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

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.

Using the TJAOM Toolkit

• 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

• 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?”

• From the Learning Modules for each outcome measure
  • Review the learning modules for each of the outcome measures that you selected

• Practice, with a colleague, each outcome measure that you selected

• 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.)

• 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

• 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

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

• PROMs:
  • Pain VAS/NPRS
  • HOOS/KOOS
  • LEFS

• Performance:
  • 30 sec-CST
  • Gait speed (self selected)
  • Stair climb test
  • SLS (30 sec)
  • 6MWT
  • TUG
  • Functional Reach

2. Acute: 3-5 day hospital stay

• PROMs:
  • Pain VAS/NPRS

• Performance:
  • Gait speed (self selected)

3. Post-Acute: Outpatient/home settings

• PROMs:
  • Pain VAS/NPRS
  • HOOS/KOOS
  • LEFS

• Performance:
  • 30 sec-CST
  • Gait speed (self selected)
  • Stair climb test
  • SLS (30 sec)
  • 6MWT (TKA)
  • TUG
  • Functional Reach

4. Active Living: 1 year post-op for life

• PROMs:
  • HOOS/KOOS
  • LEFS

• Performance:
  • 30 sec-CST
  • Gait speed (self selected)
  • Stair climb test
  • SLS (30 sec)
  • 6MWT (TKA)
  • TUG
  • Functional Reach

The TJAOM Toolkit

The TJAOM Toolkit includes the following:

• Performance measure summaries:
  • Stair Climb Test
  • 30 sec Chair Stand Test (30sec-CST)
  • Gait Speed (10 Metre Walk Test, 10MWT)
  • 6 Minute Walk Test (6MWT)
  • Timed Up and Go (TUG)
  • Functional Reach Test (FRT)
  • Single Leg Stance (SLS)

• Patient reported measure summaries:
  • Numeric Pain Rating Scale (NPRS)
  • Visual Analogue Scale (VAS): Pain
  • Knee injury and Osteoarthritis Outcome Score (KOOS)
  • Hip disability and Osteoarthritis Outcome Score (HOOS)
  • Lower Extremity Functional Scale (LEFS)

• The glossary of terms

• Discharge letter template and appendices:
  • TJAOM Discharge Letter and Appendices
  • How to use the TJAOM Discharge Letter Template and Appendices