Is Physical Therapy Clearance Before Arthroplasty Home Discharge Necessary?
- Conditions
- Same-day DischargePhysical TherapyTotal Joint Arthroplasty
- Interventions
- Other: Conventional postoperative physical therapy clearanceOther: Novel same-day discharge protocol after total joint arthroplasty
- Registration Number
- NCT05858086
- Lead Sponsor
- University of Maryland, Baltimore
- Brief Summary
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.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 210
- 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).
- 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.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Conventional Postoperative Physical Therapy Clearance Conventional postoperative physical therapy clearance Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge Preoperative Physical Therapy, Postoperative Ambulation with Nursing Novel same-day discharge protocol after total joint arthroplasty Patients will receive gait/stair training from physical therapy prior to total joint arthroplasty, then ambulate with nursing postoperatively prior to home discharge
- Primary Outcome Measures
Name Time Method Number of postoperative falls per patient 6 weeks postoperatively
- Secondary Outcome Measures
Name Time Method Number of emergency room visits per patient 90 days postoperatively Patient satisfaction scores 6 weeks postoperatively Surgical Satisfaction Questionnaire-8 (SSQ-8; range 0-100) and numeric satisfaction scale (NSS; range 0-100). Higher scores denote better outcome.
Number of hospital readmissions per patient 90 days postoperatively Patient reported outcome measure 6 weeks postoperatively Patient-Reported Outcomes Measurement Information System (PROMIS; mean score 50 with standard deviation of 10). Higher scores denote more of measured domain.
Trial Locations
- Locations (2)
University of Maryland
🇺🇸Baltimore, Maryland, United States
Hospital for Special Surgery
🇺🇸New York, New York, United States