According to new research findings presented at the recent American College of Rheumatology Annual Meeting in Washington, DC, the success rate of functional gains after total knee replacement surgeries in the United States in 2011 varies widely. Researchers from Arcadia University, Glenside, Pa, and the University of Massachusetts Medical School, Worcester, Mass, set out to analyze how physical therapy might be related to levels of postoperative walking function.
For the study, Carol Oatis, PhD, PT, lead investigator and professor of physical therapy at Arcadia University, and her team reached out to 179 knee osteoarthritis (OA) patients who were undergoing total knee replacement surgery. Of the participants, a reported 68% were female and the mean age was 65.1 years. The participants wore an accelerometer ankle device to measure walking before surgery, with a mean use of 3.3 days worn.
At baseline, 8 weeks, and 6 months postsurgery, the study reports that 174, 163, and 168 participants wore the accelerometer for at least one valid day. The patients also submitted self-reports, and the researchers examined physical therapy records of 90 individuals who completed outpatient rehabilitation and 27 who competed rehabilitation in home care.
“Our findings demonstrated wide variability in the utilization of physical therapy in these subjects, in the amount of physical therapy, the number of days in physical therapy, and also, wide variability in the kind of physical therapy after surgery,” Oatis says.
The researchers determined that the participants' average and median daily step counts were approximately 1,000 steps fewer at 8 weeks postsurgery than they were prior to the surgery. At 6 months postsurgery, the mean and median increase in steps was only 738 and 354 steps, respectively, although 30% of the participants ended physical therapy after 8 weeks and had to continue rehabilitation efforts on their own. Approximately 40% of patients completed their rehabilitation after 9 weeks, according to the study.
"What struck me was that a large percentage of people had been discharged from physical therapy while their physical activity level was still greatly below their preoperative levels," Oatis says. "I thought that was a pretty stunning picture of the relationship between the timing of rehabilitation services and functional activity."
Oatis adds that it is unknown what physical therapists tell patients they need to work on after they are discharged from physical therapy, and many patients expect they will have greater functional ability postsurgery than they actually achieve. "By recognizing the disconnect, we can be more overt in conversations with patients, and help them focus on physical activity and behavioral goals after surgery," Oatis says.
[Source: American College of Rheumatology]