A home visit program versus a non-home visit program in total knee replacement patients: a randomized controlled trial

Abstract

BackgroundThe goals in total knee replacement (TKR) are pain relief, restore functions, and improve quality of life. Surgical outcomes were not related to patients’ satisfaction. Low 1-year WOMAC especially in the first 6 weeks and painful TKR related to patient dissatisfied. To improve satisfaction, we created the home visit program (TKR-H) after hospital discharge. INHOMESSS was the rationale for home visit activities.MethodsWe recruited 52 TKRs. Four TKRs were excluded. We used simple randomization for 24 patients as a home visit (TKR-H) and 24 patients as a non-home visit (TKR). Patients were evaluated by general demographics, pain intensity scores (VAS), range of motion (ROM), WOMAC, knee scores, and functional scores as a primary objective. A duration for gait aid independent and patient’s satisfaction score as secondary objective. The study was 6 weeks after surgery.ResultsTKR-H and TKR had significant differences in the mean of WOMAC score (88.29 ± 10.66 vs. 68.00 ± 12.47, respectively, P < 0.001), pain score (VAS) (6.25 ± 10.13 vs. 35.67 ± 22.05, respectively, P < 0.001), knee score (81.67 ± 10.08 vs. 68.38 ± 6.45, respectively, P < 0.001), functional score (77.83 ± 4.22 vs. 73.70 ± 7.48, respectively, P = 0.037), and range of motion (107.71 ± 8.47 vs. 98.17 ± 9.57, respectively, P = 0.001). The patient’s satisfaction score in TKR-H group (4.71 ± 0.46) was significantly higher than the TKR group (4.13 ± 0.45) (P < 0.001) and time to gait aid independent (2.75 ± 0.99 vs. 3.71 ± 1.23, respectively, P = 0.005).ConclusionOur TKR-H showed better clinical outcomes and satisfaction than non-home visit. The rationale in TKR-H improves satisfaction after total knee replacement.Trial registrationTCTR20190514001.

Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials

“…In all studies, the intervention commenced upon hospital discharge, and participants were followed up for 1–3 months. Two studies included patients undergoing TKA only [ 21 , 22 ], one study included patients undergoing THA only [ 19 ], and one study included patients undergoing both THA and TKA [ 20 ].…”

“…Blinding of participants and personnel was not achieved in three studies [ 20–22 ] because of the nature of the interventions. One study [ 20 ] blinded outcome assessors to treatment allocation, two studies [ 19 , 22 ] did not provide sufficient information, and one study [ 21 ] did not blind outcome assessors. Some concerns for attrition bias due to incomplete outcome data secondary to loss to participant follow-up existed in one study [ 20 ].…”

“…Studies used interventions that could be classified into two categories: 1) prescribing interventions to change analgesic prescribing practices upon hospital discharge (n = 2) [ 19 , 20 ], and 2) patient education on analgesic use during the subacute period (n = 2) [ 21 , 22 ]. Of the educational interventions, one study provided patient-specific advice through a mobile phone application [ 21 ].…”

“…Of the educational interventions, one study provided patient-specific advice through a mobile phone application [ 21 ]. Another study provided patient education during multidisciplinary patient home visits [ 22 ] ( Table 1 ).…”

“…Two studies evaluated the effect of providing tailored patient education after hospital discharge [ 21 , 22 ]. An RCT conducted by Pronk et al [ 21 ] randomized 71 patients to receive either 1) a personalized pain management smartphone application involving patient pain score input, personalized advice on pain medication use, physiotherapy exercise, and nonpharmacological pain management (n = 38) or 2) usual care (n = 33) for 14 days after hospital discharge after primary TKA.…”