Translation from Concept to Clinic

Rehabilitation after total knee arthroplasty (TKA) is typically generic and based on population-level estimates of recovery. Individualized, patient-centered care improves orthopedic outcomes1 and is desired by patients after TKA.2, 3 However, clinicians lack the necessary tools to deliver this kind of care consistently. We developed a novel approach for generating individualized recovery trajectories in rehabilitation to improve patient-centered care for patients with TKA.4 We worked closely with relevant stakeholders to incorporate our approach into a clinical support tool—the Knee Recovery App—designed for TKA rehabilitation. The purpose of this project is to evaluate the effectiveness of the Knee Recovery App while gathering information about its implementation using the RE-AIM framework.5

The Knee Recovery App will be implemented as standard of care in two physical therapy clinics in Greenville, SC, owned by ATI Physical Therapy. The app will be used directly by physical therapists to generate individualized recovery information for all patients between the ages of 40 and 90 seeking rehabilitation after TKA (n=30).

We will use a Hybrid Type 1 design to test the effectiveness of the Knee Recovery App while gathering information about its implementation potential.6 Physical therapists will use the app to generate patient-specific recovery estimates to (1) inform patients of their expected recovery and (2) develop a patient-centered plan of care. Outcomes will be collected prospectively throughout the episode of care and compared to a retrospective cohort of age and sex-matched patients (n=60) in ATI’s quality improvement database of patients with TKA. Group differences will be examined using linear models and effect size will be calculated with Cohen’s d. Effectiveness outcomes will include functional measures and surveys related to patient-centered care (Table 1). We will evaluate the implementation potential of our app using a mixed-methods approach informed by the RE-AIM framework (Table 1).7 Our qualitative approach will consist of directed content analysis of semi-structured interviews with representation from all stakeholders (n=30).8 Quantitative implementation outcomes will be extracted from three sources: (1) ATI’s quality improvement database, (2) information stored on the Knee Recovery App, and (3) survey administered to clinicians.

Our novel approach for individualized rehabilitation has the potential to improve patient-centered care and outcomes in TKA rehabilitation. The RE-AIM framework informed our implementation strategy and will provide the structure to examine barriers and facilitators to clinical use of the Knee Recovery App. We anticipate the results of this project will inform a future cluster randomized trial in the ATI system guided by the PRISM framework.