Abstract
Introduction
The advent of ambulatory total joint replacements has called for measures to reduce postoperative length of stay, while improving patient function and postoperative satisfaction. This prospective, randomized trial evaluated the efficacy of one-on-one preoperative physical therapy (PT) education with a supplemental web-based PT web-portal on discharge disposition, postoperative function and patient satisfaction after total joint replacement.
Materials & Methods
Between February and June 2015, 126 patients underwent unilateral total knee (n=63) or total hip arthroplasty (n=63). All patients attended a group preoperative education (preopEd) class [standard of care] and were subsequently randomized into two groups. One group received no further education as per the standard of care [control; TKA= 31; THA=32] and the other received an in-person one-on-one preoperative PT education session (preopPTEd) as well as access to a web-portal during the postoperative period [experimental; TKA=32; THA=31]. Discharge disposition was attained from hospital records. Patient satisfaction and WOMAC scores were evaluated by a series of patient administered questionnaires.
Results
The group that received preopPTEd trended towards a reduction in hospital length of stay compared to the current standard of care (2.4 days vs. 2.6 days; p=0.077). However, the group that received preopPTEd met the postoperative functional discharge requirements significantly faster (1.6 days vs. 2.7 days, respectively; p<0.001) and required fewer postoperative PT visits (3.3 vs. 4.4 visits respectively; p<0.001) than those who did not. With respect to satisfaction, patients who received the preopPTEd felt they were better prepared to leave the hospital postoperatively and were overall more satisfied with their postoperative education (p<0.001 and p<0.001, respectively). The majority (69.8%) of patients who did not receive preopPTEd reported that they would have benefitted from additional preopPTEd. There were no clinically relevant improvements in the WOMAC subscores or total score between the groups. All findings were consistent in both the TKA and THA sub-groups.
Conclusion
Patients who received the preopPTEd required fewer PT visits and met the postoperative functional PT discharge criteria faster than those who did not. Patients who received preopPTEd also reported being better prepared to leave the hospital after surgery and better overall satisfaction compared to the current standard of care. The one-on-one preoperative PT education session with supplemental web-portal education pathway may be an adjunct to help reduce postoperative length of stay for ambulatory total joint replacements.
