The aim of the Knee Arthroplasty Physical Therapy Pathways (KAPPA) trial was to determine if early postoperative criteria can be established to stratify TKA patients into a self-directed rehabilitation or supervised physical therapy pathway without compromising clinical outcomes or patient satisfaction.
Overall, 60 TKA patients were initially allocated to a self-directed, unsupervised protocol for their postoperative rehabilitation. Baseline demographics, along with functional and self-reported outcomes, were assessed preoperatively and at 2 weeks, 6 weeks, and 4 months following surgery. Patients were referred to supervised outpatient physical therapy if they met any of the following Knee Arthroplasty Physical Therapy Pathways (KAPPA) criteria: (1) knee flexion range of motion 90 degrees; (2) knee extension range of motion lacking >10 degrees; or (3) dissatisfaction with the progress of their rehabilitation. Patients in the study who did not meet any of the KAPPA criteria for referral to supervised physical therapy at 2 weeks or 6 weeks following their TKA continued with self-directed rehabilitation at home.
At 2 weeks post-TKA, 28 participants met the KAPPA criteria for supervised physical therapy for reasons of knee flexion 90 degrees (61%), a lack of knee extension >10 degrees (36%), or not being satisfied with the progress of their recovery (3%). The remaining 32 participants continued with a self-directed rehabilitation pathway. All outcomes assessed favored the self-directed group at 2 weeks, however, after an average of 4 supervised physical therapy sessions at 4 months there were no longer any differences between the 2 groups.
Approximately half of the included participants in the KAPPA trial could successfully self-direct their rehabilitation following TKA without supervised physical therapy, while also maintaining excellent clinical and self-reported outcomes. A physical assessment of knee ROM corresponded to all other outcomes when assessed at 2 weeks post-TKA.
The results of the KAPPA trial support the feasibility of self-directed rehabilitation and have established potential early postoperative criteria to indicate who may benefit from referral to supervised physical therapy at 2 weeks post-surgery.
Supervised physical therapy
Rehabilitation
