The administration of a perioperative telephone support program called
the Joint Action Program can improve functional outcomes after total knee
replacement in specific patient subgroups, according to a study presented at
the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
“The joint action participants in the following subgroups had
significantly greater gain in function as compared to controls: all patients
with strong emotional health, the nonobese patients with poorer emotional
health and patients with no comorbidities,” Patricia D. Franklin, MD, MPH,
said during her presentation. “We would consider this structured support
program for improving daily activity in the rehabilitation period for these
However, Franklin and colleagues found that patient factors, such as
poor emotional health coupled with obesity or medical or musculoskeletal
comorbidities, counterbalanced the effect of the intervention.
“This effect was differentially observed in women, as they reported
more pain in their other joints,” she added. “Taken together, the
data supports tailoring rehabilitation to the patient subgroups.”
Franklin and her colleagues conducted their study to determine whether a
perioperative telephone support program would improve physical function in
particular subgroups undergoing total knee replacement (TKR), particularly
those with poor emotional health or obesity, at 6 months and 12 months after
The National Institutes of Health-funded study included
180 patients older than 21 years who underwent primary unilateral TKR for
osteoarthritis. The group had a mean age of 65 years, a body mass index of 32,
an average pre-physical function score of 32.7% and 13% were Hispanic. In
addition, two-thirds of the group were women.
Joint Action Program
The investigators randomly assigned 88 patients to receive the usual
rehabilitation program, while 90 patients underwent the same rehabilitation and
the Joint Action Program. Patients in the intervention group received four
telephone calls before surgery and eight calls during postoperative weeks two
through 10 that coincided with their rehabilitation and were delivered by a
health educator trained in motivational interviewing who was armed with a
toolkit of written materials with common patient questions.
“The focus was self efficacy, meaning the knowledge and skills of
the patients was improved in their daily need for exercise and activity, as
well as setting goals for the day or the week, monitoring, keeping logs,
addressing barriers to physical activity and taking ownership of
rehabilitation,” Franklin said.
Patients in both groups completed self-input surveys including the
SF-36, WOMAC, joint specific index, Charlson Comorbidity Index, and assessed
pain in their contralateral knees, hips or low backs.
“We noted a gender discrepancy in the report of moderate to severe
pain in nonoperative joints,” Franklin said. They found that 70% of men
reported moderate to severe pain only in their operative joints compared to 47%
of women. More than 50% of women also reported moderate to severe pain in their
contralateral knees, ipsilateral hips and low backs — two to three times
more often than men.
At 6-month follow-up, the study revealed that patients in the
intervention group showed a significantly greater gain of almost 16 points in
the SF-36 physical component score than the control group.
Subgroups of patients in the intervention group who were not obese with
low or high mental component scores (MCS) scores had significantly better
function — nearly twice the gain in physical component scores — than
those in the control group. Nonobese patients without comorbidities in the
intervention group had a 50% greater gain in function than patients in the
usual group, Franklin said.
The investigators will continue to evaluate the effect of the telephone
calls at 12 months and explore their results using objective measures such as
accelerometry and independent physical therapy assessments using the Timed Up
and Go and Timed Walk tests. – by Renee Blisard
For more information:
- Franklin P, Rosal MC, Li W, et al. Can telephone support during
post-TKR rehabilitation improve post-op function: A randomized controlled
trial. Paper #1. Presented at the American Academy of Orthopaedic Surgeons 2012
Annual Meeting. Feb. 7-11. San Francisco.
- Patricia D. Franklin, MD, MPH, can be reached at University of
Massachusetts Medical School, 55 Lake Ave. North, Worcester, MA 01655;
508-856-5748; email: email@example.com.
- Disclosure: The study described in this article was funded
by an award from NIAMS; RO1 AR05054479-01. No industry funds or relationships
are involved in this research.