Total Joint Arthroplasty and Outcome Measures (TJAOM) Toolkit
This article is currently under review and may not be up to date. Please come back soon to see the finished work! (15/06/2024)
The TJAOM Knowledge Translation Task Force
- TJAOM Toolkit 1.0 Team: Dr. Marie Westby, Ronda Field, Maureen Duggan, Dolores Langford, Robyn Laytham, Steven Longstaff, Phil Sweeney, Lauren Welch, Alison Hoens
- TJAOM Toolkit 2.0 Team: Dr. Marie Westby, Jane Burns, Melissa Idle, Clyde Smith, Aman Bajwa, Kelly Kavanagh, Jill Kipnis, Chiara Singh, Wing Ting Truong, Tony Hui, Paul Blazey, Jason Craig and Alison Hoens.
Introduction[edit | edit source]
The Total Joint Arthroplasty and Outcome Measures (TJAOM) Toolkit was developed by a dedicated task force comprising experts in the fields of physical therapy, orthopaedics, and rehabilitation. This toolkit aims to standardise and enhance the assessment of patients undergoing hip and knee replacement surgeries, ensuring consistent, high-quality care and improved patient outcomes.
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 June 2024.
Purpose[edit | edit source]
The toolkit provides clinicians with a comprehensive guide to selecting and using appropriate outcome measures. It helps in capturing and interpreting patient progress, facilitating effective treatment planning, and improving communication between patients and healthcare providers.
- Goal: To provide clinicians with recommendations of outcome measures appropriate for use along the continuum of care for patients before and after total joint arthroplasty (TJA).
- Why: Despite recognising the significant benefits of using outcome measures routinely for patients with TJA, PTs struggle with knowing which ones to use at different stages e.g. pre- and post–operatively. To address this need, the Total Joint Arthroplasty and Outcome Measures (TJAOM) Toolkit was developed and recently updated, by over 40 BC PT clinicians, students and researchers.
- What: The TJAOM toolkit includes:
- interactive PDF summaries of recommended outcome measures (patient-reported and performance-based tests) appropriate for each phase of the TJA continuum
- links to videos for performance-based tests
- a discharge letter template with interpretation guide.
- a video providing information about outcome measurement concepts and clinical interpretation and
- tables of ratings for all reviewed outcome measures.
Abbreviations Used in the Tookit[edit | edit source]
Abbreviations were used on this page, on the website and interactive PDFs, video lecture and template discharge letter. To see the full list click this link.
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Guide to using the Toolkit[edit | edit source]
Getting Started[edit | edit source]
- Access the Toolkit
- Visit the UBC TJAOM Toolkit for the complete set of resources.
- Understand the Structure
- The toolkit is divided into sections based on the type of joint (hip or knee) and includes both patient-reported outcome measures(PROMs) and performance-based tests (PBTs).
- Select Appropriate Measures
- Use the guidelines provided to select measures that are valid, reliable, responsive, and feasible for your clinical setting.
How to Use the Measures[edit | edit source]
- Review the Recommendations
- Familiarise yourself with the recommended outcome measures for hip and knee replacements.
- Using the Measures
- Follow the detailed instructions for administering each measure, considering patient factors and clinical feasibility.
- Interpret the Results
- Use the provided normative values, reference values, and minimal detectable change (MDC) or minimal clinically important difference (MCID) values to interpret the results meaningfully.
- Document and Communicate
- Record the results and discuss them with patients to enhance understanding and engagement in their care.
Recommended Outcome Measures[edit | edit source]
To ensure high-quality and consistent care for patients undergoing hip and knee replacement surgeries, the task force has identified a set of recommended outcome measures. These measures are divided into two categories: Patient-Reported Outcome Measures (PROMs) and Performance-Based Tests (PBTs).
Below are tables listing the recommended outcome measures, each with a brief description, the applicable phase(s) of care, and the relevant joint(s). For a more detailed overview of each measure, including phases, test description, ICF description, feasibility, time to complete, validity, reliability, and responsiveness, please click on the link provided in the table. Detailed descriptions can also be found further down the page.
Patient-Reported Outcome Measures (PROMs)[edit | edit source]
PROMs are an important tool , they provide feedback on a patient's health condition that comes directly from the patient and does not take into account any interpretation of the patient's response by a health professional. PROMs can take the form of questionnaires (in paper or electronic form) that include instructions and can be completed independently by the patient.
