ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 2859

Randomized Controlled Trial of Postoperative Care Navigation in Total Knee Arthroplasty Patients: Does One Size Fit All?

Elena Losina1, Jamie E. Collins1, John Wright2, Meghan E. Daigle1, Laurel Donnell-Fink3, Doris Strnad2, Vladislav Lerner1, Stanley Abrams4 and Jeffrey N. Katz5, 1Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, 2Orthopaedics, Brigham and Women's Hospital, Boston, MA, 3Brigham and Women's Hospital, Boston, MA, 4Orthopedics and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, 5Rheumatology and Orthopedics, Brigham and Women's Hospital, Boston, MA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Behavioral strategies, Joint arthroplasty, Knee, motivational interviewing and outcomes

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Title: ACR/ARHP Combined Abstract Session: Rehabilitation

Session Type: Combined Abstract Sessions

Background/Purpose: A number of TKA recipients have suboptimal improvements after surgery. Our objective was to establish the efficacy of a motivational-interviewing (MI)-based telephone intervention aimed at improving functional outcomes post-TKA and to identify subgroups especially likely (or unlikely) to benefit from the intervention.

Methods: We conducted the RCT to compare functional status in TKA recipients randomized to one of two strategies: 1) enhanced postoperative care with frequent follow-up by a care navigator; 2) usual postoperative care. Those who were randomized into the care navigation arm received ten calls from a trained non-clinician care navigator over the first 6 months post-TKA. The trained navigator used theory driven MI to engage TKA recipients in discussions about their rehabilitation goals, including plans for and confidence in achieving those goals. Patients in the usual care arm received standard postoperative care. Patients in both arms were assessed at baseline, 3 and 6 months post-TKA. The study enrolled subjects 40+ years of age with OA who were scheduled for TKA. Primary outcome was the difference between the arms in WOMAC function score change, over the 6 months post-TKA. We defined a satisfactory functional improvement as either achieving WOMAC function scores <15 or reducing pre-operative functional score by 19+ points, suggested as MCID in TKA patients (Escobar, 2007). We examined whether sex, obesity and pain catastrophizing affected the efficacy of the care navigator intervention.

Results: We enrolled 309 TKA recipients, average age 67 years; 60% female, 84% Kellgren-Lawrence Grade 4, 50% obese (BMI>=30kg/m2). Mean pre-operative WOMAC function score was 40 (18), on a 0-100 scale, 100-worst. Baseline characteristics did not differ between study arms. At 6 months, participants in care navigation arm improved by 29.4 (16.1) points compared to 26.1 (18.3) in control arm (p=0.1126). Overall, 21% of study participants did not achieve satisfactory functional improvements, with similar rates across arms. Greater pain catastrophizing led to less improvement overall and its association with poor outcome was more prominent among females compared to males (p value for interaction = 0.002). Further analysis, restricted to females, showed that greater pain catastrophizing modified the impact of the intervention: females with a low degree of pain catastrophizing improved by 8 points more (33 vs. 25) in the navigation arm than in the control arm, while females with a high degree of pain catastrophizing improved by five points less in the navigation arm than in the control arm (p-value for interaction= 0.0233).

Conclusion: The results of this RCT did not show benefits of the MI based enhanced postoperative care navigation in functional improvements in TKA recipients. The negative overall result could be explained by differential effect of intervention among females with high and low levels of pain catastrophizing. Greater focus on understanding the determinants of and effective therapies for reducing pain catastrophizing could improve the efficacy of interventions focused on better functional outcomes in TKA recipients.

 


Disclosure:

E. Losina,
None;

J. E. Collins,
None;

J. Wright,

DePuy, A Johnson & Johnson Company,

5,

DePuy, A Johnson & Johnson Company,

7;

M. E. Daigle,
None;

L. Donnell-Fink,
None;

D. Strnad,
None;

V. Lerner,
None;

S. Abrams,
None;

J. N. Katz,
None.

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/randomized-controlled-trial-of-postoperative-care-navigation-in-total-knee-arthroplasty-patients-does-one-size-fit-all/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology