Physical therapists collect different outcome measures after total joint arthroplasty as compared to most orthopaedic surgeons: a New England study

Abstract

BackgroundFollowing total knee and hip arthroplasty, patient progress can be assessed with patient-reported outcome measures (PROMs) and performance-based outcome measures (PBOMs). The American Joint Replacement Registry 2016 guide recommends collecting several measures, including Patient Reported Outcome Measure Information System Global, Knee Injury and Osteoarthritis Outcome Score Jr, and Hip Injury and Osteoarthritis Outcome Score Jr. This study aimed to assess the current and anticipated use of PROMs and PBOMs by New England physical therapists.MethodsAn online survey was conducted in July and August of 2015 asking physical therapists in New England to rate their current and anticipated future use of PROMs and PBOMs in terms of clinical decision making associated with the treatment and care of patients after total hip and knee replacement.ResultsThere were 122 responses. The most often used and recommended PROMS were the Numeric Pain Rating Scale (99.2% and 97.5%, respectively) and Lower Extremity Function Scale (76.2% and 77.0%). There was significant variability in the use of different PBOMs, but the most often used and recommended were the Timed Up and Go (93.4% and 85.2%) and the Single Leg Balance Test (90.2% and 87.7%).ConclusionsThis study suggests that orthopaedic surgeons and physical therapists use different PROMs and PBOMs for postoperative assessment of total joint patients and highlights the need for more collaboration and consistency between these disciplines.

Patient, physiotherapist and surgeon endorsement of the core domain set for total hip and total knee replacement in Germany: a study protocol for an OMERACT initiative

“…However, physiotherapists use different types of measurement instruments compared with orthopaedic surgeons. 18 To harmonise TJR clinical trial outcomes, it is important that all stakeholders agree on the core domain areas and on the instruments used to measure these areas. However, no information about such agreement is yet available in Germany.…”

The advantages of electronic patient-reported measures and an example digital platform to collect ePROs after total knee arthroplasty

“…For example, one study recently found that physical therapists collect different outcome measures after total joint arthroplasty compared to most orthopaedic surgeons. 24…”

Timed Up and Go test is predictive of Patient-Reported Outcomes Measurement Information System physical function in patients awaiting total knee arthroplasty

“…As the number of TKA cases rise, there are greater pressures on surgeons and health-care systems to demonstrate that the benefits outweigh the associated costs [4] . Recovery of physical function is an important outcome of TKA and may be measured using patient-reported outcomes or performance-based outcomes [5] , [6] . Both are used to evaluate outcomes after TKA; however, orthopedic surgeons who use outcome measures tend to rely primarily on patient-reported outcomes which may not fully characterize the patient's physical function due to influences such as level of pain [5] , [7] .…”

“…Recovery of physical function is an important outcome of TKA and may be measured using patient-reported outcomes or performance-based outcomes [5] , [6] . Both are used to evaluate outcomes after TKA; however, orthopedic surgeons who use outcome measures tend to rely primarily on patient-reported outcomes which may not fully characterize the patient's physical function due to influences such as level of pain [5] , [7] . There is a lack of widespread collection and use of patient-reported outcomes by orthopedic surgeons due to real and perceived barriers [8] .…”

“…The Timed Up and Go (TUG) is a recommended measure of function, balance, and walking ability for people with knee OA and one of the most commonly used performance-based outcome measures for TKA [5] , [16] , [17] . Physical therapists are more likely to use performance-based measures to characterize function after TKA than orthopedic surgeons [5] . Performance-based measures, such as the TUG, show greater responsiveness in the acute stage after TKA than patient-reported outcome measures [7] .…”