Benefits of direct patient discharge to outpatient physical therapy after total knee arthroplasty
Jesse C. Christensen,1 Roger J. Paxton,1,2 Carol Baym,1 Jeri E. Forster,1 Michael R. Dayton,3 Craig A. Hogan,3 and Jennifer E. Stevens-Lapsley1Knee
Purpose:
To investigate the effectiveness of home health physical therapy followed by outpatient physical therapy as compared to patients discharged directly to outpatient physical therapy in improving functional performance, strength/activation and residual knee pain outcomes among patients who received a total knee arthroplasty.
Materials and Methods:
A secondary analysis of longitudinal data in which patients with total knee arthroplasty underwent home health physical therapy or were discharged directly to outpatient physical therapy. Main outcome measures included the stair climb test, timed up and go, six-minute walk test, quadriceps and hamstring strength, quadriceps activation and residual knee pain.
Results:
Patients referred to home health physical therapy prior to outpatient physical therapy demonstrated significantly greater declines in stair climb test (10.3; 95% CI (6.5, 14); t=5.41; p<0.0001), timed up and go (2.0; 95% CI (6.5, 14); t=4.10; p<0.0001), six-minute walk (53.8; 95% CI (6.5, 14); t=4.35; p<0.0001), quadriceps strength (( 21.7%; 95% CI (19.3%, 24.9%); t=2.53; p=0.01), hamstring strength (44.7%; 95% CI( 43.4%, 45.7%), t=3.17; p=0.002) and higher residual knee pain (0.53; 95% CI (0.04, 1.03); t=2.13; p=0.03) 1 month after total knee arthroplasty compared to those referred directly to outpatient physical therapy.
Conclusions:
These findings suggest that patients discharged directly to outpatient physical therapy had a more rapid recovery 1 month after total knee arthroplasty. Additional research is needed to investigate the potential causal relation between care pathways and clinical outcomes following total knee arthroplasty.
Link to article