Recovery Rate After Hip

1
Recovery Rate After Hip Knee Arthroplasty

• Kevin Harrison, FHA
• Catherine McAuley, VCH
• Mark Rebman, FHA
• John Campbell, FHA

2
Overview

• Background
• Literature Review
• Research Protocol
• Process
• Current Status
• Next Steps

3
Rehab Task Group

• Established through Collaborative
• Links rehab leaders
• Promote standardization

4
Rehab Task Group - Members

• Catherine McAuley - VCH
• Kevin Harrison - FHA
• Susan Illmayer - VIHA
• Dave Troughten - VIHA
• Darlene Arsenault - IH
• James Simpson - IH
• Lynnda Swan - IH
• Marcia Leiva - NH

5
Background

• Need to document normal recovery
• 1st step ? Milestones draft
• Literature review ROM strength gait aids
  function pain

6
Literature Review

• Most recovery reported at limited times (6 weeks,
  3 months, 6 months)
• Early recovery phase information limited
• Kennedyi used growth curves to report WOMAC,
  TUG, 6MWT
• Stratfordii reports LEFS (TKA with THA)

• Kennedy et al. Journal of Arthroplasty. 2006
  21(4)559-566.
• Stratford et al. Physiotherapy Canada. 2005
  57154-157.

7
Research Protocol

• Objectives
• Construct growth curves for post-op rate of
  recovery for TKA THA for domains of interest
• ROM
• Strength
• Gait aids
• Function
• Pain

8
Research Protocol Chart Audit

• Retrospective chart audit
• Fraser Health Authority
• Langley Memorial
• Chilliwack General
• Burnaby General
• Surrey Memorial
• Vancouver Coastal Health Authority
• Mary Pack Arthritis Centre

9
Research Protocol - Inclusion

• Inclusion Criteria
• Surgery in 2005
• Elective primary THA or TKA
• WBAT
• TKA 8 visits in first 8 weeks
• THA 5 visits in first 8 weeks

10
Research Protocol - Exclusion

• Exclusion Criteria
• Resurfacing
• Revision
• Unicompartmental
• Multiple joint surgery
• Weight bearing restrictions
• Cognitive deficits

11
Research Protocol - Data

• Age, gender, Charnley
• Total of visits
• Date of visit
• Prior Physiotherapy

12
Research Protocol - Data

• Charnley Class
• A - Disease in target hip only, no other
  disabling problems
• B1 - Arthritis also in contralateral hip
• B2 - Contralateral hip has been replaced
• C1 - Multi-joint arthroplasties
  C2 Systemic disease - other medical condition
  that limits ability to walk
• C3 - Both C1 and C2

13
Research Protocol - Data

• TKA
• ROM flexion extension
• Strength quads hams
• Pain
• Walking aid outdoors
• Walking speed
• LEFS/Oxford

14
Research Protocol - Data

• THA
• Strength quads abductors
• Pain
• Walking aid outdoors
• Walking speed (10m)
• LEFS / Oxford

15
Research Protocol Stats

• Hierarchical linear modelling
• Statistician recruited
• Normal curves of recovery
• Gender Age
• Charnley

16
Process Ethics!

• Ethics Review Boards
• Fraser Health FHREB 4 site approvals
• Vancouver Coastal CREB 2 site approvals
• Vancouver Coastal
• Mary Pack

17
Process Ethics!

• Challenges
• CREB transition to electronic format
• Office relocations
• Encryptions protected folders
• Funding

18
Process Data Collection

• Data entry format
• Database design
• Confidentiality measures
• Consult with statistician
• Research assistant

19
Current Status Audits Completed

• Surrey Memorial
• 154 TKA
• 20 THA
• Langley Memorial
• 48 TKA
• Chilliwack General
• 85 TKA
• Mary Pack Arthritis Centre in process
• 40 joints reviewed only 20 included

20
Next Steps

• Assess data quality issues
• Complete current audit plan
• Identify most useful data elements
• eg. include ROM, leave out strength
• Build recovery curves with useful data

21
Next Steps Provincial Sites

• Clinical trials of curves
• Test clinical utility
• Patient progress
• Program evaluation
• Revise milestones document
• RTG Meeting Outcomes
• Publish results