Background/Purpose: Functional outcomes are variable among patients following total knee arthroplasty (TKA). Evidence is lacking to support best practices in rehabilitation to optimize functional outcomes. The purpose of this research was to determine associations of post-operative function defined by standardized patient report and objective PT evaluation with timing, amount, and content of physical therapy (PT) services in TKA patients.

Methods: We requested 142 and received 91 outpatient (OP) and 27 home care (HC) PT records for patients participating in a randomized behavioral trial for patients who had received a unilateral primary TKA, had completed the 6-month study assessment and their post-TKA PT rehabilitation. PT researchers performed a retrospective review of PT intervention data from 37 facilities, recording intervention type, frequency and dosage data for each subject during their terminal course of PT services. Performance outcomes measured at 6 month post TKA included flexion range of motion (ROM), timed stair climb (TSC) and WOMAC physical function (PF).  Linear regression models assessed associations between PT intervention frequency and content (i.e., open and closed chain (CC) exercises and progressions) and 6 month outcomes, with and without adjusting for gender, age, baseline physical component score of SF-36, WOMAC PF, and number of comorbid conditions.

Results: 91 records, including 74 (81%) OP and 17 (19%) HC from 37 facilities, contained complete exercise information. Number of PT interventions, number of CC interventions and progressions and number of CC exercises per visit were associated with improved TSC (p < .05) with coefficients ranging from -.45 to -.99.  Number of CC progressions was also associated with improved ROM (1.41; p< .01).  Earlier initiation of OC exercises was associated with improved WOMAC PF scores. Adjusted coefficients revealed similar associations between the number of progressions of CC exercises and improved TSC (p < .05) and knee flexion ROM (p < .01), between number of CC exercises per PT visit and ROM and between OC exercises and WOMAC PF. Number of PT visits did not predict outcomes. An increased number of passive interventions predicted poorer ROM outcomes (p < .01).

Conclusion: Preliminary data suggest that the number and progressions of CC exercises used per visit and over the episode of care contribute to improved objective performance outcomes following TKA. Timing of exercise initiation contributes to improved patient-reported outcomes. Content, dosage and timing of PT exercises rather than number of visits appear to be predictive of performance outcomes. Further research is needed to clarify the role of PT content, dosage and intensity in optimizing functional outcomes following TKA.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-elements-of-physical-therapy-interventions-contribute-to-improved-outcomes-following-total-knee-arthroplasty/