title: The AViKA (Adding Value in Knee Arthroplasty) postoperative care navigation trial: rationale and design features.
abstract: BACKGROUND
  Utilization of total knee arthroplasty is increasing rapidly. A substantial number of total knee arthroplasty recipients have persistent pain after surgery. Our objective was to design a randomized controlled trial to establish the efficacy of a motivational-interviewing-based telephone intervention aimed at improving patient outcomes and satisfaction following total knee arthroplasty.
  
  
  METHODS
  The study was conducted at Brigham and Women's Hospital in Boston, Massachusetts. The study focused on individuals 40 years or older with a primary diagnosis of osteoarthritis who were scheduled for total knee arthroplasty. The study compared two management strategies over the first six months postoperatively: 1) enhanced postoperative care with frequent follow-up by a care navigator; 2) usual postoperative care. Those who were randomized into the enhanced postoperative care arm received ten calls from a trained non-clinician care navigator over the first six postoperative months. The navigator used motivational interviewing techniques to engage patients in discussions related to their rehabilitation goals, including patient's plans for and confidence in achieving those goals. Patients in the usual care arm received standard postoperative management and received no navigator phone calls. Patients in both arms were assessed at baseline, three months, and six months postoperatively.
  
  
  CONCLUSIONS
  The primary outcome of the study was improvement in function as measured by the difference in Western Ontario and McMaster Universities Osteoarthritis Index function score between preoperative (baseline) status and six months postoperatively. Data were collected to identify factors that may be related to total knee arthroplasty outcomes, including preoperative pain, pain catastrophizing, self-efficacy, and depression. A formal economic analysis is also planned to determine the cost-effectiveness of the care navigator as a component of total knee arthroplasty care.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01540851.
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. elosina@partners.org.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Collins
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Daigle
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Donnell-Fink
authors.forename: Julian J Z
authors.initials: JJ
authors.lastname: Prokopetz
authors.forename: Doris
authors.initials: D
authors.lastname: Strnad
authors.forename: Vladislav
authors.initials: V
authors.lastname: Lerner
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Rome
authors.forename: Roya
authors.initials: R
authors.lastname: Ghazinouri
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Skoniecki
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: John
authors.initials: J
authors.lastname: Wright
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000191:economics / Q000534:rehabilitation*; D001900:Boston; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D062405:Motivational Interviewing / Q000191:economics; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D062526:Patient Navigation / Q000191:economics; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D020127:Recovery of Function; D012107:Research Design; D011795:Surveys and Questionnaires; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome