Factors Affecting Outpatient PT Attendance Following TKA

Hi, my name is Greg Bennett, and I'm a 3rd year medical student at LSU in New Orleans. Before I begin, I'd like to thank my fellow coauthors for their contributions. Our project looked at factors affecting Outpatient physical therapy after Total knee arthroplasty.

Total knee arthroplasty is an elective procedure aimed at improving quality of life and function for individuals with severe Knee Pain. After Surgery, Physical therapy is the gold standard for post-op recovery to improve function, strength, and range of motion. However, few studies have examined Physical therapy adherence specifically in individuals after TKA.

Given that utilization of Physical therapy after Total knee arthroplasty appears to be associated with improved function, it is important to identify patient characteristics that predict Physical therapy attendance. So the purpose of this study is to identify patient factors that predict initial patient engagement in PT defined as attending at least 2 Outpatient PT sessions and completion of a full course of Physical therapy, defined as attending at least 16 Outpatient physical therapy sessions.

Our project was a Retrospective chart review of individuals who underwent Primary TKA at an urban academic Private hospital by a single orthopedic surgeon between January 2016 and December of 2019. We recommended individuals complete 16 PT visits within 6 weeks of Surgery, and individuals who attended PT outside of our network were removed from analysis.

We had 270 individuals who underwent TKA with 219 attending in-house Physical therapy of at least 2 visits with no records of PT being conducted outside of our system. The average age of our study cohort was about 69 years old. The majority were female, and about half were Caucasian.

Most had a Kelgren Lawrence grade of 4, and the KL grade is a radiographic classification system to stratify Osteoarthritis severity, with 4 being the highest grade.

88% attended two or more PT visits, and the overall completion of 16 or more PT visits within six weeks of Surgery was 74%.

When looking at predictors of engagement in Physical therapy, we found that individuals that live more than 40 kilometers from the PT facility were less likely to attend two or more PT visits.

For completion of Physical therapy, we found that white patients were more likely to complete Physical therapy compared to black or Other patients, as well as individuals with a higher KL grade were less likely to complete PT.

Sex, age, BMI, education, marital status, and insurance type had no significant impact on engagement or completion of Physical therapy.

Taking a deeper dive into the distance effect on engagement of PT, we found that the percent of individuals attending two or more sessions decreased as the distance increased. For example, 93% of individuals living within 20 kilometers of the PT office engaged in Physical therapy, whereas this number dropped to 61% if they live more than 100 kilometers away.

It's important to point out that the distance effect was only significant for engagement in Physical therapy, not completion of Physical therapy. So our study shows that if individuals attend at least 2 PT sessions, their distance to the clinic does not have an impact on completing Physical therapy, which is the overall goal to ensure full recovery.

This emphasizes the importance of preoperative planning for rehab to ensure prompt and appropriate PT arrangements. Especially because studies have shown that delays in starting PT are associated with worse outcomes.

This also highlights the utilization of Other modalities such as at-home PT, especially for individuals in the rural setting, which was prevalent for our study population being based in southeastern Louisiana, but this is also a current topic of Research in light of the COVID Pandemic.

Our study also showed a higher KL grade could be used to screen for patients needing extra followup to ensure completion of the prescribed Physical therapy regimen.

And lastly, the association between race and completion of Physical therapy is a complex issue, involves many Other factors and Social determinants of health that could not be adequately captured in our study, but certainly warrants further investigation. It is important for providers to be aware of any disparities and in order to direct appropriate resources to help ensure equal access to healthcare and equitable quality of post-op recovery.

In conclusion, our study shows the importance of preoperative or immediate post-op referral to a PT clinic to ensure smooth transition and engagement in Physical therapy, especially among individuals that live more than 40 kilometers from the PT office.

Thank you for listening to my presentation. If you have any questions or comments, please reach out by email.