What augmented physical activity and empowerment can bring to patients receiving total knee replacement: content, implementation, and comparative effectiveness of a new function-tailored care pathway in a routine care setting

BACKGROUND: In the routine setting of the 20-bed orthopaedic ward of a regional hospital in Netherlands, we developed, implemented, and evaluated a new, function-tailored perioperative care pathway for patients receiving total knee replacement (TKR), aimed at faster functional recovery by reduction of inactivity and stimulation of self-efficacy of the patients.

METHODS: To assess effectiveness, we compared, using prospectively collected data from medical files, patient groups before (n = 127) and after (n = 108) introduction of the new care pathway with respect to time to recovery of physical functioning during hospitalisation (five milestones), length of hospital stay (LoS), referrals to an inpatient rehabilitation facility, and readmissions. Multivariable regression was used to adjust results for differences between the two groups in preoperatively assessed risk factors for delayed recovery.

RESULTS: Comparison of patient groups before (n = 127) and after (n = 108) introduction of the tailored care pathway showed that the tailored rehabilitation pathway decreased the time to recovery of physical functioning (from 4.5 to 4.1 days, P < 0.05), the mean LoS (from 5.2 days to 4.2 days, P < 0.01).

CONCLUSION: We demonstrated that the introduction of a function-tailored care pathway shortens the hospital stay and accelerates the recovery of physical functioning.