| Measure | ICF Description | Time to Complete / Feasibility | Phase | Joint |
|---|---|---|---|---|
| EuroQoL-5D-5L (EQ-5D-5L) Generic measure of health status based on 5 dimensions of health |
Body function, Participation, HRQoL | 5 minutes to administer and score. Quick to complete and score, routinely used in joint replacement clinical registries, but requires free registration to use. | Pre-op, Post-acute, Active living | Hip, Knee |
| Forgotten Joint Score-12 (FJS-12) Measures self-efficacy and lower extremity function |
Activity | 5 minutes to complete and score. Freely available for clinical use but requires registration to access. | Post-acute, Active living | Hip, Knee |
| Knee Injury and Osteoarthritis Outcome Score (KOOS) Measures pain, symptoms, function in daily living, sport and recreation, and HRQoL |
Body function, Activity, Participation, Quality of life | 10 mins to complete, 5 mins to score. Quick and easy for patient to complete. Some additional time required by clinician to score although online versions with automatic scoring are available. Registration for clinical use is recommended | Pre-op, Post-acute, Active living | Knee |
| KOOS-Joint Replacement (KOOS-JR) Measures stiffness, pain, and ADL after TKA |
Body function, Activity | ≤ 3 mins. Quick and easy for patient to complete. Some additional time required by clinician to score although online versions with automatic scoring are available. Registration for clinical use is recommended | Pre-op, Post-acute, Active living | Knee |
| Hip Disability and Osteoarthritis Outcome Score (HOOS) Measures pain, other symptoms, function in daily living, sport and recreation, and HRQoL |
Body function, Activity, Participation | 10 minutes to complete, 5 minutes to score. Simple, quick to complete & score. Registration for clinical use is recommended. | Pre-op, Post-acute, Active living | Hip |
| HOOS-Joint Replacement (HOOS-JR) Measures pain and function/daily living after THA |
Body function, Activity | Can be completed in <3 minutes. Simple, quick to complete & score. Registration for clinical use is recommended. | Pre-op, Post-acute, Active living | Hip |
| Lower Extremity Functional Scale (LEFS) Measures current ability to do common activities at home, work, school, recreation, and sport |
Activity, Participation | Approx 5 minutes to complete and score. Quick and easy. | Pre-op, Post-acute, Active living | Hip, Knee |
| Numeric Pain Rating Scale (NPRS) Measures pain intensity at rest or with activity |
Body function | Approx 1 minute to complete and score. Simple. | Pre-op, Acute, Post-acute, Active living | Hip, Knee |
| Oxford Hip Score (OHS) Measures pain and function in relation to daily activities |
Body function, Activity | 5-10 minutes to complete and score. Routinely used in joint replacement clinical registries, however, requires free registration to use. | Pre-op, Post-acute, Active living | Hip |
| Oxford Knee Score (OKS) Measures pain and function in relation to daily activities |
Body function, Activity | 5-10 minutes to complete and score. Routinely used in joint replacement clinical registries, however, requires free registration to use. | Pre-op, Post-acute, Active living | Knee |
| Pain Visual Analogue Scale (Pain VAS) Measures pain intensity at rest or with activity |
Body function | Approx 1 minute to complete and score. Simple. | Pre-op, Acute, Post-acute, Active living | Hip, Knee |
| Patient Specific Functional Scale (PSFS) Measures difficulty of 3 self-selected activities that the patient identifies as important |
Activity, Participation | Approx 5 minutes to complete and score. Quick and easy. | Pre-op, Acute, Post-acute, Active living | Hip, Knee |
Performance-Based Tests (PBTs)[edit | edit source]
Performance-Based clinical reported outcome measures require the patient to perform a task or set of movements that are supervised by a health care professional. Scores for performance-based measures can be either an objective measurement (e.g., time to complete a task) or a qualitative assessment that is assigned a score (e.g., normal or abnormal mechanics for a given task).
| Measure | ICF Description | Time to Complete / Feasibility | Phase | Joint |
|---|---|---|---|---|
| 4 Metre Walk Test (4mWT) Measures gait speed and functional mobility |
Body function, Activity | Approx 5 minutes to complete & score; Quick & simple with minimal equipment/space required. | Pre-op, Acute, Post-acute, Active living | Hip, Knee |
| 10 Metre Walk Test (10mWT) Measures gait speed and functional mobility |
Activity, Participation | <5 minutes. Quick and simple with minimal equipment and space | Pre-op, Acute, Post-acute, Active living | Hip, Knee |
| 40 Metre Fast-paced Walk Test (40mFPWT) Measures gait speed and functional mobility at a fast pace |
Activity, Participation | <10 minutes. Easy with minimal equipment/space required | Pre-op, Post-acute, Active living | Hip, Knee |
| 6 Minute Walk Test (6MWT) Measures submaximal aerobic capacity and ability to walk over longer distances |
Activity | Approx 10 minutes to complete and score. Simple but requires a 30 m unobstructed walkway. | Pre-op, Post-acute, Active living | Hip, Knee |
| 30 Second Chair Stand Test (30sCST) Measures lower limb function, dynamic balance, and strength |
Body function, Activity | Approx 2 minutes to complete and score. Minimum equipment and space required. | Pre-op, Post-acute, Active living | Hip, Knee |
| Balance Evaluation Systems Test (BESTest) Measures dynamic balance, functional mobility, and gait |
Activity | 30 minutes. Free for clinical and research purposes. Time consuming and requires adherence to detailed instructions and several pieces of equipment including purchase of Tempur foam. | Pre-op, Post-acute, Active living | Hip, Knee |
