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

全膝关节置换术（TKA）后的康复通常是通用和低效的;大多数患者接受 康复的内容和剂量相同，而不管他们的个人需要，偏好或期望。 这种通用的治疗模式将是不可持续的退伍军人健康管理局（VHA），因为 在不久的将来，对TKA手术和术后护理的需求呈指数级增长。没有新 提高TKA康复效率的策略，像VHA这样的组织将努力满足， 支付这种激增的需求，退伍军人可能会被拒绝及时获得他们需要的术后护理 以达到最佳恢复效果我们开发了一种创新的新临床决策支持（CDS）工具， TKA康复的效率。使用类似历史患者的实际恢复数据，该工具可以预测 TKA术后新患者的恢复轨迹。这使得临床医生能够（1）分配康复资源 根据个人需要，（2）确定手术后早期存在次优结局风险的退伍军人，（3） 治疗策略，退伍军人的独特目标和临床表现，（4）监测退伍军人的恢复 相对于整个术后康复期的预期。在这个项目中，我们建议扩展CDS 通过建立基于个别退伍军人的预测恢复的使用指南（Aim 1）。这些指导方针将在三轮德尔菲程序中由专家协商一致确定。随后，委员会注意到， 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 门诊物理治疗诊所采用前后设计（目标2）。我们将比较患者报告的功能 治疗的退伍军人队列之间的（下肢功能量表）和物理治疗访视利用率 有没有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过程数据 关于工具的使用。最终，我们希望这项研究将作为一个模板，扩大我们的工具的 在康复和其他方面为众多VHA人群提供能力。

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.