Goal Attainment Scaling Rehabilitation Improves Satisfaction with Work Activities for Younger Working Patients After Knee Arthroplasty

Abstract

Background: Knee arthroplasty (KA) is increasingly performed in relatively young, active patients. This heterogeneous patient population often has high expectations, including work resumption and performance of knee-demanding leisure-time activities. Goal attainment scaling (GAS) may personalize rehabilitation by using patient-specific, activity-oriented rehabilitation goals. Since unmet expectations are a leading cause of dissatisfaction after KA, personalized rehabilitation may improve patient satisfaction. We hypothesized that, compared with standard rehabilitation, GAS-based rehabilitation would result in younger, active patients having higher satisfaction regarding activities after KA. Methods: We performed a single-center randomized controlled trial. Eligible patients were <65 years of age, working outside the home, and scheduled to undergo unicompartmental or total KA. The required sample size was 120 patients. Using GAS, patients developed personal activity goals with a physiotherapist preoperatively. These goals were used to monitor patients’ goal attainment and provide goal-specific feedback during postoperative outpatient rehabilitation. Standard rehabilitation consisted of regular outpatient physiotherapy visits. The primary outcome measures were visual analogue scale (VAS) scores (scale of 0 to 100) for satisfaction regarding activities of daily living and work and leisure-time activities 1 year postoperatively, which were analyzed using generalized estimating equation models. Results: Patient satisfaction with work activities was significantly higher in the GAS group (β = 10.7 points, 98% confidence interval [CI] = 2.0 to 19.4 points) than in the control group. Patient satisfaction with activities of daily living and leisure-time activities did not differ between groups. We found no differences in VAS satisfaction scores between unicompartmental KA and total KA. Conclusions: Personalized, goal-specific rehabilitation using GAS resulted in higher patient satisfaction with work activities, compared with standard rehabilitation, 1 year after KA. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Beneficial and limiting factors in return to work after primary total knee replacement: Patients’ perspective

“…Incorporating a client-centered approach by the treating specialists could result in a more tailored treatment program which could enhance satisfactory short- and long terms results. A nice example is the recent study on Goal Attainment Scaling among working age knee arthroplasty patients that shows that preoperatively formulated patient-centered activity goals resulted in an increased satisfaction for these work-related activities until 12 months post-operatively [ 24 ]…”

Prevention at work needed to curb the worldwide strong increase in knee replacement surgery for working-age osteoarthritis patients

“…Therefore, occupational health professionals around the world face the urgent challenge to develop evidence of how to improve a patient’s ability for sustained employability – as an essential value in life – after surgery ( 19 ). Promising initiatives have recently been described although not validated for work participation yet ( 20 – 23 ). More importantly, occupational health professionals should play a primary role in reducing the steep increase in replacement surgery by mitigating the risk of knee OA.…”

Recommendations for Patients with High Return to Sports Expectations after TKA Remain Controversial

“…This was in line with previous observations [ 24 , 25 ], where patient-reported outcomes suggest a correlation between preoperative levels of physical activity and RTS capacity after TKA. Most patients return to low-impact sports after TKA with popular activities such as bicycle riding, swimming, hiking, and sometimes skiing (alpine) [ 26 , 27 , 28 , 29 , 30 ]. Previous similar studies observed that most surgeons are rather reluctant to recommend participation in high-impact sports after TKA [ 31 , 32 ], leading concerns were aseptic loosening due to increased wear and debris [ 33 , 34 ].…”

“…Previous clinical outcome measurements may not be able to differentiate between the groups and standard post-operative rehabilitation program may not meet the needs of every patient. As recently demonstrated, goal attainment scaling (GAS) may be one approach to improve satisfaction for active patients with high RTS expectations [ 29 , 83 ].…”