Expert Consensus on Best Practices for Post–Acute Rehabilitation After Total Hip and Knee Arthroplasty: A Canada and United States Delphi Study
Article first published online: 24 FEB 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis Care & Research
Volume 66, Issue 3, pages 411–423, March 2014
How to Cite
Westby, M. D., Brittain, A. and Backman, C. L. (2014), Expert Consensus on Best Practices for Post–Acute Rehabilitation After Total Hip and Knee Arthroplasty: A Canada and United States Delphi Study. Arthritis Care Res, 66: 411–423. doi: 10.1002/acr.22164
- Issue published online: 24 FEB 2014
- Article first published online: 24 FEB 2014
- Accepted manuscript online: 10 SEP 2013 03:32PM EST
- Manuscript Accepted: 3 SEP 2013
- Manuscript Received: 23 JAN 2013
- British Columbia Medical Services Foundation
- Canadian Institutes of Health Research Strategic Training Fellowship in Quality of Life Research
- Roman Babicki Fellowship in Medical Research
- University of British Columbia
To synthesize professional and patient expertise with available evidence to recommend best practices for post–acute rehabilitation following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis (OA).
Two expert panels of clinicians, researchers, and patients from Canada and the US participated in a 3-round, online Delphi survey.
Consensus was reached on 22 THA and 24 TKA best practice key statements. Recommendations common to both procedures included the need for supervised rehabilitation interventions provided by trained health professionals early after discharge from the acute care setting to optimize patient outcomes. Personal and environmental contextual factors were identified as influencing the process and outcomes of THA and TKA rehabilitation. Routine outcome assessment was recommended and several standardized outcome tools identified. Short-term followup care in the first 2 years postsurgery was recommended for both procedures. Specifics on timing, rehabilitation providers, need for long-term followup, and interventions differed for THA and TKA. Some recommendations received different levels of support based on the type of panelist (patient, physical therapist, surgeon), professional role (clinician, researcher), and/or country.
A rigorous consensus method led to key recommendations for post–acute rehabilitation after primary THA and TKA for OA, which together with available evidence and acknowledgment of contextual factors will inform the development of clinical practice guidelines. This is an important step toward reducing practice variation, closing the evidence–practice gap, and improving the quality of rehabilitation services after THA and TKA.