Prehabilitation for TKA may yield shorter length of stay, better discharge disposition

Patients who participated in a prehabilitation protocol for total knee arthroplasty experienced shorter length of stay and better discharge disposition, according to results published in The Annals of Translational Medicine.

Prehab – The Role of Exercise Before Surgery. Progressive Physical Therapy and Rehabilitation, Orange CA

by Casey Tingle, Healio Orthopedics Today February 5, 2019

Michael M. Mont MD, and colleagues compared length of stay and discharge disposition to home, home with health aide or skilled nursing facility among 476 patients undergoing TKA who either did (n=114) or did not (n=362) participate in a prehabilitation program. The prehabilitation program included exercises, nutritional advice, education regarding home safety and reducing medical risks, and pain management skills prior to surgery.

Results showed a significantly shorter average length of stay, as well as a more favorable discharge disposition status, in the prehabilitation group compared with the control group. Researchers found 77.2% of patients in the prehabilitation group went home without assistance vs. 42.8% of patients in the control group. Discharge to a skilled nursing facility was also significantly lower in the prehabilitation group, according to results.

“Face-to-face prehabilitation is an effective way to improve surgical outcomes, but it is administratively challenging and expensive,” Mont told Healio.com/Orthopedics. “[Artificial intelligence] AI-based systems, like PeerWell PreHab that automate patient optimization using data, are effective at improving outcomes and reducing costs without adding to the administrative load.”

Disclosures: Mont reports he is a board or committee member for the American Academy of Orthopaedic Surgeons; is a paid consultant for Cymedica, DJ Orthopaedics, Johnson & Johnson, Ongoing Care Solutions, Orthosensor, Pacira, Peerwell, Performance Dynamics Inc., Sage, Stryker and TissueGene; receives research support from DJ Orthopaedics, Johnson & Johnson, the NIH, Ongoing Care Solutions, Orthosensor, Stryker and TissueGene; is on the editorial of governing board for Journal of Arthroplasty, Journal of Knee Surgery, Orthopedics and Surgical Techniques International; receives IP royalties from Microport and Stryker; and has stock or stock options in Peerwell. Please see the full study for a list of all other authors’ relevant financial disclosures.

Source Healio Orthopedics Today

The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty, Chughtai M, Shah N, Sultan A, Solow M, Tiberi J, Mehran N, North T, Moskal J, Newman J, Samuel L, Bhave A, & Mont M. Ann Transl Med. 2018;doi:10.21037/atm.2018.11.27.

Is it necessary to perform prehabilitation exercise for patients undergoing total knee arthroplasty: meta-analysis of randomized controlled trials, Chen H, Li S, Ruan T, Liu L, Fang L. Phys Sportsmed. 2018 Feb;46(1):36-43. doi: 10.1080/00913847.2018.1403274. Epub 2017 Nov 15. Erratum in: Phys Sportsmed. 2018 Sep;46(3):399-403.

Effects of a tele-prehabilitation program or an in-person prehabilitation program in surgical candidates awaiting total hip or knee arthroplasty: Protocol of a pilot single blind randomized controlled trial, Doiron-Cadrin P, Kairy D, Vendittoli PA, Lowry V, Poitras S, Desmeules F. Contemp Clin Trials Commun. 2016 Oct 5;4:192-198. doi: 10.1016/j.conctc.2016.10.001. eCollection 2016 Dec 15.

The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty: A pilot randomized trial, Cavill S, McKenzie K, Munro A, McKeever J, Whelan L, Biggs L, Skinner EH, Haines TP. Physiother Theory Pract. 2016 May;32(4):262-70. doi: 10.3109/09593985.2016.1138174. Epub 2016 Apr 6.

Prehabilitation improves physical function of individuals with severe disability from hip or knee osteoarthritis, Desmeules F, Hall J, Woodhouse LJ, Physiother Can. 2013 Spring;65(2):116-24. doi: 10.3138/ptc.2011-60.

Prehabilitation before knee arthroplasty increases postsurgical function: a case study, Jaggers JR, Simpson CD, Frost KL, Quesada PM, Topp RV, Swank AM, Nyland JA. J Strength Cond Res. 2007 May;21(2):632-4.

Also see
OA bracing may bolster prehabilitation protocols
Prehab – The Role of Exercise Before Surgery in Progressive Physical Therapy and Rehabilitation
Better Sooner and Later: Prehabilitation in PT in Motion

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