Comparative effectiveness of alternative clinical pathways for primary hip and knee joint replacement patients: a pragmatic randomized, controlled trial

Abstract

While effect sizes were small compared with major effects of the surgery itself, an evidence-informed clinical pathway can improve health related quality of life (HRQoL) of hip and knee arthroplasty patients with degenerative joint disorder in routine clinical practice for up to 12 months post-operatively. CLINICALTRIALS.GOV IDENTIFIER: NCT00277186.

Systematic review and meta-analysis of enhanced recovery programmes in surgical patients

“…. Thirty‐eight eligible studies with relevant outcomes were found, including two quasi‐randomized studies. In total 67 papers on these studies were reviewed ( Appendix S1 , supporting information).…”

“…Twenty studies reporting length of stay had standardized discharge criteria. In one the criteria differed between intervention and control groups. In another study length of stay was explicitly part of the intervention, with discharge planned for day 3 in the intervention group and day 6 for the control group.…”

Total joint arthroplasty: practice variation of physiotherapy across the continuum of care in Alberta

“…An indication of limited capacity in rural regions that was seen in this survey was a trend toward fewer therapy sessions reported by rural physiotherapists relative to the physiotherapists in urban settings. The pressure on providing physiotherapy in the community was also felt with the decreasing LOS for TJA, which has shifted the provision of rehabilitation services from the acute care setting into the community where little standardization in care exists [23, 34]. While the focus of the acute care pathway is to prepare patients for discharge, little focus has been directed toward the delivery of services in the community once the patient has been discharged.…”

“…While the focus of the acute care pathway is to prepare patients for discharge, little focus has been directed toward the delivery of services in the community once the patient has been discharged. No clinical pathway or quality indicators exist in the community for rehabilitation services [23]. Future work is required to determine how post discharge services should be organized and identify approaches to optimize patient outcomes.…”

“…The clinical pathways include medical, pharmaceutical and rehabilitation management directed at a 3 to 4 day length of stay (LOS) in acute care settings. The primary aim of implementing clinical pathways for THA and TKA in Alberta was to standardize care and provide best practice [23]. In spite of guidelines for rehabilitation of TJA, no clinical pathways exist for pre-operative or post-acute care within the province.…”