ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #973

 

Goal Attainment Scaling After Knee Arthroplasty in Younger, Active Patients, a New Individualized Rehabilitation Intervention Resulting in Goal Achievement and Improved Satisfaction For Activities: A Cohort Study

Suzanne Witjes, MD, PhD, Schijndel NETHERLANDS
Alexander Hoorntje, BMedSc, Breda NETHERLANDS
Paul Kuijer, PhD, Amsterdam NETHERLANDS
Koen L. M. Koenraadt, PhD, Breda NETHERLANDS
Leendert Blankevoort, PhD, Amsterdam NETHERLANDS
Gino M. M. J. Kerkhoffs, MD, PhD, Prof., Amsterdam NETHERLANDS
Rutger van Geenen, MD, PhD, Breda NETHERLANDS

Amphia Hospital, Breda, NETHERLANDS

FDA Status Not Applicable

Summary

A new individualized rehabilitation intervention, with Goal Attainment Scaling, after knee arthroplasty in younger, active patients resulted in goal achievement, regardless of goal intensity. More goals were attained at six months by UKA patients than by TKA patients. This rehabilitation improved satisfaction of all KA patients for all activities, especially when they attained their goals.

Abstract

Objective

To investigate activity goals, intensity and achievement of those activity goals of younger Knee Arthroplasty (KA) patients, to identify differences between Total Knee Arthroplasty (TKA) and Unicondylar Knee Arthroplasty (UKA) patients, and whether an individualized Goal Attainment Scaling (GAS)-based rehabilitation improves satisfaction for activities in these younger patients.
Design: Prospective cohort study (preoperative, three, six, and 12 months postoperative).
Setting: Department of orthopedic surgery and physiotherapy practices.
Participants: 53 patients aged 65 and younger, who underwent KA.
Intervention: GAS-based rehabilitation.
Main outcome measures: GAS activity goals for activities of daily life (ADL), work and leisure time, the corresponding metabolic equivalent of task (MET) values, the corrected MET values, GAS scores at three and six months, and Visual Analog Scales (VAS) for satisfaction with activities.

Results

The intensity levels of all 144 formulated activity goals were light in 16%, moderate in 63% and vigorous in 21% of all levels. Intensity levels did not differ between TKA and UKA patients. Following a rehabilitation of six months with GAS 90% of all types of activity goals were attained. Goal attainment did not differ between MET intensity levels. Higher goal attainment was achieved in the UKA group (100%) compared to the TKA patients (82%) after six months (p<0.001). VAS satisfaction for all activities improved from preoperative to three and to six months, to VAS 80/100, and plateaued from six to 12 months. For all activities satisfaction at three months and six months was higher when the GAS goal was attained. Patients were satisfied with both effect and coaching of rehabilitation, and physiotherapists were especially satisfied about their patients’ progression when they attained their goals.

Conclusions

Younger patients aim to perform many different activities of varying metabolic intensity levels following KA. After six months of rehabilitation with GAS, around 90% of their preoperatively formulated activity goals were attained, independent of the MET intensity level. After six months, UKA patients attain significantly more activity goals than TKA patients. KA followed by GAS-based rehabilitation also results in improvement of satisfaction for activities of ADL, work and leisure time in younger patients, especially when they attain their goals. This GAS-based individualized rehabilitation leads to satisfaction of both patients and physiotherapists. Lastly, GAS might be a useful objective outcome measure in evaluating clinical outcomes of individual KA patients.