Patients benefit from one-on-one counseling session prior to knee or hip replacement surgery

A study at Hospital for Special Surgery (HSS) finds that patients benefit from a one-on-one education session provided by a physical therapist and access to a custom web portal prior to knee or hip replacement surgery. The patients indicated they were more satisfied with their pre-surgery education and felt better prepared to leave the hospital after joint replacement, compared to those who did not participate in the session or have access to the website.

The research will be presented at the upcoming meeting of the American Association of Physical Therapy on February 20 in Anaheim, CA.

"Controversy exists regarding the most effective means of delivering preoperative physical therapy education prior to total joint replacement," said lead investigator Rupali Joshi, PT, PhD. "Our study sought to evaluate the effect of a face-to-face counseling session coupled with web-based education on patient satisfaction and functional outcomes."

The goal of the half-hour sessions, which generally took place on the patients' pre-surgical screening day, was to educate them on what to expect when undergoing joint replacement.

"It has been shown that preoperative education is most beneficial when provided one-on-one," said Dr. Joshi. "The sessions are customized to address a patient's specific needs regarding preoperative preparation and what to expect in the hospital and during rehab and recovery. We also assist patients with setting realistic goals regarding outcomes, and they are able to ask any questions they may have in a private setting."

"After surgery, patients may be dealing with issues such as fatigue, discomfort or anxiety, and it is not the most opportune time to give them information about the road ahead," said Amar Ranawat, MD, an orthopedic surgeon at HSS and study author. "With the face-to-face information session and user-friendly web portal, they can receive and retain much of the information prior to surgery. Many patients feel more confident knowing what to expect."

In the study, researchers followed 126 patients who underwent knee or hip replacement for osteoarthritis between February and June 2015.

All of the patients attended a group education class before surgery, the standard of care for those scheduled for joint replacement at HSS. They were then randomized into two separate groups. The median age in both groups was 61.

In group one, 63 patients attended the one-on-one education session with a physical therapist in addition to the group class. They also were granted access to the informational web portal, which also could be accessed on mobile phones and tablets, and included videos.

The control group of 63 patients attended the standard group class and received a booklet about what to expect after joint replacement. They received no further education.

Patient satisfaction and patient-reported functional scores, which measured pain, joint stiffness and function both before and after surgery, were evaluated by a series of patient questionnaires.

"Significantly more patients who attended the extra one-on-one counseling session with the physical therapist before surgery indicated that they were better prepared to leave the hospital after surgery and were overall more satisfied with the preoperative education they received," Dr. Joshi noted. "Almost 97 percent of these patients accessed the informational web portal, and all of them said they would recommend it for patients undergoing the same procedure."

Almost 70 percent of patients from the group that did not receive the supplemental educational session or web portal access believed they could have benefited from additional education before surgery.

Patients who received one-on-one counseling also needed fewer physical therapy sessions in the hospital before discharge and met PT discharge criteria sooner. This includes the ability to get out of bed and walk with or without an assistive device and going up and down stairs independently.

The program is now being implemented for hip and knee replacement patients at Hospital for Special Surgery. The next step, according to Dr. Joshi, will be to test the usefulness of pre-surgery one-on-one education and a customized web portal for patients scheduled for other types of surgery.