Discovering that a well-supported, evidence-based virtual physical therapy program produces the same functional and patient-reported outcomes as outpatient physical therapy—even for ambulatory TKA procedures—is a game-changer.
The rise in musculoskeletal care utilization is driving the exploration of more sustainable models to incentivize high-value care. As many total joint replacement procedures are already under bundled payments, health systems must find new ways to reduce cost while maintaining clinical outcomes.
Many health systems are studying the efficacy of remote patient monitoring and digital patient engagement on preoperative patient optimization and postoperative recovery. For total knee arthroplasty (TKA) procedures, virtual physical therapy has been proven to produce similar outcomes to outpatient physical therapy for traditional TKAs.
Currently, between 2.8% and 5% of TKAs in the U.S. are performed on an outpatient basis, typically on relatively young patients with few co-morbidities. However, the prevalence of same-day TKA procedures is increasing exponentially, fueled by cost containment pressures and the recent removal of TKA and total hip arthroplasty (THA) procedures from the Medicare Inpatient-Only list.
Some projections anticipate that more than 50% of TKAs will be offered as ambulatory procedures within the next five years. While orthopedic practices have become much more comfortable with the benefits of remote physical therapy, there is still apprehension regarding its adoption for outpatient procedures.
A study to evaluate outpatient vs. virtual physical therapy
Our institution devised a study to determine if formal physical therapy is necessary following outpatient TKA procedures. Patients undergoing same-day discharge TKAs between August 2019 and March 2021 were randomized to either outpatient physical therapy (OPT) or an internet-based virtual physical therapy (VPT) program.
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