Do Coaching, Money Encourage Activity in Knee Patients?

Can telephonic coaching and financial incentives improve post-op rehab for total knee arthroplasty (TKA) patients?

These are the questions researchers posed in their recent study “Cost-Effectiveness of Health Coaching and Financial Incentives to Promote Physical Activity after Total Knee Replacement.” This study appears in the July 2018 edition of Osteoarthritis and Cartilage.

Co-author, Elena Losina, Ph.D., Robert W. Lovett Professor of Orthopedic Surgery, Harvard Medical School director, policy and innovation evaluation in orthopedic treatments (PIVOT) center co-director, orthopedics and arthritis center for outcomes research (ORACORe) department of orthopedic surgery Brigham and Women’s hospital told OTW, “Total knee replacement [TKR] is a very effective procedure that greatly reduces pain and improves function in more than 80% of those who undergo this surgery.”

“Unfortunately, pain relief is not ‘translating’ into greater uptake of physical activity. Since physical activity has been shown to lead to greater quality of life and lower risk of chronic conditions, greater uptake of physical activity is a public health priority.”

“We used the Osteoarthritis Policy Model, a computer simulation of knee osteoarthritis, to evaluate the cost-effectiveness of telephonic health coaching and financial incentives compared to usual care. We derived transition probabilities, utilities, and costs from trial data. We conducted lifetime analyses from the healthcare perspective and discounted all cost-effectiveness outcomes by 3% annually. We also conducted a probabilistic sensitivity analysis (PSA), simultaneously varying cost, utilities, and transition probabilities.”

Dr. Losina told OTW, “The most intriguing results were the fact that coaching based on self-reported engagement in physical activity was not very efficacious, but the intervention that included both internal and external (financial incentives) triggers has been rather effective.”

“Total knee replacement recipients who achieve substantial pain relief should increase the value of TKR by engaging into moderate physical activity (PA) such as walking. Small regular incentives could help to form this healthy habit. The impact of incentives could be further solidified if physicians would emphasize the benefits of PA and provide the infrastructure for interventions supporting PA.”