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Preoperative physical therapy results in shorter length of stay and discharge disposition following total knee arthroplasty: A retrospective study

Sheldon R. Garrison, Kelly Schenider, Maharaj Singh, Jennifer Pogodzinski
Aurora Research Institute, Aurora Health Care, Milwaukee, USA

DOI: 10.2340/20030711-1000017

Abstract

Objective: Total knee arthroplasty is an effective surgical approach used to treat arthritis and knee trauma. Its utilization has grown, as has the accompanying financial impact, resulting in an equal need to advance physical therapy practice. One emerging approach improving patient outcomes and reducing cost is the inclusion of a preoperative physical therapy visit. The aim of this study was to quantify the economic impact of a standardized preoperative physical therapy visit in the healthcare setting.
Design: This study is a retrospective review of 1,043 adult patients who underwent total knee arthroplasty.
Methods: Patients who underwent total knee arthro-plasty were divided into those who received a prehab compared with those who did not.
Results: Preoperative physical therapy resulted in a marked decrease in length of stay, with 37.1% of preoperative physical therapy patients leaving inpatient care on post-operative day 1 compared to 27.0% of the no preoperative physical therapy controls (p ≤ 0.001). Preoperative physical therapy also improved discharge disposition, with 41.6% of preoperative physical therapy patients returning home and utilizing outpatient services compared to 23.2% of controls (p ≤ 0.001). No effect on duration of care was observed.
Conclusion: These data suggest that a single preoperative physical therapy visit improves key outcomes, both clinically and financially, following total knee arthroplasty.

Lay Abstract

Total knee replacement is an effective approach to treat arthritis and knee injury. Demand for this surgery is growing rapidly, as is the need to implement cost-effect approaches to deliver high-quality patient care. To address this need, physical therapists have begun implementing a clinical visit before surgery, or prehabilitative therapy, which is focused on functional skill training, home safety preparation and education. However, it is unclear how the visit impacts key cost drivers, such as the length of time patients stay in the hospital following surgery. Therefore, we evaluated 1,043 patients who underwent total knee replacement, and found that patients who participated in prehabilitative therapy left the hospital faster, resulting in significant cost savings. Moreover, patients were also more likely to return home, rather than remain in a skilled care facility or require costly home-health care services. This study suggests utilization of prehabilitative therapy prior to total knee replacement substantially reduces cost.

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