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Postoperative Care Navigation for Total Knee Arthroplasty Patients: A Randomized Controlled Trial
Author(s) -
Losina Elena,
Collins Jamie E.,
Wright John,
Daigle Meghan E.,
DonnellFink Laurel A.,
Strnad Doris,
Usiskin Ilana M.,
Yang Heidi Y.,
Lerner Vladislav,
Katz Jeffrey N.
Publication year - 2016
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22829
Subject(s) - medicine , physical therapy , osteoarthritis , randomized controlled trial , arthroplasty , pain catastrophizing , physical medicine and rehabilitation , chronic pain , surgery , alternative medicine , pathology
Objective To establish the efficacy of motivational interviewing–based postoperative care navigation in improving functional status after total knee arthroplasty (TKA) and to identify subgroups likely to benefit from the intervention. Methods We conducted a parallel randomized controlled trial in TKA recipients with 2 arms: postoperative care with frequent followup by a care navigator or usual care. The primary outcome was the difference between the arms in Western Ontario and McMaster Universities Osteoarthritis Index function score change, over 6 months postsurgery. We performed a preplanned subgroup analysis of differential efficacy by obesity and exploratory subgroup analyses on sex and pain catastrophizing. Results We enrolled 308 subjects undergoing TKA for osteoarthritis. Mean ± SD preoperative function score was 41 ± 17 (0–100 scale, where 100 = worst function). At 6 months, subjects in the navigation arm improved by mean ± SD 30 ± 16 points compared to 27 ± 18 points in the usual‐care arm ( P = 0.148). Participants with moderate to high levels of pain catastrophizing were unlikely to benefit from navigation compared to those with lower levels of pain catastrophizing ( P = 0.013 for interaction). Conclusion Subjects assigned to the navigation intervention did not demonstrate greater functional improvement compared to those in the control group. The negative overall result could be explained by the large effect on functional improvement of TKA itself compared to the smaller, additional benefit from care navigation, as well as by potential differential effects for subjects with moderate to high degrees of pain catastrophizing. Greater focus on developing programs for reducing pain catastrophizing could lead to better functional outcomes following TKA.