title: Variations in Delivery and Exercise Content of Physical Therapy Rehabilitation Following Total Knee Replacement Surgery: A Cross-Sectional Observation Study.
abstract: OBJECTIVE
  Prevalence of total knee replacement (TKR) is large and growing but functional outcomes are variable. Physical therapy (PT) is integral to functional recovery following TKR but little is known about the quantity or content of PT delivered. Purposes of this study were to describe the amount and exercise content of PT provided in the terminal episode of PT care following TKR and to examine factors associated with utilization and content.
  
  
  METHODS
  Subjects included participants in a clinical trial of behavioral interventions for patients undergoing primary unilateral TKR who had completed the 6-month study evaluation. PT records were requested from 142 consecutive participants who had completed their post-TKR rehabilitation, 102 in/out patient care, and 40 in homecare. Information on utilization and exercises was extracted from a retrospective review of the PT records.
  
  
  RESULTS
  We received 90 (88%) outpatient and 27 (68%) homecare PT records. Records showed variability in timing, amount and content of PT. Patients receiving outpatient PT had more visits and remained in PT longer (p<0.001). Exercises known in the TKR literature were utilized more frequently in the outpatient setting (p=0.001) than in home care. Records from both settings had limited documentation of strengthening progression.
  
  
  CONCLUSIONS
  The study reveals considerable variability in timing, utilization and exercise content of PT following TKR and suggests sub-optimal exercise for strengthening. While methods we employed document variability, improved systematic PT documentation and in-depth research are needed to identify optimal timing, utilization and content of PT following TKR.
authors.affiliation: Department of Physical Therapy, Arcadia University, 450 S. Easton Road, Glenside, PA 19038, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Oatis
authors.affiliation: Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA ; Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: The Queens Medical Center, 1301 Punchbowl St, Honolulu, HI 96813, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: DiRusso
authors.affiliation: The Physical Therapy Associates of Myerstown, 11 E Lincoln Ave, Myerstown, PA 17067, USA.
authors.forename: Mindy J
authors.initials: MJ
authors.lastname: Hoover
authors.affiliation: Sports and More Physical Therapy, Inc., 8300 Health Park, Suite 127, Raleigh, NC 27615, USA.
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Johnston
authors.affiliation: Drayer PT Institute, 998 Hospitality Way, Aberdeen, MD 21001, USA.
authors.forename: Monika K
authors.initials: MK
authors.lastname: Butz
authors.affiliation: UPMC Shadyside, 5230 Centre Ave, Pittsburgh, PA 15232, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Phillips
authors.affiliation: St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Nanovic
authors.affiliation: HealthEast Optimum Rehabilitation, Midway Clinic, 1390 University Avenue West Saint Paul, Minnesota 55104, USA.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Cummings
authors.affiliation: Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
authors.forename: Milagros C
authors.initials: MC
authors.lastname: Rosal
authors.affiliation: Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Ayers
authors.affiliation: Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Franklin
keywords: Knee replacement; Physical therapy; Rehabilitation; Surgery