Effect of Immediate Postoperative Physical Therapy on Length of Stay for Total Joint Arthroplasty Patients

Chen, Antonia F.; Stewart, Melissa K.; Heyl, Alma E.; Klatt, Brian A.

doi:10.1016/j.arth.2012.01.011

Cited by 64 publications

(47 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two meta-analyses were performed for the continuous outcome variable LOS, using a random-effects model with inverse variance methods to calculate a standard mean difference and 95% confidence intervals (CI). One meta-analysis was conducted for all randomized clinical trials [32, 36, 43, 45] and another was conducted for all prospective and quasi-experimental studies [29, 33, 35, 40, 46, 47]. Previous research [48] has provided a scale for interpreting the strength of the standard mean difference: 0.2 indicates a small effect, 0.5 indicates a medium effect, and 0.8 indicates a large effect.…”

Section: Methodsmentioning

confidence: 99%

“…Inpatient physical therapy services are commonly utilized following THA or TKA and are often considered an important part of post-operative management. Over the past decade, research has focused on early post-operative physical therapy with these patients and its impact on functional outcomes, costs, length of stay (LOS), and adverse reactions in the inpatient setting [29–40]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis

et al. 2017

View full text Add to dashboard Cite

ObjectiveTo investigate the role of early initiation of rehabilitation on length of stay (LOS) and cost following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty.Data sourcesElectronic databases PubMed, CINAHL, Pedro, Embase, AMED, and the Cochrane Library were searched in July 2016. Five additional trials were identified through reference list scanning.Study selectionEligible studies were published in English language peer-reviewed journals; included participants that had undergone total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty reported clearly defined timing of rehabilitation onset for at least two groups; and reported at least one measure of LOS or cost. Inclusion criteria were applied by 2 independent authors, with disagreements being determined by a third author. Searching identified 1,029 potential articles, of which 17 studies with 26,614 participants met the inclusion criteria.Data extractionData was extracted independently by 2 authors, with disagreements being determined by a third author. Methodological quality of each study was evaluated independently by 2 authors using the Downs and Black checklist. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate standardized mean differences (SMD) and 95% confidence intervals for LOS.Data synthesisWhen compared with standard care, early initiation of physical therapy demonstrated a decrease in length of stay for the 4 randomized clinical trials (SMD = -1.90; 95% CI -2.76 to -1.05; I2 = 93%) and for the quasi-experimental and 5 prospective studies (SMD = -1.47; 95% CI -1.85 to -1.10; I2 = 88%).ConclusionEarly initiation of rehabilitation following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty is associated with a shorter LOS, a lower overall cost, with no evidence of an increased number of adverse reactions. Additional high quality studies with standardized methodology are needed to further examine the impact of early initiation of physical therapy among patients with joint replacement procedures.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis

et al. 2017

View full text Add to dashboard Cite

show abstract

“…However, a current emphasis on active (rather than passive) physiotherapy, earlier ambulation (as soon as 4 hours postoperatively), and shorter hospital stays, are driving many centers to search for analgesic modalities with the least possible motor effects. 18,19 Within this context, ACB has been proposed as a possible alternative to femoral nerve block to provide analgesia to the anteromedial knee while preserving quadriceps strength. It should be noted that ACB is not yet a well-established or broadly adopted clinical intervention.…”

Section: Clinical Significancementioning

confidence: 99%

The Nerves of the Adductor Canal and the Innervation of the Knee

Laurant

Peng

Arango

et al. 2016

Regional Anesthesia and Pain Medicine

236

139

View full text Add to dashboard Cite

The results suggest that both the SN and NVM contribute to the innervation of the anteromedial knee joint and are therefore important targets of adductor canal block. Given the site of exit of both nerves in the distal third of the adductor canal, the midportion of the adductor canal is suggested as an optimal site of local anesthetic administration to block both target nerves while minimizing the possibility of proximal spread to the femoral triangle.

show abstract

“…Early mobility has many potential advantages to the postoperative recovery process of patients undergoing TJA. Prior studies have indicated that early mobilization can decrease complications such as venous thromboembolic events, decrease length of stay (LOS), decrease hospital-acquired conditions, decrease hospital costs, and improve functional outcomes [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. As a result, efforts to improve early mobilization may indirectly improve value by improving quality and decreasing costs.…”

Section: Introductionmentioning

confidence: 99%

Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing

et al. 2017

View full text Add to dashboard Cite

BackgroundAn early physical therapy (PT) care pathway was implemented to provide same-day ambulation after total joint arthroplasty by changing PT staffing hours.MethodsAfter receiving an exemption from our institutional review board, we performed a secondary data analysis on a cohort of patients that underwent primary TJA of the hip or knee 6 months before and 12 months after implementation of the change. Data on same-day ambulation rates, length of stay (LOS), and in-hospital costs were reviewed.ResultsEarly evaluation and mobilization of patients by PT improved on postoperative day (POD) 0 from 64% to 85% after the change (P ≤ .001). The median LOS before the change was 3.27 days compared to 3.23 days after the change (P = .014). Patients with higher American Society of Anesthesiologists scores were less likely to ambulate on POD 0 (P = .038) and had longer hospital stays (P < .001). Early mobilization in the entire cohort was associated with a greater cost savings (P < .001).ConclusionsA relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.

show abstract

Effect of Immediate Postoperative Physical Therapy on Length of Stay for Total Joint Arthroplasty Patients

Cited by 64 publications

References 12 publications

Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis

Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis

The Nerves of the Adductor Canal and the Innervation of the Knee

Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing

Contact Info

Product

Resources

About