The aim of this study was to determine the safety, feasibility and acceptability of adding a novel psychologically-informed physiotherapist-delivered approach (KOMPACT-P) to usual care compared to usual care alone (group education) for people undergoing TKA.
We conducted a mixed methods pilot randomised controlled trial at two hospitals with the co-primary outcomes of safety, feasibility, and acceptability. Participants were randomised using a 2:1 ratio into KOMPACT-P and usual care (UC) groups respectively, with stratification based on site, sex and psychological status using the Depression, Anxiety and Stress Score-21 at baseline.
Baseline characteristics and survey data were collected at 4-6 weeks before TKA. Treatment group participants undertook 3 KOMPACT-P sessions before TKA then a semi-structured interview to explore treatment acceptability. Surveys were repeated 1 week before TKA by all participants. Hospital length of stay data was collected from the medical record. Quantitative data is presented using descriptive analysis. Qualitative data was presented using thematic analysis to explain quantitative results.
COVID-19 restrictions to elective surgery, research and delayed recommencement of usual care severely limited our recruitment (active recruitment during 16 months over 4 years). Data from 17 participants (N=9 KOMPACT-P group) are presented. Regarding safety, the KOMPACT-P group length of stay was one day longer than usual care (KOMPACT-P mean 6 SD 3 vs UC mean 5 SD 2 nights), which may be explained by baseline differences in BMI (KOMPACT-P mean 40kg/m2 SD 10 vs UC mean 31kg/m2 SD 5) and anaesthetic risk (ASA 3 88% vs 50%). KOMPACT-P group reported a 1.4 point increase in DASS-21 anxiety from baseline to immediately before TKA compared to usual care (0.8pt reduction). Feasibility data demonstrated very low recruitment rates due to the short timeframes between pre-admission education and TKA, and COVID-19 restrictions (. Retention rate was acceptable in both groups (100% vs 75%). Participant attendance was high (90%) when a flexible approach to intervention mode was used. Externally rated intervention fidelity was 72%. Acceptability of the KOMPACT-P intervention was high quantitatively (mean score 82%) and qualitatively.
The KOMPACT-P intervention may be a safe, feasible and acceptable approach to pre-operative TKA care targeted to people at increased risk of long hospital stays due to psychological and physical health. Future trials need to consider timing of participant recruitment in the pre-operative period, and scaling of physiotherapist training to provide the intervention.
With the appropriate training and support, physiotherapists can provide safe psychologically-informed interventions with good fidelity, in a way that is acceptable to patients. This may address issues of stigma for patients with psychological symptoms by integrating physical and psychological health supports. Providing ongoing professional development and supervision to upskill physiotherapists in this area requires organisational and system level supports for safety and sustainability for physiotherapists in all domains of practice.
Orthopaedics
Advanced scope of practice
