In an analysis of 112 records from 30 physical therapy (PT) sites regarding care for patients who had undergone total knee replacement (TKR) surgery, investigators found that the content and amount of specific exercises varied widely

The Arthritis Care & Research study also revealed that the specific details of PT interventions—including kinds of exercise, intensity, and dosage—may be important determinants of the functional outcomes of patients.

Post?acute PT data were collected from patients undergoing primary unilateral TKR and participating in a clinical trial of a phone?based coaching intervention. PT records from the terminal episode of care were reviewed and utilization and exercise content data were extracted. Descriptive statistics and linear regression models characterized PT treatment factors and identified associations with 6?month outcomes.

We analyzed 112 records from 30 PT sites. Content and dosage of specific exercises and incidence of progression varied widely. Open chain exercises were utilized more frequently than the closed chain (median and interquartile range (21(4,49) vs 13(4,28.5)).

Median (interquartile range) occurrence of progression of closed and open chain exercise was 0 (0,2) and 1 (0,3) respectively. Shorter timed stair climb was associated with the greater total number of PT interventions and use and progression of closed chain exercises.

The results suggest that evidence-based PT interventions may be under-utilized in clinical practice and that the amount of therapy may be insufficient. 

Total knee replacement

"Without clear evidence for the contributions of post-acute PT following total knee replacement, new reimbursement models establish incentives that can potentially reduce post-acute PT services. Anecdotal data suggests this is already occurring for patients post TKR," said lead author Dr. Carol Oatis, of Arcadia University. "We are using our current results to inform further research to identify PT 'best practice.'"