One-on-One Beats Group Classes for Pre-Op Education

According to a new Hospital for Special Surgery (HSS) study, patients who had a one-on-one education session with a physical therapist and access to a web-based microsite prior to joint replacement surgery achieved physical therapy goals more quickly after knee or hip replacement compared to patients who did not have the educational session or access to the microsite. The study was published in the January 2018 issue of Clinical Orthopaedics and Related Research.

“Although many institutions utilize group classes for preoperative education, up to 77% of patients have unfulfilled knowledge expectations with respect to their postoperative function,” said lead investigator and research therapist Rupali Soeters, P.T., M.Ed., Ph.D.

“Knowledge is power. Supplemental one-on-one education gives joint replacement patients more information about what to expect and can allay some of their concerns.” she said.

Soeters noted the benefits to patients of a one-on-one education session with a physical therapist and access to a web-based microsite prior to joint replacement surgery. “The difference between a group class and one-on-one education is that the private session gives the patient an opportunity to practice mobility and assistive devices before surgery, discuss concerns and questions in a private environment, and set realistic goals regarding outcomes with the therapist.”

“After surgery, patients may be dealing with issues such as fatigue, discomfort or anxiety, and it may not be the most opportune time to give them information about the road ahead,” said Amar Ranawat, M.D., an orthopedic surgeon at HSS and senior study author. “With the face-to-face information session and user-friendly website, they can receive and retain much of the information prior to surgery. Many patients feel more confident knowing what to expect.”

“In the study, researchers followed 126 patients who underwent knee or hip replacement for osteoarthritis between February and June 2015. All of the patients attended a group education class before surgery which was the standard of care for patients scheduled for a joint replacement at Hospital for Special Surgery. They were then randomized into two separate groups. The mean age in both groups was 61.”

In group one, 63 patients attended the one-on-one education session with a physical therapist about two weeks before their surgery, in addition to the group class. After the session, they were given access to a customized website, so they had a great deal of information at their fingertips both before and after surgery.

The individual patient websites were highly customized to each procedure, with detailed information on precautions to take after surgery, exercises, ambulation and activities of daily living. Besides being accessible on computers, all of the information was available on cell phones and tablets.

The control group of 63 patients attended the standard group class. They received no further education other than a booklet about what to expect after joint replacement.

“Researchers analyzed how quickly patients achieved physical therapy goals after surgery; length of their hospital stay and how they were progressing four to six weeks after joint replacement in terms of pain, stiffness and physical function.”

“Patients with access to one-on-one education and the personalized website achieved physical therapy goals more quickly after surgery. They needed fewer physical therapy sessions in the hospital (3.3 sessions) versus the control group (4.4 sessions). The group receiving one-on-one education also met PT discharge criteria sooner (1.6 days versus 2.7 days for the control group). This included the ability to get in and out of bed, walk with or without an assistive device about 150 feet, and go up and down stairs independently. Researchers found no difference in pain and function six weeks out from surgery.”

As large joint arthroplasty trends go more and more towards outpatient care, the lessons from this study may be a significant way to improve pre-op education.