| Brief Balance Evaluation Systems Test (Brief-BESTest) Measures dynamic balance, functional mobility, and gait |
Activity | 10 minutes to complete. Free for clinical and research purposes. Time consuming and requires adherence to detailed instructions and several pieces of equipment including purchase of Tempur foam. | Pre-op, Post-acute, Active living | Hip, Knee |
| Mini Balance Evaluation Systems Test (Mini-BESTest) Measures dynamic balance, functional mobility, and gait |
Activity | 10-15 minutes to complete. Free for clinical and research purposes. Time consuming and requires adherence to detailed instructions and several pieces of equipment including purchase of Tempur foam. | Pre-op, Post-acute, Active living | Hip, Knee |
| Berg Balance Scale (BBS) Measures static and dynamic balance |
Activity | 15-20 minutes to administer and score. Easy to administer and score but significant time to administer. | Pre-op, Post-acute, Active living | Hip, Knee |
| Four Square Step Test (FSST, 4SST) Measures dynamic balance |
Activity | <5 minutes. Quick and simple with minimal equipment/ space required. | Pre-op, Acute, Post-acute, Active living | Hip, Knee |
| Functional Reach Test (FRT) Measures static balance |
Activity | Approx 5 minutes to complete and score. Quick with minimal equipment/ space required. | Pre-op, Post-acute, Active living | Hip, Knee |
| Single Leg Stance (SLS) Measures static balance |
Body function, Activity | Approx 5 minutes to administer and score. Quick and simple with no equipment and minimal space required. To address possible safety issues, test with eyes open. | Pre-op, Post-acute, Active living | Hip, Knee |
| Stair Climb Test (SCT) Measures functional strength, dynamic balance, and agility |
Activity, Participation | Approx 2 minutes to complete and score. Appropriate and feasible for assessing and detecting change in function. | Pre-op, Post-acute, Active living | Hip, Knee |
| Step Test (ST) Measures lower extremity function, dynamic balance, and proprioception |
Body function, Activity | Less than 5 minutes. Quick and simple with minimal equipment/ space required. | Pre-op, Post-acute, Active living | Hip, Knee |
| Timed Up and Go (TUG, TUAG) Measures strength, agility, mobility, dynamic balance, and gait |
Activity | Approx 3 minutes to set up, complete and score. Quick and simple with minimal equipment/ space required. | Pre-op, Acute, Post-acute, Active living | Hip, Knee |
Sharing Information and Discharge Planning[edit | edit source]
Effective communication and discharge planning are important in providing holistic, patient-centred care. The (TJAOM) Toolkit includes valuable resources to ensure that patient progress is accurately documented and effectively communicated to all members of the healthcare team.
Importance of Sharing Information[edit | edit source]
- Consistency in Care: Standardised outcome measures and discharge templates help ensure that all healthcare providers are on the same page regarding patient progress and care plans. This consistency is crucial for delivering high-quality, coordinated care.
- Improved Patient Outcomes: Accurate and timely sharing of patient information can lead to better clinical decisions, more tailored interventions, and ultimately, improved patient outcomes.
- Patient Engagement: Involving patients in the discussion of their progress through the use of PROMs and PBTs fosters greater engagement and adherence to treatment plans. Patients who understand their progress are more likely to be motivated and compliant with their rehabilitation protocols.
Discharge Planning Process[edit | edit source]
- Assessment and Documentation: Use the recommended outcome measures to assess patient progress comprehensively. Document these findings using the toolkit's templates to provide a clear and detailed account of the patient's status at discharge.
- Communication: Share the discharge summary and outcome measure results with the patient's entire healthcare team. This includes primary care providers, physiotherapists, occupational therapists, and any other relevant specialists. Ensuring everyone has access to the same information supports continuity of care.
- Follow-Up Care: Outline the next steps in the patient's care plan, including recommended follow-up appointments, home exercises, and any additional therapy. Clearly communicated follow-up plans help prevent readmissions and promote ongoing recovery.
- Patient Education: Provide patients with copies of their outcome measure results and explain what these results mean in terms they can understand. Educate them about the importance of adhering to their discharge plan and attending follow-up appointments.
Overview[edit | edit source]
The TJAOM resources help ensure that clinicians have access to consistent and reliable methods for assessing and documenting patient progress, facilitating better outcomes and smoother transitions in care for patients undergoing hip and knee replacement surgeries. These outcome measures are designed to enhance clinical decision-making and patient engagement. Effective use of these measures ensures consistent, high-quality care and better communication across the healthcare team, ultimately leading to improved patient outcomes.
Other Supporting Resources[edit | edit source]
- TJAOM Discharge Letter Template - also includes tables of normative and reference values for various tests to assist in comparing patient results to age and gender-matched norms.
- Video Rating Table
- Ratings of All Proposed Outcome Measures for TJAOM Toolkit
