Variation in Outcomes and Number of Visits Following Care Guideline Implementation: Part 2 of an Analysis of 12 355 Patients After Total Knee Arthroplasty.
Jacob J Capin, Kate I Minick, Jennifer E Stevens-Lapsley and 5 others
PMID 36503269WHAT IT FOUND
After a knee replacement care guideline, function score gains were 5.6 points higher than in the non-guideline group, on a 0 to 100 scale, and clinic-to-clinic variation fell.
The gain was below the 10 point threshold for meaningful change, and visits did not increase.
Key findings
01The guideline group had an estimated mean knee function score improvement of 28.7 points, compared with 23.0 points in the non-guideline group, a reported difference of 5.6 points on a 0 to 100 scale that did not exceed the 10 point threshold for clinically meaningful change.
02Between-clinic variation in knee function score changes decreased by 63%, and within-clinic variation decreased by 4%.
03The adjusted mean number of visits was 10.7 in the non-guideline group and 10.5 in the guideline group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study compared patients before and after the guideline, but clinics and patients were not randomized, so the guideline cannot be proven to have caused the changes. Predefined outcomes were not published before the study, and changes over time, surgery technique, pain management, or monitoring could have contributed. The 5.6 point mean difference was below the 10 point threshold the authors called clinically meaningful, so the average patient may not have noticed a meaningful benefit. The sample came from one integrated healthcare system, and not all therapists attended the initial guideline training, so results may not apply to other settings. The study used patient-reported knee function scores, not performance-based functional tests.
The easy way to misread this
Do not conclude the guideline caused better function or that the 5.6 point gain is clinically important. The study was retrospective, not randomized, and the mean difference was below the 10 point threshold the authors called clinically meaningful.