Patient-to-Patient Coaching Improves TKR Outcomes?

In a recent pilot study, researchers at Hospital for Special Surgery (HSS) in New York City asked individuals who had undergone knee replacement to serve as peer counselors in a pre-habilitation program.

Iris Navarro-Millan, M.D., M.S.P.H., a rheumatologist at HSS who served as principal investigator, explained how peer or social support can affect patient outcomes and satisfaction levels, “On a national level, up to 30% of patients may have persistent pain after knee replacement surgery for osteoarthritis. One possible approach to improve outcomes is to optimize muscle strength, physical condition and mental preparation before surgery. Social cognitive theory posits that self-efficacy, peer or social support, sociocultural factors and expectations influence goals and outcomes.”

Using focus groups of people who underwent knee replacement at HSS, the team set out to obtain information about the patients’ thoughts and experiences.

“We asked patients about their challenges before and after knee replacement, potential barriers to accessing a pre-habilitation program and perspectives on what it might be like working with a peer coach to encourage exercise prior to knee replacement,” Dr. Navarro reported.

According to Navarro, the focus group revealed how patients influence other patients in a powerful way.

• “Many patients with osteoarthritis delayed knee replacement for many years, often until the pain became very bad;
• Many weren’t sure of the best way to prepare for knee replacement surgery;
• They appreciated advice from other patients about preparation and recovery, and learning about the positive experiences of others often motivated them to have the surgery;
• The concept of peer coaches was well received;
• A few participants were already informally helping others scheduled for surgery and found it very rewarding.”

Asked what sort of specific things should be covered during peer-to-peer counseling, ”Dr. Navarro told OTW, “We identified that patients experienced anxiety in anticipation for knee replacement and discussing ways that could help them manage their anxiety before and after surgery was something that patients expressed to be helpful for them. They also expressed that learning how to prepare physically for knee replacement surgery and the importance of rehabilitation was important to them.”

“I cannot emphasize enough that the concepts around mental and physical health discussed in a peer-to-peer coaching intervention must be evidence-based and not only based on an individual’s personal experiences. This is the next step in our project—to develop an evidence-based peer-to-peer program that can help patients better prepare mentally and physically for knee replacement surgery.”