Adding Value in Knee Arthroplasty Post-total Knee Replacement (TKR) Care Navigator Trial (AViKA)
Adding Value in Knee Arthroplasty Post TKR Care Navigator Trial
The objectives of this research are to:
Conduct a proof of concept randomized controlled trial with up to 300 patients undergoing primary total knee replacement (TKA) at Brigham and Women's Hospital (BWH). The trial will compare a "Care Navigator" post-discharge intervention versus "Usual Care" post discharge management of patients undergoing TKA. The intervention will focus on the challenging process of transitions from the acute care hospital to inpatient or outpatient rehabilitation, and from inpatient rehabilitation to home.
The principal goals of the trial are:
- To establish whether "Care Navigator" intervention improves functional outcomes as compared with the "Usual Care" treatment six months after TKA surgery.
- To establish whether "Care Navigator" intervention is cost effective six months after TKA surgery.
The investigators hypothesize that:
- Incorporating the Care Navigator role into the "Usual Care" treatment will increase TKA patients' rate of adherence to the rehabilitation protocol and improve functional outcomes.
- Addition of a Care Navigator is cost-effective.
研究概览
详细说明
The "Post-TKA Care Navigator" proof of concept intervention will be implemented as a randomized controlled trial. The investigators aim to identify and enroll a cohort of up to 300 subjects who have decided to undergo total knee replacement (TKA) at BWH. Subjects will be patients of the five orthopedic surgeons at Brigham and Women's Hospital who perform the most TKAs: Drs. Wright, Brick, Ready, Martin and Thornhill. Subjects will be followed from about two weeks prior to the operation to six months after discharge.
The investigators will assign patients into two groups, at random: 1) receiving current standard of post-operative care and 2) adding "Post-TKA Care Navigator". The role of the Care Navigator will be to follow up with patients via frequent telephone conversations, ranging from weekly during the first month to bi-weekly for the next 6 weeks to monthly by the 14th week post op. subjects assigned to the care navigator will receive up to 10 telephone calls over a period of 5 months. The goal of the Care Navigator would be to ensure or encourage compliance with physical therapy, triage patient concerns, questions and complaints, and identify those patients that require a call from a clinician to address a problem in the recovery process. For those issues that can be resolved easily at home the navigator would suggest strategies. The value of the post-TKA Care Navigator will be assessed by comparing functional status, satisfaction with surgery, utilization of health care, adherence to physical therapy, range of knee motion and intervention costs across the two randomized groups.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Massachusetts
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Boston、Massachusetts、美国、02115
- Brigham & Women's Hospital
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Scheduled to undergo primary TKA at Brigham & Women's Hospital
- Osteoarthritis is the principal underlying diagnosis
- Age >=40 at the projected date of TKA
- English-speaking
Exclusion Criteria:
- Osteoarthritis is not the principal underlying diagnosis (e.g. inflammatory arthritis)
- Dementia
- Psychological issues that preclude participation, as identified by participating surgeons
- Non-English speaker
- Diagnosis other than Osteoarthritis or secondary Osteoarthritis
- Age < 40 at the projected date of TKA
- Lives in a nursing home
- Implantation of Unicompartamental Knee Arthroscopy or Interpositional Arthroplasty
- Bilateral TKA in same admission (simultaneous)or planned bilateral within 6 months
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
有源比较器:Care Navigator Intervention Group
Subjects randomized to the Care Navigator Intervention group will receive up to 10 telephone calls from a care navigator for 5 months post-operatively
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Subjects assigned to the Care Navigator intervention group will receive 10 calls from a care navigator after discharge from the hospital for 5 months after their total knee replacement.
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有源比较器:Usual Care Group
Subjects in the Usual Care group receive the current standard post-operative TKA care
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Subjects assigned to the Standard Post-Operative TKA Care group will receive the current standard of care for post-operative care
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Change in WOMAC Physical Function
大体时间:Change in functional status from baseline to 6 months
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The change in functional status will be measured using the WOMAC Physical Function scale at Baseline and 6 months
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Change in functional status from baseline to 6 months
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Satisfaction
大体时间:Measured at 6 months post TKA
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Percentage of patients in each study arm who reported being very satisfied with the results of TKA
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Measured at 6 months post TKA
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Range of Motion
大体时间:6 months after TKA
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Percentage of participants able to bend knee at least 120 degrees
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6 months after TKA
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合作者和调查者
出版物和有用的链接
一般刊物
- Losina E, Collins JE, Daigle ME, Donnell-Fink LA, Prokopetz JJ, Strnad D, Lerner V, Rome BN, Ghazinouri R, Skoniecki DJ, Katz JN, Wright J. The AViKA (Adding Value in Knee Arthroplasty) postoperative care navigation trial: rationale and design features. BMC Musculoskelet Disord. 2013 Oct 12;14:290. doi: 10.1186/1471-2474-14-290.
- Losina E, Collins JE, Wright J, Daigle ME, Donnell-Fink LA, Strnad D, Usiskin IM, Yang HY, Lerner V, Katz JN. Postoperative Care Navigation for Total Knee Arthroplasty Patients: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1252-9. doi: 10.1002/acr.22829. Epub 2016 Jul 28.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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