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

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

The TJAOM Toolkit

The TJAOM Toolkit includes:

• A tabulated summary of the evidence for manual therapy, exercise, acupuncture, low level laser therapy (LLLT), ultrasound (US), extracorporeal shock wave therapy (ESWT), iontophoresis using dexamethasone, iontophoresis using NSAID or lidocaine, orthotic devices, and taping, appropriate outcome measures for this population, as well as associated 'take home messages' and 'clinical implications'
• An algorithm to assist clinicians in ascertaining when to incorporate specific interventions
• And the following appendices:
  • A) Details of the Articles
  • B) Manual Therapy
  • C) Details of Exercise Prescription
  • D) LASER Dosage Calculation
  • E) Braces, Splints, and Taping
  • F) Outcome Measures
  • G) Medical and Surgical Interventions

Clinicians want to provide evidence-informed management of tendinopathy but many struggle with accessing, appraising and synthesizing the vast array of literature available on this topic. This KT initiative highlights the need for, challenges associated with, evidence-informed process for and positive response to the development of decision aids synthesizing the current evidence to guide clinical management of this patient population.