Total Joint Arthroplasty and Outcome Measures (TJAOM) Toolkit

The TJAOM Knowledge Translation Task Force

Dr. Marie Westby, Ronda Field, Maureen Duggan, Dolores Langford, Robyn Laytham, Steven Longstaff, Phil Sweeney, Lauren Welch, Alison Hoens

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Introduction to the Total Joint Arthroplasty and Outcome Measures (TJAOM) Toolkit

The TJAOM Knowledge Translation Task Force is pleased to share with you the TJAOM Toolkit. The purpose of the toolkit is to provide clinicians with outcome measures appropriate for use along the continuum of care for patients before and after total joint arthroplasty.

The development of this toolkit is one of multiple Physical Therapy Knowledge Broker projects (including the Achilles Tendinopathy Toolkit and the Lateral Epicondyle Tendinopathy (Tennis Elbow) Toolkit) supported by the UBC Department of Physical Therapy, the Physiotherapy Association of BC, the Vancouver Coastal Research Institute, and the Providence Healthcare Research Institute.

The following information is current as of February 2015.


Guide to using the TJAOM Toolkit

  1. From the Recommended Outcome Measures along the Continuum of Total Joint Arthroplasty:
    • Identify the relevant phase of care:
      • Pre-op, Acute, Post-acute, Active Living
    • Select, based on the needs of your patients and practice setting, at least one of each category of outcome measure:
      • Patient-Reported Outcome Measure (PROM) e.g. Pain VAS/NRPS, LEFS, HOOS or KOOS
      • Performance Measure e.g. 30 sec-CST, Gait speed, Stair Climb, TUG, Functional Reach, SLS, 6MWT
  2. From the One Page Summaries for each outcome measure
    • Review the information for the outcome measures that you selected, AND
    • Review the instructions of how to do the test from the link provided in the section “How do I do it?”
  3. From the Learning Modules for each outcome measure
    • Review the learning modules for each of the outcome measures that you selected
  4. Practice, with a colleague, each outcome measure that you selected
  5. Trial, with 5 consecutive patients, each outcome measure that you selected
    • Do it (according to the instructions)
    • Score it (according to the instructions)
    • Interpret it (according to the information about the MDC, MCID, cut-offs, norms etc.)
  6. Use, with all appropriate patients, at admission, at least once through the series of treatments, and at discharge, each outcome measure that you selected
    • Do it
    • Score it
    • Interpret it
    • Explain the interpretation to the patient
    • Adjust your treatment according to the results
    • Document the result, interpretation and any changes to treatment
  7. Use the Discharge Letter Template and Appendices to communicate the results and interpretation with the physician.
    • Read “How to use the Total Joint Arthroplasty and Outcome Measures (TJAOM) Discharge Letter Template and Appendices”
    • Customize the letter with your clinic/organization’s logo and address
    • Cut and paste the outcome measures and suggested interpretation statements that are relevant for the patient

Recommended Outcome Measures along the Total Joint Arthroplasty Continuum

The purpose of this document is to provide evidence-based guidance (evidence derived from a survey, chart audit, focus group, Delphi process and the literature) regarding the most appropriate outcome measures (OMs) to use for patients along the continuum of care for Total Hip Arthroplasty and Total Knee Arthroplasty. The selection of how many and which OMs to use is at the discretion of the clinician based upon the unique contexts of the practice setting.

Legend: HOOS = Hip disability and Osteoarthritis Outcome Score; KOOS = Knee injury and Osteoarthritis Outcome Score; LEFS = Lower Extremity Functional Scale; NRPS = Numeric Pain Rating Scale; PROMs = Patient-Reported Outcome Measures; SLS = Single Leg Stance; TUG = Timed-Up-and-Go; VAS = Visual Analogue Scale; 6MWT = 6 Minute Walk Test; 30-CST= 30 Sec Chair Stand Test

1. Pre-Op: Moderate to advanced OA

2. Acute: 3-5 day hospital stay

  • PROMs:
    • Pain VAS/NPRS[1]

3. Post-Acute: Outpatient/home settings

4. Active Living: 1 year post-op and onwards

Recommended Outcome Measures along the Total Joint Arthroplasty Continuum.png

One Page Summaries

The toolkit contains these one page summaries to encourage you to review the information for the outcome measures that you selected and to review the instructions of how to do the test from the link provided in the section “How do I do it?”.


Learning Modules

Online learning modules for each recommended outcome measure are currently being developed.  These learning modules will provide the step by step process to apply, score and interpret each of the recommended outcome measures.


Discharge Letter Template and Appendices

Use the Discharge Letter Template and Appendices to communicate the results and interpretation with the physician. Read “How to use the Total Joint Arthroplasty and Outcome Measures (TJAOM) Discharge Letter Template and Appendices”, customize the letter with your clinic/organization’s logo and address and cut and paste the outcome measures and suggested interpretation statements that are relevant for the patient.


Other Supporting Resources


References

  1. 1.0 1.1 1.2 1.3 Dobson F, Hinman RS, Roos EM, Abbott JG, Stratford P, David AM, Buchbinder R, Snyder-Mackler L, Henrotin Y, Thumboo J, Hansen P, Bennell KL (2013). OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage; 21:1042-52.
  2. 2.0 2.1 2.2 Alviar MJ, Olver J, Brand C, Hale T, & Khan F. (2011) Do patient-reported outcome measures used in assessing outcomes rehabilitation after hip and knee arthroplasty capture issues relevant to patients? Results of a systematic reviewfckLR nd ICF linking process. J Rehabil Med; 43(5):374-81.
  3. 3.0 3.1 3.2 Alviar MJ, Olver J, Brand C, Tropea J, Hale T, Pirpiris, M, Khan F. (2011). Do patient-reported outcome measures in hip and knee arthroplasty rehabilitation have robust measurement attributes? A systematic review. J Rehabil Med; 43:572-83.
  4. 4.0 4.1 4.2 Collins NJ & Roos EM (2012). Patient-Reported Outcomes for Total Hip and Knee Arthroplasty: Commonly Used Instruments and Attributes of a “Good” Measure. Clin Geriatr Med; 28:367–94.
  5. 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 Westby MD, Brittain, A, Backman CL (2013). Expert consensus on best practices for post-acute rehabilitation after total hip and knee arthroplasty: A Canada-US Delphi study. Arthritis Care Res. Sep 10. Epub ahead of print.
  6. 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 6.14 6.15 6.16 Hawker GA, Mian S, Kendzerska T, French M (2011). Measures of adult pain. Arthritis Care Res. 63(Suppl 11):S240-52.
  7. 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 McAuley C, Westby MD, Hoens A, Troughton D, Field R, Duggan M, Reid WD (2014). A survey of physiotherapists' experience using outcome measures in total hip and knee arthroplasty. Phys Can. Jan 21. Epub ahead of print.