Preoperative Patient Expectation of Discharge Planning is an Essential Component in Total Knee Arthroplasty

Feng, James E.; Anoushiravani, Afshin A.; Morton, Jessica; Petersen, William; Singh, Vivek; Schwarzkopf, Ran; Macaulay, William

doi:10.1186/s43019-022-00152-4

Cited by 7 publications

(13 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As demand for TJA procedure rises and LOS decreases, efficient planning is essential to patient satisfaction, timely discharge, and cost containment. Reductions in LOS are facilitated by postsurgical pathways consisting of a multidisciplinary perioperative approach [6,12] and by determining a patient's appropriate discharge location as early as possible [20]. Objective measures such as the RAPT and AM-PAC scores can help guide the discharge planning process [14,19,24,26].…”

Section: Discussionmentioning

confidence: 99%

“…Another important predictor of discharge destination to consider is patient expectations [7]. Incorporating the patient into decision-making on discharge destination before admission results shortens LOS and increases the number of home discharges [1,4,6,9].…”

Section: Introductionmentioning

confidence: 99%

“…Through patient education, shared decision-making, and managing patient expectations, care teams can identify safe and appropriate discharge destinations [6]. Many aspects of care require presurgical planning.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

Tuohy,

Schwartz-Dillard,

McInerney

et al. 2023

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

Background: The Risk Assessment and Prediction Tool (RAPT) and the Activity Measure for Post-Acute Care “6-Clicks” Mobility Score (AM-PAC) are validated discharge planning tools for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Planning for discharge with these tools considers very different factors and it is important to determine if they relate. Purpose: We sought to determine whether the preoperative RAPT score would correlate with postoperative AM-PAC score for predicting discharge destination for THA and TKA populations. Secondarily, we sought to examine whether the AM-PAC and RAPT scores would remain statistically significant predictors of discharge destination despite covariates. Methods: A retrospective cohort study was performed for patients who underwent THA or TKA from January 2020 to December 2022 at a specialty orthopedic hospital. Primary variables included the RAPT score, the AM-PAC score, and discharge disposition. Correlation between AM-PAC and RAPT scores was tested using Pearson’s correlation coefficient, and association between both scores and discharge destination was tested using chi-square tests and multivariable logistic regression. Results: Our comparison of AM-PAC scores and RAPT scores found a statistically significant, positive correlation in both THA and TKA patients. Regression analysis found that increased RAPT and AM-PAC scores resulted in higher odds of being discharged home for both populations, after adjusting for all other variables. In both cohorts, patients discharged to a facility were more likely to be female, be over the age of 70 years, have Medicare/Medicaid insurance, and have a higher number of preoperative social work visits or any incidence of an intraoperative or hospital complication. Conclusions: This retrospective study found that RAPT score correlated with AM-PAC score for predicting discharge destination for elective THA and TKA populations, suggesting that these scores may be predictors of home discharge destination even when accounting for covariates. Further study is recommended.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

Tuohy,

Schwartz-Dillard,

McInerney

et al. 2023

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

show abstract

“…Checklists most commonly included preoperative screening and testing requirements. 2, encompassing reviews and consensus statements, [7][8][9]18,19,[21][22][23][24][25] randomized controlled trials, [26][27][28][29] retrospective or prospective observational designs, 20,[30][31][32][33][34][35][36][37][38][39][40][41] qualitative research, [42][43][44][45][46] and a national survey. 47 Most of the nonreview articles involved studies in the United States, with two in Canada 40,44 and one each in France, 31 Ireland, 32 Denmark, 36 the Netherlands 28 and Australia.…”

Section: Synthesis Of Information In Existing 'Joint Class' Curriculamentioning

confidence: 99%

Synthesis of ‘joint class’ curricula at high volume joint replacement centres and a preliminary model for development and evaluation

