Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery

Kittelson, Andrew J; Elings, J.; Colborn, Kathryn; Hoogeboom, Thomas J.; Christensen, Jesse C.; Meeteren, N.L.U. van; Buuren, Stef van; Stevens‐Lapsley, Jennifer E.

doi:10.1186/s12891-020-03493-x

Cited by 20 publications

(23 citation statements)

References 24 publications

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“…4,5 To support clinicians in adapting the guidelines to individual patients and making individualized decisions, personalized outcomes forecasts (POFs) might be of value. 4,[6][7][8][9] A POF is an estimation of an individual patient's outcome over time based on historic outcome data of patients with similar characteristics to the individual patient. 6 Only a specific subset of previously treated patients is selected from existing records to create the forecasts.…”

Section: Introductionmentioning

confidence: 99%

“…6 Only a specific subset of previously treated patients is selected from existing records to create the forecasts. 4,[6][7][8] In physical therapy care, outcome forecasts have already been proposed in different subfields to support therapists and patients by increasing their insight into the expected treatment course. 7,10,11 Personalized outcome forecasts might be used in practice to facilitate therapists' clinical reasoning by supporting the personalization of the care plan.…”

Section: Introductionmentioning

confidence: 99%

“…4,[6][7][8] In physical therapy care, outcome forecasts have already been proposed in different subfields to support therapists and patients by increasing their insight into the expected treatment course. 7,10,11 Personalized outcome forecasts might be used in practice to facilitate therapists' clinical reasoning by supporting the personalization of the care plan. Furthermore, therapists might be able to better inform patients of the expected course and outcome of therapy, thereby supporting patient engagement and shared decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

et al. 2022

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Objective Guidelines recommend supervised exercise therapy and lifestyle counseling by a physical therapist as initial treatment of patients with intermittent claudication. However, guidelines provide only a crude estimate of the outcomes that therapists and patients might expect from treatment. The purpose of this study was to explore the impact of personalized outcomes forecasts (POFs) on the decision-making process of physical therapists and to learn lessons on facilitating the use of forecasts in daily practice. Methods A vignette-based, think-aloud interview study design was used. The participants were physical therapists trained in treating patients with intermittent claudication. Vignettes described fictitious patients diagnosed with intermittent claudication and included POFs. A directed approach was used to code, organize, and describe the data. Transcripts were analyzed using a thematic approach. Results Sixteen therapists participated in the study. Three themes were identified: (1) setting and contextualizing treatment expectations; (2) setting (shared) goals and (de)motivating the patient, and (3) establishing and monitoring the treatment plan. Therapists mentioned that POFs could be useful for setting expectations and realistic treatment goals, contextualizing expected treatment response, stimulating patients to achieve their goals, and deciding on treatment frequency and treatment timing. Therapists thought POFs would be of less use for changing treatment goals during follow-up visits or for establishing intensity or type of training. Conclusion To overcome challenges that may arise when adopting POFs in daily practice, adequate training of physical therapists should be conducted. Potential areas to address with training include statistical and data literacy as well as guidance on integrating POFs with existing treatment protocols. Impact The use of POFs by physical therapists might contribute to a more person-centered care approach. The insights provided by this study on the first use of POFs by physical therapists can serve as an example and lesson on how to optimally implement such supporting tools into daily practice.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

et al. 2022

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“…Moreover, these personalized outcome forecasts can elicit shared decision-making and improve clinical reasoning of the therapist, potentially resulting in more realistic and personalized treatment goals and interventions, as well as (importantly) improved monitoring of progression. 24 , 25 To further improve physical therapy care for people with claudication intermittens, we recently initiated a project aimed to integrate the personalized outcome forecasts with guideline recommendations. 23 Guidelines can have the negative side effect that they not only reduce the unwanted practice variation, but also the wanted treatment variation in practice.…”

Section: Steps Toward a Learning Health System Based On Routinely Collected Datamentioning

confidence: 99%

Using a Learning Health System to Improve Physical Therapy Care for Patients With Intermittent Claudication: Lessons Learned From the ClaudicatioNet Quality System

Sinnige

Spruijt²,

Saes³

et al. 2021

Physical Therapy

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Routinely collected outcomes data can be used to improve physical therapy care through benchmarking, personalization, continued education, and treatment optimization. In this article, we describe how we created a nationwide infrastructure to routinely collect data from daily practice and how we utilized these data through a support system (called the ClaudicatioNet Quality system) to improve physical therapy care for patients with intermittent claudication in the Netherlands. ClaudicatioNet is a nationwide network of 2100 specialized physical therapists, providing high-quality supervised exercise therapy in combination with lifestyle counseling. The ClaudicatioNet Quality system utilizes a large national registry in which specific relevant health outcomes have been routinely collected since 2015. These data have then been used in turn to assess quality of care and provide transparency to therapists and other stakeholders. The Quality system is intended to serve as a learning health system, to support continuous learning at the therapist, practice, and network level. In our approach, we provide individual patients and physical therapists opportunities to personalize, benchmark, and evaluate (and possibly alter) a treatment plan using routinely collected data from historical patients. In this article, the Quality system is described based on the essential elements of a learning health system. We also describe the challenges and lessons learned in developing the Quality system.

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“…For example, Kennedy at al. (2008) reported curves for the Lower Extremity Functional Scale and the Six-Minute Walk Test up to 1 year following TKA, and Kittelson et al (2020) produced a range of motion reference chart specifically aimed at monitoring postoperative recovery. In addition to functional metrics, patient reported measures (PROMs) have come to the fore to assess clinical outcomes from a patient's perspective, which is believed to better reflect patients' health status and quality of life.…”

Section: Epic Series In Health Sciencesmentioning

confidence: 99%

Feeling Better After TKA: Reference chart for remotely collected pain scores

Antunes¹,

Jacob²,

Meyer³

et al.

EPiC Series in Health Sciences

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Remote patient monitoring, using wearable devices and connected patient engagement platforms has the potential to improve timely clinical decisions. Data collected from multiple patients, including using the remote engagement platforms themselves, can be used to produce evidence-based reference to support clinical decisions. While some normative references for functional measure currently exist for total knee arthroplasty (TKA), these are still lacking for VAS pain scores. Therefore, VAS pain scores on a 10-point Likert scale were analyzed for 66 patients, each reporting at least five scores in the 180 days following surgery. These were used to produce a normative recovery model for total knee arthroplasty patients. A nonlinear mixed effects model was fitted, whereby the response variable is assumed to be distributed following a beta-binomial distribution. The population mean trend showed a with wide dispersion in the first few days following surgery, showing scores ranging throughout the 10-point scale. After the first week, the expected pain score steadily decreases, resulting in a score no higher than one in 50% of the population beyond 90 days after surgery. The fitted model allows referencing individual patient's pain scores at different stages of recovery, against the model’s predicted distribution. This approach can support early detection of patients that significantly deviate from the reference model and be a useful integration into clinical decision support software tools.

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Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery

Cited by 20 publications

References 24 publications

Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

Using a Learning Health System to Improve Physical Therapy Care for Patients With Intermittent Claudication: Lessons Learned From the ClaudicatioNet Quality System

Feeling Better After TKA: Reference chart for remotely collected pain scores

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