Is Physical Therapy Clearance Before Arthroplasty Home Discharge Necessary?

Purpose

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.

Conditions

  • Physical Therapy
  • Total Joint Arthroplasty
  • Same-day Discharge

Eligibility

Eligible Ages
Between 18 Years and 90 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • 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).

Exclusion Criteria

  • 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

Phase
N/A
Study Type
Interventional
Allocation
Non-Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Health Services Research
Masking
Single (Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Conventional Postoperative Physical Therapy Clearance 		Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge
  • Other: Conventional postoperative physical therapy clearance
    Physical therapy evaluation and clearance after total joint arthroplasty
Experimental
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
  • Other: Novel same-day discharge protocol after total joint arthroplasty
    Preoperative gait/stair training with physical therapy, then postoperative ambulation with nursing after total joint arthroplasty

Recruiting Locations

University of Maryland
Baltimore, Maryland 21201
Contact:
Sumon Nandi
617-717-8065
sumon.nandi@som.umaryland.edu

More Details

Status
Recruiting
Sponsor
University of Maryland, Baltimore

Study Contact