Formal Physical Therapy Following Total Hip and Knee Arthroplasty Incurs Additional Cost Without Improving Outcomes

Yayac, Michael; Moltz, Rachel; Pivec, Robert; Lonner, Jess H.; Courtney, P. Maxwell; Austin, Matthew S.

doi:10.1016/j.arth.2020.04.023

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…Extended therapy incentivizes therapists but places undue financial and temporal strains on our health-care system without significant functional gains or improved outcomes [ 69 ]. In addition, a prolonged rehabilitation track limits access for patients with greater needs beyond primary hip and knee replacement.…”

Section: Future Directions and Recommendationsmentioning

confidence: 99%

An Update on Physical Therapy Adjuncts in Orthopedics

et al. 2022

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Section: Future Directions and Recommendationsmentioning

confidence: 99%

An Update on Physical Therapy Adjuncts in Orthopedics

et al. 2022

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“…PT exercises can also be painful, as one of the most commonly asked questions regarding PT in the postoperative period after THA is about pain expectations [ 26 ]. Additionally, Yayac et al demonstrated that TJA patients who underwent supervised PT had a significantly higher readmission rate than those who were discharged with self-directed home exercise regimens [ 9 ]. After controlling for patient demographics and comorbidities, they found that patients who had supervised home PT were over three times more likely to be readmitted in the 90-day postoperative period.…”

Section: Reviewmentioning

confidence: 99%

“…Finally, the added cost associated with it must be considered. Yayac et al [ 9 ] analyzed costs and outcomes in their retrospective study; while no clinically significant difference was found between function or quality of life between groups at two years, they concluded that formal therapy costs included 8% of a 90-day episode of care costs for those receiving supervised home PT and outpatient PT and 3% for those receiving supervised home PT only [ 9 ]. The results of the current study highlight the need to re-examine the application of routine PT following primary THA, especially with post-discharge costs accounting for up to 36% of total costs in the bundle payments for TJA [ 27 ].…”

Section: Reviewmentioning

confidence: 99%

“…Additionally, with the increased interest in alternative healthcare models, the focus has shifted to finding methods to reduce episode-of-care costs [ 12 , 13 ]. The costs associated with formal PT after discharge are not trivial, comprising up to 8% of total costs for TJA episodes of care [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies over the past few years have demonstrated that formal PT, whether inpatient or outpatient, may not have any benefit over home-based unsupervised exercise programs [7][8][9]. While this has led to a shift away from formal PT utilization by some, there are no guidelines to assist in determining which patients may benefit [7].…”

Section: Introductionmentioning

confidence: 99%

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Unsupervised Home Exercises Versus Formal Physical Therapy After Primary Total Hip Arthroplasty: A Systematic Review

Chaudhry¹,

Hayes²,

Wells³

et al. 2022

Cureus

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Historically, postoperative exercise and physical therapy (PT) have been viewed as crucial to a successful outcome following primary total hip arthroplasty (THA). This systematic review and meta-analysis aimed to assess differences in both short- and long-term objective and self-reported measures between primary THA patients with formal supervised physical therapy versus unsupervised home exercises after discharge. A search was conducted of six electronic databases from inception to December 14, 2020, for randomized controlled trials (RCTs) comparing changes from baseline in lower extremity strength (LES), aerobic capacity, and self-reported physical function and quality of life (QoL) between supervised and unsupervised physical therapy/exercise regimens following primary THA. Outcomes were separated into short-term (<6 months from surgery, closest to 3 months) and long-term (≥6 months from surgery, closest to 12 months) measures. Meta-analyses were performed when possible and reported in standardized mean differences (SMDs) with 95% confidence intervals (CI). Seven studies (N=398) were included for review. No significant differences were observed with regard to lower extremity strength (p=0.85), aerobic capacity (p=0.98), or short-term quality of life scores (p=0.18). Although patients in supervised physical therapy demonstrated improved short-term self-reported outcomes compared to those performing unsupervised exercises, this was represented by a small effect size (SMD 0.23 [95% CI, 0.02-0.44]; p=0.04). No differences were observed between groups regarding long-term lower extremity strength (p=0.24), physical outcome scores (p=0.37), or quality of life (p=0.14). The routine use of supervised physical therapy may not provide any clinically significant benefit over unsupervised exercises following primary THA. These results suggest that providers should reconsider the routine use of supervised physical therapy after discharge.

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