Table 2 Quality indicators for rehabilitation before and after total knee arthroplasty
Patient Information | |
1 | Before surgery, a physical therapist should be aware of patient information, such as age, sex, comorbidities (e.g., obesity, diabetes), and radiographic characteristics |
2 | A physical therapist or another member of the rehabilitation team should gather and document information regarding family support, social support, and the home setup |
3 | A physical therapist or another member of the rehabilitation team should document the patient’s goals for work, sports, and other life activities before surgery and assess their achievement postoperatively |
Assessment of pain, knee function, and physical functions | |
4 | Across the entire TKA continuum—from preoperative to acute, and beyond—a physical therapist should assess knee pain using a standardized tool, such as the visual analog scale, numerical rating scale, face pain scale, or a scale included in a patient-reported outcome measure, and document these assessments |
5 | Across the entire TKA continuum—from preoperative to acute, and beyond—a physical therapist should assess knee function using standardized tools, such as knee range of motion (ROM) measurement, knee extension strength assessment, and knee circumference measurement, and document these assessments |
6 | Across the entire TKA continuum—from preoperative to acute, and beyond—a physical therapist should assess physical function using standardized performance-based tests, such as walking speed measurement, the Timed Up and Go test, and 6-min walk test, and document these assessments |
7 | In the acute-care phase and beyond, a physical therapist should assess and document the balance ability and risk of falling, using not only standard assessment batteries but also other appropriate methods as needed |
8 | Before surgery and at regular intervals after the acute-care phase, a physical therapist or another member of the rehabilitation team should assess and document patient-reported outcomes, including disease-specific and general quality of life (QOL) measures |
Preoperative Interventions | |
9 | A physical therapist or another member of the rehabilitation team should provide instructions regarding assistive devices, such as walking aids, and guidance on the home setup, both preoperatively and postoperatively, as needed, and document these interventions |
10 | A physical therapist should provide instructions for exercise and patient education, including an explanation of the postoperative course and lifestyle advice such as pain management, and document these interventions |
Acute-Care Interventions | |
11 | A physical therapist or another member of the rehabilitation team should initiate rehabilitation and mobilization within 24Â h of surgery and document these interventions |
12 | A physical therapist should provide and document supervised exercise therapy, including ROM exercises, strength training, and balance and gait training |
13 | A physical therapist should avoid the routine use of continuous passive motion (CPM) |
14 | A physical therapist should provide and document neuromuscular electrical stimulation (NMES) to improve muscle strength and function |
15 | A physical therapist should provide and document cryotherapy for pain management when appropriate |
16 | A physical therapist should provide and document transcutaneous electrical nerve stimulation (TENS) for pain management whenever appropriate |
17 | A physical therapist or another member of the rehabilitation team should instruct and document postoperative knee flexion at rest during the first 7Â days |
18 | A physical therapist and other members of the rehabilitation team should facilitate patients' achievement of the activities of daily living (ADLs) necessary for discharge within the planned length of hospital stay |
19 | A physical therapist should provide general guidance for living at home and a home exercise program after discharge |
Post-Acute Care Interventions | |
20 | A physical therapist or another member of the rehabilitation team should regularly verify and document the patient's adherence to the home exercise program for the first 6–8 weeks after surgery |
21 | A physical therapist or another member of the rehabilitation team should provide and document instructions or interventions to promote increased physical activity |
Others | |
22 | A physical therapist or another member of the rehabilitation team should implement clinical pathways throughout the TKA continuum, from the preoperative to postoperative phases |
23 | A physical therapist or another member of the rehabilitation team should prepare and document a rehabilitation summary for each transfer to another hospital or facility |
24 | A physical therapist or another member of the rehabilitation team should assess and document patient satisfaction with the rehabilitation program |