groups at completion of outpatient physical therapy, the home health group took average of 20 days longer to reach benchmarks
  • Authors believe results point to need for patient education and choice; potential cost savings of immediate outpatient physical therapy

A new study finds that when it comes to results, patients who undergo total knee arthroplasty (TKA) and engage in home physical therapy before participating in outpatient physical therapy ultimately wind up doing just about as well as patients who proceed directly to physical therapy sessions. The time it takes them to reach those outcomes, however, is another story.

Writing in a recent issue of Orthopedic Nursing (abstract only available for free), researchers report on the results from an analysis of 109 TKA patients who participated in a hospital's joint replacement program, and who had the option of entering into outpatient physical therapy beginning within a week after surgery (87 individuals, called the OP group) or receiving home health care for 2 to 3 weeks before moving on to outpatient physical therapy (22 individuals, labeled the HH group). Researchers reviewed medical records from 2005 to 2010 to find out if the 2 paths resulted in different outcomes and what those outcomes were after completion of outpatient physical therapy.

Researchers found that in terms of outcomes as measured by the 6-minute walk test (6MWT) and the Knee Injury Osteoarthritis Outcome Score (KOOS), both groups ultimately achieved similar scores (adjusted for age and other variables). Patients averaged nearly 80% of age and sex-predicted distances on the 6MWT and registered KOOS subscale scores (activities of daily living, pain, symptoms, and quality-of-life) that didn't vary significantly between groups.

When they looked at the time it took for patients to reach those outcomes, however, the researchers found that patients in the OP group reached postoperative milestones about 20 days sooner, on average, than their HH counterparts. Additionally, both groups averaged about the same number of outpatient physical therapy sessions, "pointing to the fact that home health [physical therapy] did not accelerate recovery (with the possible exception of knee flexion [range of motion])," authors write.

The outpatient track consisted of 2 to 3 physical therapy sessions per week for 4 to 6 weeks, plus a daily exercise program focused on range of motion, stretching, low-impact cardiovascular conditioning, and lower extremity strengthening and endurance. The HH program was harder to discern through medical records, authors write, but likely included physical therapy 3 times a week for 2 to 3 weeks, "with the ultimate goal of tolerance for outpatient [physical therapy] to complete rehabilitation."

In the end, authors write, the decision as to whether to pursue immediate outpatient physical therapy or a period of home health physical therapy may depend on individual patient circumstances; still, they assert, "the results of this study provide evidence to the importance of patient education and shared decision-making between patients and the multidisciplinary team."

"If the patient and the clinician determine that home health is necessary, then no loss of functional gains should be expected," authors write. "However, it may take a longer time period, and perhaps expense, to achieve those gains."

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. 

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