Authors: Nancy Bryant, MLT, ASCP, CCRC; Deanna Whitacre, PT; Benjamin T Gibson, PT; Mikayla E McGrath, BS; Charles DeCook, MD (PI)
Abstract
Introduction
Total Knee Arthroplasty (TKA) is expected to grow over the next 10 years with an estimated increase same day discharge (SDD) plan of care. Previous studies have shown internet-based PT after TKA performed as well as patients receiving traditional physical therapy (PT), but limited research on SDD population. This study purpose is to compare traditional OPT to internet-based PT in a broad range of patients undergoing TKA.
Methods
Consented patients undergoing SDD TKA from August 2019 to March 2020 were enrolled and randomized to either an outpatient (OPT) or internet-based PT program. Participants completed Veterans Rand 12 Mental and Physical (VR-12 MCS/PCS) and knee injury and osteoarthritis junior (KOOS Jr.) preop, 6 and 12 weeks after surgery. Timed up and go (TUG), range of motion, and 4-meter gait was measured preoperative and 6 weeks postoperative. Physical therapy information was collected 90 days postoperative.
Results
Of the 93 patients who met the inclusion criteria and had surgery, 48 were randomized to internet-based PT and 45 to OPT group. 8 internet-based PT crossed over postoperatively due to ROM and gait clinical indication (7) and patient preference (1), and 1 OPT crossover patient due to lack of internet access. This left 40 internet-based, and 44 OPT for analysis. No significant difference in KOOS Jr, VR-12 MCS/PCS, or satisfaction at 6 and 12 weeks postoperative. No significant differences in 6 week TUG (9.67 v 9.17,p=0.58), 4-meter gait (3.74 vs 3.47, p=0.24), knee flexion (117.14 vs 119.11,p=0.30) or extension (0.21 vs 0.31,p=0.72) in internet-based PT versus OPT groups, respectively. Average 10.98 OPT sessions, 11.1 minutes of travel, copay of $18.17 per visit, and $196.40 total cost for OPT patients.
Conclusion
Patients using internet-based PT had similar outcomes, and significant cost and time savings, as patients using traditional outpatient PT following TKA.