Postoperative care navigation for total knee arthroplasty XXXX : A randomized controlled trial.

@entity1 @entity158 @entity571 @entity28
OBJECTIVE: To establish the efficacy of motivational-interviewing (MI)-based postoperative care navigation in improving functional status post-total knee arthroplasty (TKA) and to identify subgroups likely to benefit from the intervention. METHODS: We conducted a parallel randomized controlled trial in TKA recipients with two arms: postoperative care with frequent follow-up by a care navigator or usual care. The primary outcome was the difference between the arms in WOMAC function score change, over six months post-surgery. We performed a pre-planned subgroup analysis of differential efficacy by @entity28 and exploratory subgroup analyses on sex and @entity158 catastrophizing. RESULTS: We enrolled 308 subjects undergoing TKA for @entity571 . Mean preoperative function score was 41 (SD 17) (0-100 scale, 100 worst). At six months, subjects in the navigation arm improved by 30 (SD 16) points on average compared to 27 (SD 18) points in the usual care arm (p=0.148). @entity1 with moderate to high levels of @entity158 catastrophizing were unlikely to benefit from navigation compared to those with lower levels of @entity158 catastrophizing (p-value for interaction 0.013). CONCLUSION: Subjects assigned to the navigation intervention did not demonstrate greater functional improvement compared to those in the control group. The negative overall result could be explained by the large effect on functional improvement of TKA itself compared to the smaller, additional benefit from care navigation, as well as potential differential effects for subjects with moderate to high degrees of @entity158 catastrophizing. Greater focus on developing programs for @entity158 catastrophizing could lead to better functional outcomes following TKA. This article is protected by copyright. All rights reserved.
