J Orthop Sports Phys Ther. 2023 Mar;53(3):151-158. doi: 10.2519/jospt.2022.11370. Epub 2022 Dec 12.
To describe the variation in outcomes and number of visits before and after implementing a care guideline for total knee arthroplasty (TKA) rehabilitation. Nonrandomized intervention study. We compared 2558 patients with TKA who received care that was not standardized (non-care guideline [NCG] group) to 9797 patients with TKA who received care according to the care guideline (CG). We fit 2 Bayesian hierarchical linear regression models using the Knee Outcome Survey - Activities of Daily Living (KOS-ADL) change score and number of physical therapy (PT) visits as the response variables, controlling for relevant predictor variables. We also compared the ratio of the standard deviations of the KOS-ADL change scores and the number of PT visits within and between clinics. The overall estimated mean improvement in KOS-ADL change score was 23.0 points (95% confidence interval [CI]: 20.3, 25.7) in the NCG group and 28.7 points (95% CI: 27.5, 29.7) in the CG group; the mean difference was 5.6 (2.7-8.6). Mean KOS-ADL change scores were higher in the CG group than the NCG group in every clinic, although only 8 clinics improved significantly. The number of PT visits did not change meaningfully (NCG: mean, 10.7 [95% CI: 9.9, 11.5]; CG: mean, 10.5 [95% CI: 9.9, 10.9]). Variation in KOS-ADL change score decreased by 4% within clinics (CG-NCG ratio: 0.96 [95% CI: 0.93, 0.99]) and 63% between clinics (CG-NCG ratio: 0.37 [95% CI: 0.21, 0.62]). Variation in number of visits decreased by 7% within clinics (CG-NCG ratio: 0.93 [95% CI: 0.90, 0.96]) and 19% between clinics (CG-NCG ratio: 0.81 [95% CI: 0.39, 1.49]). Implementing a care guideline for TKA rehabilitation may improve outcomes and reduce unwarranted variation in practice within clinics and especially between clinics within a large health care system. .
描述在实施全膝关节置换术 (TKA) 康复护理指南前后，结局和就诊次数的变化。非随机干预研究。我们比较了接受非标准化护理（非护理指南 [NCG] 组）的 2558 例 TKA 患者和接受护理指南护理的 9797 例 TKA 患者（CG）。我们使用 Knee Outcome Survey-日常生活活动（KOS-ADL）变化评分和物理治疗（PT）就诊次数作为反应变量，拟合了 2 个贝叶斯分层线性回归模型，控制了相关预测变量。我们还比较了诊所内和诊所间 KOS-ADL 变化评分和 PT 就诊次数的标准差比值。NCG 组 KOS-ADL 变化评分的总体估计平均改善为 23.0 分（95%置信区间 [CI]：20.3，25.7），CG 组为 28.7 分（95% CI：27.5，29.7）；平均差异为 5.6（2.7-8.6）。在每个诊所中，CG 组的 KOS-ADL 变化评分均高于 NCG 组，但只有 8 个诊所的评分显著提高。PT 就诊次数没有明显变化（NCG：平均 10.7 [95% CI：9.9，11.5]；CG：平均 10.5 [95% CI：9.9，10.9]）。诊所内 KOS-ADL 变化评分的变异减少了 4%（CG-NCG 比值：0.96 [95% CI：0.93，0.99]），诊所间变异减少了 63%（CG-NCG 比值：0.37 [95% CI：0.21，0.62]）。诊所内就诊次数的变异减少了 7%（CG-NCG 比值：0.93 [95% CI：0.90，0.96]），诊所间变异减少了 19%（CG-NCG 比值：0.81 [95% CI：0.39，1.49]）。实施 TKA 康复护理指南可能会改善结局，并减少诊所内和尤其是大型医疗保健系统内诊所间实践的不必要变异。
