Is Postoperative Physical Therapy Clearance Necessary for Safe Home Discharge After Total Joint Arthroplasty?
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 210
- 试验地点
- 2
- 主要终点
- Number of postoperative falls per patient
研究概览
简要总结
Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge in patients having surgery late in the day. Failed same-day discharge in eligible TJA patients results in unnecessary hospital bed occupancy, which increases costs, limits operating room throughput for patients requiring inpatient admission, and introduces risks associated with longer length-of-stay.
In collaboration with an institutional PT department, the investigators developed a protocol for discharging same-day TJA patients without postoperative PT clearance. Immediately preoperatively, PT administers gait training. Patients are then discharged home after ambulating with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization. This allows for the maximum number of patients discharged home, including the last patient of the day, PT staffing limitations notwithstanding. Single-institution pilot data demonstrates no increased risk of falls, emergency room (ER) visits, or readmissions with this process.
The investigators propose a prospective, controlled, multicenter study to expand on pilot data. The study aim is to assess safety of day-of-surgery preoperative PT and postoperative ambulation with PACU nursing before TJA discharge. The primary endpoint is postoperative falls, while secondary endpoints include 90-day ER visits, 90-day hospital readmissions, patient-reported outcome measures, and patient satisfaction scores.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 90 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •are 18 years of age or older
- •undergo primary THA or TKA
- •are eligible for same-day home discharge (friends or family available to stay at home with the patient for one week postoperatively and medically stable for discharge from PACU per anesthesia).
排除标准
- •90 years of age or older
- •have sleep apnea (not eligible for same-day discharge)
- •require overnight stay for any reason
- •undergo revision THA or TKA.
研究组 & 干预措施
Conventional Postoperative Physical Therapy Clearance
Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge
干预措施: Conventional postoperative physical therapy clearance (Other)
Preoperative Physical Therapy, Postoperative Ambulation with Nursing
Patients will receive gait/stair training from physical therapy prior to total joint arthroplasty, then ambulate with nursing postoperatively prior to home discharge
干预措施: Novel same-day discharge protocol after total joint arthroplasty (Other)
结局指标
主要结局
Number of postoperative falls per patient
时间窗: 6 weeks postoperatively
次要结局
- Number of emergency room visits per patient(90 days postoperatively)
- Patient satisfaction scores(6 weeks postoperatively)
- Number of hospital readmissions per patient(90 days postoperatively)
- Patient reported outcome measure(6 weeks postoperatively)
研究者
Sumon Nandi
Clinical Professor, Chief of Adult Reconstruction, Director of Orthopaedic Research
West Virginia University