Background/Purpose: Total knee replacement surgery (TKR) for osteoarthritis is a highly prevalent treatment with widely variable functional outcomes. Most patients receive physical therapy (PT) following TKR, but PT practice is variable and associations between specific content and dosage of PT interventions and functional outcomes are unknown. Randomized clinical trials demonstrate functional benefits from specific exercise regimens, but what interventions are implemented in clinical practice are unknown. Details of intervention content and dosage are not routinely available in PT clinical documentation. To carry out a pragmatic study of the effectiveness of real-world PT interventions we set out to develop a secure web-based documentation system for physical therapists (PTs) that would meet four goals: 1) capture PT intervention details including content, dosage, intensity and progression; 2) be used easily by practicing clinicians; 3) provide a treatment summary for use as a daily record; and 4) allow data analysis of intervention factors in a multi-site application for health services research. Such a system would provide consistent metrics for future registries and EHRs to assure complete and comprehensive documentation for research and quality measurement.

Methods: We used an iterative process to develop the data capture system and generate an all-inclusive menu of PT interventions used to treat patients post-TKR. The system required a secure user-friendly computer interface allowing clinical access to input data and designed to facilitate aggregation of data for analysis. The intervention menu was generated in four steps: 1) extraction of interventions from 112 patient records from each patient’s final episode of post-TKR care; 2) feasibility testing of the compiled list of interventions by 7 PTs and PT interns from 4 clinics in another geographic region to identify interventions not already included in the list;3) content review and subsequent revision by 4 national PT post-TKR rehabilitation experts; and 4) review and revision by 2 international PT post-TKR rehabilitation experts.

Results: The final intervention menu includes eight intervention categories (strengthening, flexibility and aerobic exercises, balance and functional training, modalities, manual therapy and patient education). Strengthening exercise is the largest category with 62 exercises. All interventions require input of data including intensity and dosage. The system is deployed in 16 practice sites with 59 PTs and 6 PTAs using the system. Input from a treatment session takes less than 5 minutes. PTs deny difficulty with input. Since deployment of the system two interventions have been added to the original list.

Conclusion: Our findings demonstrate the feasibility of a customized web-based data capture system to collect comprehensive intervention data including the content, intensity and dosage of PT treatments for patients post-TKR. We currently use the system in a study to identify intervention factors associated with positive patient outcomes. The system demonstrates a framework to study PT care in other diagnostic categories to identify “best practice” in PT care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-and-feasibility-of-a-web-based-data-capture-system-to-collect-uniform-comprehensive-post-total-knee-replacement-physical-therapy-intervention-data-for-both-clinical-and-research-purposes/