Physical therapy-led orthopedic triage
THA/TKA, OA, pain
Three physical therapists (PTs) with long experience (20–40 years) of working with patients with OA and about one year’s experience of the PT-led triage of patients with OA conducted the physical assessment in this trial. The duration of the appointment was set at a maximum of 60 min, with the aim of determining whether the patient was a candidate for a total hip/knee replacement (THA/TKA). The assessment was performed according to a checklist created by a team consisting of the three PTs, two OS and the research group. The checklist was used to ensure that all relevant information needed to decide on the patient’s suitability for surgical intervention were obtained. The checklist consisted of questions pertaining to the patient’s pain and disabilities, as well as details of a full clinical examination. During the assessment, the PTs also provided the patient with general information about OA and advice on how best to handle their OA with physical activity. If the patient was assessed as not being a candidate for surgery, they received the information about this and continued care during the assessment. If the assessment was unclear, or if the patient was considered suitable for surgery, the PT informed the patients about this and the fact that the assessment would be discussed with the OS before making a decision. The patients also received information that they would receive a letter at home with the final decision about continued care. All patients in the PT-led triage group were discussed during a weekly conference with the assessing PT and an assigned OS. Prior to the conference, the OS was provided with the checklist and the X-ray images. Based on this, blinded to the PT’s decision, the OS assessed whether the patient was suitable for surgery, non-surgical treatment, or a follow-up visit. During the conference, the PT informed the OS about the findings from the assessment according to the checklist. Both the PT and the OS then informed one another about their decision and together they made a final decision about the patient’s suitability for surgery. After the conference, a letter containing the final decision about continued care, i.e. whether the patient was suitable for surgery, non-surgical treatment or a follow-up visit with an orthopedic surgeon, was sent to the patient. The follow-up with an OS could be either a phone call or an appointment at the hospital and was scheduled within four weeks or up to six months after the initial assessment.