Improving Rehabilitation for Veterans After Total Knee Arthroplasty Using Individualized Recovery Trajectories
Project Number5I01RX003770-03
Former Number1I01RX003770-01
Contact PI/Project LeaderSTEVENS-LAPSLEY, JENNIFER E.
Awardee OrganizationVA EASTERN COLORADO HEALTH CARE SYSTEM
Description
Abstract Text
Rehabilitation after total knee arthroplasty (TKA) is typically generic and inefficient; most patients receive the
same contents and dosage of rehabilitation regardless of their individual needs, preferences, or expectations.
This generic treatment paradigm will be unsustainable in the Veterans Health Administration (VHA) as the
demand for TKA surgery and postoperative care increase exponentially in the near future. Without new
strategies to improve the efficiency of TKA rehabilitation, organizations like the VHA will struggle to meet and
pay for this surging demand, and Veterans may be denied timely access to the postoperative care they need
for optimal recovery. We have developed an innovative new clinical decision support (CDS) tool to optimize
efficiency in TKA rehabilitation. Using the actual recovery data of similar historical patients, the tool can predict
the recovery trajectory for new patients after TKA. This allows clinicians to (1) allocate rehabilitation resources
based upon individual need, (2) identify Veterans at risk for suboptimal outcomes early after surgery, (3) tailor
treatment strategies to Veterans’ unique goals and clinical presentation, and (4) monitor Veterans’ recovery
relative to expected throughout postoperative rehabilitation. In this project, we propose to expand the CDS
tool’s capabilities by establishing utilization guidelines based upon individual Veteran’s predicted recovery (Aim
1). These guidelines will be established by expert consensus in a three round Delphi process. Subsequently,
we will test the CDS tool’s impact on Veteran’s functional recovery and rehabilitation utilization in four VHA
outpatient physical therapy clinics using a pre-post design (Aim 2). We will compare patient-reported function
(Lower Extremity Functional Scale) and physical therapy visit utilization between cohorts of Veterans treated
with and without the CDS tool. Additionally, we will gather data from participating VHA clinicians and Veterans
regarding the translation of our tool into clinical practice to assess its readiness for dissemination throughout
the VHA (Aim 3). This will include qualitative data from participant focus groups and quantitative process data
regarding the tool’s utilization. Ultimately, we expect this study will serve as a template for expanding our tool’s
capabilities into numerous VHA populations in rehabilitation and beyond.
Public Health Relevance Statement
This study will examine the impact of a new clinical decision support tool for rehabilitation after total knee
arthroplasty (TKA). Typically, TKA rehabilitation is generic with most patients receiving the same dosage and
contents of rehabilitation despite notable diversity among patients who undergo TKA. Our clinical support
decision tool is designed to help physical therapists tailor rehabilitation treatments and dosages to the
individual needs, goals, and preferences of Veterans recovering from TKA. This study has the potential to
improve Veterans’ functional recovery after TKA, while simultaneously reducing the average number of
physical therapy visits Veterans attend after surgery by tailoring rehabilitation dosage based upon need. This
will ensure the Veterans Health Administration (VHA) has the resources and capacity to provide adequate
rehabilitation to every Veteran seeking TKA in the VHA system. Additionally, if successful, this clinical decision
support tool could be used to improve outcomes and access for additional patient populations in the future.
NIH Spending Category
No NIH Spending Category available.
Project Terms
AddressAffectAmbulatory Care FacilitiesCaringClinicClinicalConsensusDataEffectivenessEnsureExpenditureFocus GroupsFutureGoalsGuidelinesHealthHealthcareImprove AccessIndividualKnee OsteoarthritisLower ExtremityMethodsMonitorOperative Surgical ProceduresOrthopedicsOutcomeOutpatientsPainParticipantPatient Self-ReportPatientsPersonsPhysical therapyPopulationPostoperative CarePostoperative PeriodProceduresProcessReadinessRecommendationRecoveryRecovery of FunctionRehabilitation therapyReportingResourcesRiskServicesStatistical ModelsSurveysSystemTestingTranslationsVeteransVeterans Health AdministrationVisitWaiting Listsbarrier to careclinical applicationclinical decision supportclinical practicecohortcomorbiditycostdesigndisabilitydosageexpectationfunctional outcomesimprovedimproved outcomeindividual patientindividualized medicineinnovationknee replacement arthroplastypatient orientedpatient populationphysical therapistpoint of carepost-operative rehabilitationpredictive toolspreferenceprospectiverehabilitation servicesupport toolstooltreatment strategyusability
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