May 22, 2018

For Total Hip or Knee Replacements, Think ‘Prehabilitation,’ Not Just Rehabilitation

By Steve Howell, PT, M.Ed.

Doctors and nurses talk every day with patients about rehabilitation, and especially patients who need total hip or knee replacements because that is when the real work begins.  It is general knowledge that physical therapy guides in the recovery process, but a comprehensive “prehabilitation,” program can be the key to a quick and full recovery.

Medical providers and patients alike are now beginning to understand the benefits of early intervention with preoperative physical therapy programs including:

• One to two sessions for patient education in a home exercise program;

• Gait training with a walker and cane, proper utilization of elevation and ice and pain control strategies;

• Setting realistic post-surgical expectations for typical recovery periods and return to normal life activities;

• Education in signs and symptoms of complications such as fever, severe pain, excessive drainage;

• Faster recovery, less pain, and more confident patients who are compliant with exercise programs;

• Less need for pain medications;

• Decreased odds of readmission to the hospital.

Beyond helping recovery, published studies have also focused on another key factor: cost reductions for patients.

The APTA post sites an October 2014 study published in the Journal of Bone & Joint Surgery titled, “Associations Between Preoperative Physical Therapy and Post-Acute Care Utilization Patterns and Cost in Total Joint Replacement.” The study “looked at hip- and knee-replacement cases within a 39-county Medicare hospital referral cluster,” and concluded that “the use of preoperative physical therapy was associated with a 29 percent decrease in the use of any post-acute care services.” The APTA reports that “this translated, after adjusting for demographic variabilities and comorbidities, into cost reductions of $1,215—‘driven largely,’ the authors wrote, ‘by reduced payments for skilled nursing facility and home health agency care.’”

The benefits of prehabilitation are seen in more than outpatient orthopaedic patients, too.  Positive results have also been seen when implemented with cancer patients.

The APTA post notes that in Nov. 2014, the Journal Anesthesiology published “Prehabilitation Versus Rehabilitation: A Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer.” Authors investigated “the impact of prehabilitation on recovery of functional exercise capacity was thus studied in patients undergoing colorectal resection for cancer.” Their conclusion: “Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program,” add, “the preoperative period (prehabilitation) may represent a more appropriate time than the postoperative period to implement an intervention.”

Prehabilitation programs are an excellent time to empower patients to commit to their return to health through exercise and education in the recovery process.  These early visits with their physical therapist set the mental and physical tone for the coaching that is to come and their new productive lives.

Steve Howell, PT, M.Ed. is a partner and practicing physical therapist with Pivot Physical Therapy, formerly Tidewater Physical Therapy.  With almost 30 years of providing outpatient orthopedic care and a knee replacement in 2008, Steve knows the recovery process well.