Is Physical Therapy Clearance Before Arthroplasty Home Discharge Necessary? (PTClearSHoT)

University of Maryland Baltimore (UMB)

Status: Enrolling

Conditions: Same-day Discharge; Total Joint Arthroplasty; Physical Therapy

Treatments: Other: Conventional postoperative physical therapy clearance; Other: Novel same-day discharge protocol after total joint arthroplasty

Study type: Interventional

Funder types: Other

Identifiers

NCT05858086

12

Details and patient eligibility

About

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.

Enrollment: 210 estimated patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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210 participants in 2 patient groups

Conventional Postoperative Physical Therapy Clearance

Active Comparator group

Description:

Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge

Treatment:

Other: Conventional postoperative physical therapy clearance

Preoperative Physical Therapy, Postoperative Ambulation with Nursing

Experimental group

Description:

Patients will receive gait/stair training from physical therapy prior to total joint arthroplasty, then ambulate with nursing postoperatively prior to home discharge

Treatment:

Other: Novel same-day discharge protocol after total joint arthroplasty