Telephone follow-up by nurse following total knee arthroplasty – protocol for a randomized clinical trial (NCT 01771315)

Abstract

BackgroundDue to shorter hospitalization, patients have to take responsibility for their rehabilitation period at a very early stage. The objective of this trial is to study the effects of two treatment schemes following total knee arthroplasty: conventional treatment following discharge from hospital and early follow-up by telephone consultations in addition to conventional treatment following discharge from hospital. The ultimate aim is to increase the effectiveness of the treatment by improving patients' health status, promote self-efficacy, and reduce the number of acute visits to the orthopaedic outpatient clinic during the rehabilitation period.Method/designThe design is a randomized un-blinded parallel group clinical trial conducted at the Department of Orthopaedic Surgery, Gentofte Hospital, the Capital Region of Denmark. In total, 116 patients will be allocated by an external randomization program to 2 groups: an intervention group following usual treatment after discharge supplemented by a nurse managed structured follow-up consultation conducted by telephone 4 and 14 days after discharge from hospital and a control group following treatment as usual. The consultations are structured by key subjects relevant to assess the health status according to the VIPS-model (the Swedish acronym for the concepts Well-being, Integrity, Prevention and Safety). The content of the consultations can vary according to the patients´ individual situations and needs. All consultations are conducted by the researcher responsible for the trial.The effect is measured 1, 3, 6 and 12 months post-surgery. The primary outcome is self-reported physical function measured by The Western Ontario and McMaster Universities Arthritis Index. Secondary outcomes are self-reported health-related quality of life, general self-efficacy and the number of acute visits to the orthopaedic outpatient clinic.DiscussionThe result of this trial is expected to provide new knowledge to support the development of targeted and effective follow-up after total knee arthroplasty in order to improve the patients´ health-related knowledge and skills of being able to take actively part in their illness and improve their health status.Trial registrationClinicalTrials.gov: NCT01771315

Long-term effects of telephone follow-up after total knee arthroplasty

“…[5] Participants were allocated according to a web based randomization system (1:1), all received conventional treatment and furthermore those in the intervention group received structured TFU four and fourteen days after discharge. [5] The effect of the intervention was measure on physical function by the Womac Index. Secondary outcomes were pain and stiffness scores, change in health-related quality of life, and changes in self-efficacy.…”

“…The trial was conducted without blinding, with the participants being informed of the results of the randomization immediately before discharge. [5] All patients included in the trial followed conventional treatment of TKA: i.e. attending a multidisciplinary pre-surgery seminar when admitted to hospital the evening before or on the day of surgery, discharge scheduled two-three days postsurgery and furthermore post-hospitalization physiotherapy, removal of stitches and outpatient consultation with the surgeon.…”

“…The first author, an experienced orthopaedic nurse, conducted all TFUs. The TFU was structured according to the nursing status as defined by the VIPS (well-being, integrity, prophylaxis, safety) model and supplemented with other issues relevant to patients after TKA [5] regarding observation of the wound, how to best manage medical treatment for pain and how to exercise as recommended.…”

Mid Term Outcome of Home-Based Exercises vs. Sophisticated Physiotherapy Protocol After Total Knee Arthroplasty

“…The number of primary total knee arthroplasty has boosted significantly in recent years and amounted to 1.5 million in 2015 (3).…”

“…The routine of TKA procedure involves a physiotherapy protocol after the patients' discharge from the hospital with a planned follow-up of the surgeon for 3 months (3,4). For quick regain of functional abilities, patients and surgeons most often employ physiotherapy methods.…”