Improving Rehabilitation for Veterans After Total Knee Arthroplasty Using Individualized Recovery Trajectories

全膝关节置换术(TKA)后的康复是典型的通用和低效的；大多数患者接受 无论其个人需要、偏好或期望如何，康复的内容和剂量都相同。 这种通用治疗模式在退伍军人健康管理局(VHA)将是不可持续的，因为 在不久的将来，对全膝关节置换术和术后护理的需求呈指数级增长。没有新的 提高TKA康复效率的战略，像VHA这样的组织将努力满足和 为这种激增的需求买单，退伍军人可能无法及时获得他们需要的术后护理 以实现最佳恢复。我们开发了创新的新临床决策支持(CDS)工具，以优化 全膝关节置换术康复的效率。使用类似历史患者的实际康复数据，该工具可以预测 全膝关节置换术后新患者的康复轨迹。这允许临床医生(1)分配康复资源 根据个人需要，(2)确定退伍军人术后早期预后不佳的风险，(3)量身定做 针对退伍军人独特的目标和临床表现的治疗策略，以及(4)监测退伍军人的恢复 相对于预期的整个术后康复。在这个项目中，我们建议扩展CDS 通过根据个别退伍军人的预测恢复(AIM)建立使用指南来提高工具的能力 1)。这些指南将在三轮德尔福进程中以专家共识的方式建立。后来， 我们将在四个VHA中测试CDS工具对退伍军人功能恢复和康复利用的影响 采用事前设计的门诊理疗诊所(目标2)。我们将比较患者报告的功能 接受治疗的退伍军人队列间的肢体功能评分和物理治疗访视利用 使用和不使用CDS工具。此外，我们将从参与VHA的临床医生和退伍军人那里收集数据 关于将我们的工具转化为临床实践，以评估其是否准备好在整个 VHA(目标3)。这将包括来自参与者焦点小组的定性数据和定量流程数据 关于工具的使用情况。最终，我们希望这项研究将成为扩展我们工具的模板 在康复和其他方面，许多VHA人口都有这种能力。

Rehabilitation after total knee arthroplasty (TKA) is typically generic and inefficient; most patients receive the same contents and dosage of rehabilitation regardless of their individual needs, preferences, or expectations. This generic treatment paradigm will be unsustainable in the Veterans Health Administration (VHA) as the demand for TKA surgery and postoperative care increase exponentially in the near future. Without new strategies to improve the efficiency of TKA rehabilitation, organizations like the VHA will struggle to meet and pay for this surging demand, and Veterans may be denied timely access to the postoperative care they need for optimal recovery. We have developed an innovative new clinical decision support (CDS) tool to optimize efficiency in TKA rehabilitation. Using the actual recovery data of similar historical patients, the tool can predict the recovery trajectory for new patients after TKA. This allows clinicians to (1) allocate rehabilitation resources based upon individual need, (2) identify Veterans at risk for suboptimal outcomes early after surgery, (3) tailor treatment strategies to Veterans’ unique goals and clinical presentation, and (4) monitor Veterans’ recovery relative to expected throughout postoperative rehabilitation. In this project, we propose to expand the CDS tool’s capabilities by establishing utilization guidelines based upon individual Veteran’s predicted recovery (Aim 1). These guidelines will be established by expert consensus in a three round Delphi process. Subsequently, we will test the CDS tool’s impact on Veteran’s functional recovery and rehabilitation utilization in four VHA outpatient physical therapy clinics using a pre-post design (Aim 2). We will compare patient-reported function (Lower Extremity Functional Scale) and physical therapy visit utilization between cohorts of Veterans treated with and without the CDS tool. Additionally, we will gather data from participating VHA clinicians and Veterans regarding the translation of our tool into clinical practice to assess its readiness for dissemination throughout the VHA (Aim 3). This will include qualitative data from participant focus groups and quantitative process data regarding the tool’s utilization. Ultimately, we expect this study will serve as a template for expanding our tool’s capabilities into numerous VHA populations in rehabilitation and beyond.