Physical Therapists Collect Different Outcome Measures after Total Joint Arthroplasty as Compared to Most Orthopedic Surgeons: a New England Study

Michael Blankstein 1,2 Allicia Imada 2 Nathaniel Nelms 1,2 Bruce Beynnon 1,2 David Halsey 1,2
1Department of Orthopaedics & Rehabilitation, University of Vermont Medical Center, Burlington, USA
2College of Medicine, University of Vermont, Burlington, USA

Following total knee and hip arthroplasty, patients’ progress can be assessed with patient reported outcome measures (PROMs) and performance–based outcome measures (PBOMs). The American Joint Replacement Registry 2016 guide recommends collection of several measures including VR–12, PROMIS–10 Global, HOOS and KOOS JR. The aim of the study was to assess physical therapists’ current practice patterns and experience with PROMs and PBOMs.

We conducted an online cross-sectional survey asking therapists in Maine, Massachusetts, Vermont, Rhode Island, New Hampshire, and Massachusetts to rate their familiarity and anticipated future use of PROMs and PBOMs. We also inquired about other treatment modalities and the number of therapy sessions patients received post-operatively.

We had 122 responses (response rate 27%). Most therapists worked in mixed rural/urban settings, full time, and in private practice. The most often used and recommended PROMS were the Numeric Pain Rating Scale (85.3%, 89.3%) and Lower Extremity Function Scale (LEFS) (67.2%, 73.0%). There was significant variability in the use of PBOMs, but the most often used and recommended were the Timed Up and Go (TUG) (74.6%, 72.1%) and the Single Leg Balance Test (71.3%, 74.6%). Responders on average held 13.5 ± 6.0 therapy sessions with knee patients and 11.2 ± 4.8 sessions with hip patients. Cryotherapy and pool exercises were the most used additional modalities.

This paper is the first to describe practice patterns of a large number of physical therapists treating arthroplasty patients in the Northeast. It demonstrates therapists use and recommend the Numeric Pain Rating Scale and the LEFS. Most are unfamiliar with PROMs that surgeons use. Therapists are likely to use and recommend the TUG and Single Leg Balance Test. This demonstrates that there is a disparity between surgeons’ and physical therapists’ post–op assessment of patient rehabilitation and highlights the need for more collaboration and consistency between disciplines.