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| Name | Class |
|---|---|
| Hospital for Special Surgery, New York | OTHER |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional Postoperative Physical Therapy Clearance | Active Comparator | Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge |
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| Preoperative Physical Therapy, Postoperative Ambulation with Nursing | Experimental | Patients will receive gait/stair training from physical therapy prior to total joint arthroplasty, then ambulate with nursing postoperatively prior to home discharge |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Novel same-day discharge protocol after total joint arthroplasty | Other | Preoperative gait/stair training with physical therapy, then postoperative ambulation with nursing after total joint arthroplasty |
| Measure | Description | Time Frame |
|---|---|---|
| Number of postoperative falls per patient | 6 weeks postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Number of emergency room visits per patient | 90 days postoperatively | |
| Number of hospital readmissions per patient | 90 days postoperatively | |
| Patient satisfaction scores |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Maryland | Recruiting | Baltimore | Maryland | 21201 | United States |
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| Conventional postoperative physical therapy clearance | Other | Physical therapy evaluation and clearance after total joint arthroplasty |
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Surgical Satisfaction Questionnaire-8 (SSQ-8; range 0-100) and numeric satisfaction scale (NSS; range 0-100). Higher scores denote better outcome. |
| 6 weeks postoperatively |
| Patient reported outcome measure | Knee Injury and Osteoarthritis Outcome Score (KOOS, JR; range 0-100). Higher scores denote better outcome. | 6 weeks postoperatively |
| Patient reported outcome measure | Hip Disability and Osteoarthritis Outcome Score (HOOS, JR; range 0-100). Higher scores denote better outcome. | 6 weeks postoperatively |
| Patient reported outcome measure | Patient-Reported Outcomes Measurement Information System (PROMIS; mean score 50 with standard deviation of 10). Higher scores denote more of measured domain. | 6 weeks postoperatively |
| Hospital for Special Surgery | Not yet recruiting | New York | New York | 10021 | United States |
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