Herrera

Stern

Russo

et al. 2023

Evaluation Clinical Practice

View full text Add to dashboard Cite

RationalePreoperative patient education through ‘joint class’ has potential to improve quality of care for total joint replacement (TJR). However, no formal guidance exists regarding curriculum content, potentially resulting in inter‐institutional variation.ObjectiveWe aimed to (a) synthesize curriculum components of ‘joint classes’ across high‐volume institutions and (b) develop a preliminary theory of change model for development and evaluation guided by the existing curricula and related literature.MethodsWe reviewed ‘joint class’ curricula from the websites of the 10 highest‐volume TJR centres (by average annual 2017–2019 volume) that publicly disclosed this information. Two reviewers qualitatively compared available content and noted common categories, which were synthesized into key domains across institutions. We then reviewed the PubMed database for literature on pre‐TJR patient education and education needs in the past 10 years. Drawing on our curriculum synthesis and related literature, we proposed a theory of change model: hypothesized mechanisms through which ‘joint class’ confers benefits to patients and health systems.ResultsWe identified 30 categories in our review of existing class content, which we synthesized into seven key domains: (I) Practical Elements, (II) Logistics, (III) Medical Information, (IV) Modifiable Risk Factors, (V) Expected Outcomes, (VI) Patient Role in Recovery and (VII) Enhanced Education. Variation across institutions was noted. Our preliminary model based on the curriculum synthesis and related literature on the impact of ‘joint class’ includes three levels: (1) Practical Elements (‘joint class’ accessibility and information quality), (2) Class Goals (increased health literacy, increased adherence, risk mitigation, realistic expectations, and reduced anxiety) and (3) Target Outcomes (improved clinical outcomes, positive patient experience and increased patient satisfaction).ConclusionOur synthesis identified core common topics included in pre‐TJR education but also highlighted variation across institutions, supporting opportunities for standardization. Clinicians and researchers can use our preliminary model to systematically develop and evaluate ‘joint classes,’ with the goal of establishing a standard of care for TJR preoperative education.

show abstract

“…Research results indicate that satisfaction varies according to the postoperative period depending on whether this optimism is satisfied [2, 9]. Addressing patients’ preoperative concept of a satisfactory outcome through education has been shown to modify preoperative expectations and subsequently reduce dissatisfaction after TKA [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Preoperative education on realistic expectations improves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized‐controlled trial

Nam

Yoo

et al. 2023

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

Purpose The aim of this study was to investigate whether an additional module on realistic expectations following total knee arthroplasty (TKA) would lead to a higher proportion of satisied patients compared to existing preoperative education. Methods This was a single-center, randomized-controlled trial. A total of 172 patients who were scheduled for TKA between September 2020 and October 2021 were enrolled. Patients were randomized to receive either only standard preoperative education, or an additional module on realistic expectations following TKA. The primary outcome was patient satisfaction. Secondary outcomes were Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, crepitus score, and range of motion. Subgroup analysis was performed based on central sensitization inventory (CSI) score stratiication. Assessment was performed at the 3-month, 6-month, and > 1-year follow-up. Results At more than 1 year, 65/78 (83.3%) patients in the intervention group and 52/80 (65.0%) patients in the control group were satisied (P = 0.03). The mean satisfaction score was measured as 4.2 ± 0.9 in the intervention and 3.9 ± 0.9 in the control at > 1 year (P = 0.01). There were signiicant diferences in Short Form-36 physical and mental component summary scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stifness scores at 6 months (P = 0.02, P = 0.02, P = 0.04, P = 0.04). The frequency of satisfaction and mean satisfaction score in the top 25 percentile CSI group were 15/16 (93.8%) and 4.6 ± 0.6 in those who received intervention and 12/19 (63.2%) and 3.8 ± 0.8 in those who did not (P = 0.01, P = 0.01). Conclusions Thorough preoperative education on realistic expectations following TKA showed efects on WOMAC pain and satisfaction at > 1 year after surgery. It was more prominent in the group with a higher CSI score at > 1-year follow-up. Level of evidence Level I.

show abstract

Preoperative Patient Expectation of Discharge Planning is an Essential Component in Total Knee Arthroplasty

Cited by 7 publications

References 38 publications

RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

Synthesis of ‘joint class’ curricula at high volume joint replacement centres and a preliminary model for development and evaluation

Preoperative education on realistic expectations improves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized‐controlled trial

Contact Info

Product

Resources

About