Adding Value in Knee Arthroplasty Post-total Knee Replacement (TKR) Care Navigator Trial - Full Text View

Purpose

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.

Condition	Intervention
Osteoarthritis Degenerative Joint Disease	Behavioral: Care Navigator


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Investigator, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Adding Value in Knee Arthroplasty Post TKR Care Navigator Trial

Resource links provided by NLM:

MedlinePlus related topics: Joint Disorders Knee Replacement Osteoarthritis

U.S. FDA Resources

Further study details as provided by Brigham and Women's Hospital:

Primary Outcome Measures:

Functional Status [ Time Frame: Change in baseline function at 6 months ] [ Designated as safety issue: No ]
Functional status will be measured using the WOMAC scale at Baseline, 3 and 6 months

Secondary Outcome Measures:

Satisfaction and cost effectiveness [ Time Frame: Measured at 3 & 6 months post TKA ] [ Designated as safety issue: No ]
Range of Motion [ Time Frame: Baseline, 3 and 6 months after TKA ] [ Designated as safety issue: No ]
Range of Motion will be documented on the baseline and 6 month musculoskeletal exam and baseline, 3 month and 6 month questionnaires (self reported)


Estimated Enrollment:	300
Study Start Date:	July 2011
Estimated Study Completion Date:	November 2018
Primary Completion Date:	May 2014 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: 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	Behavioral: Care Navigator Subjects assigned to the Care Navigator intervention group will receive 10 calls from a care navigator after discharged from the hospital for 5 months after their total knee replacement. Subjects assigned to the usual Care group will receive current standard of post-operative care
Active Comparator: Usual Care Group Subjects in the Usual Care group receive the current standard post-operative TKA care	Behavioral: Care Navigator Subjects assigned to the Care Navigator intervention group will receive 10 calls from a care navigator after discharged from the hospital for 5 months after their total knee replacement. Subjects assigned to the usual Care group will receive current standard of post-operative care

Detailed Description:

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.

Eligibility


Ages Eligible for Study:	40 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

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

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01540851

Locations


United States, Massachusetts
Brigham & Women's Hospital
Boston, Massachusetts, United States, 02115

Sponsors and Collaborators

Brigham and Women's Hospital

Investigators


Principal Investigator:	Elena Losina, PhD	Brigham and Women's Hospital

More Information

Publications:

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.


Responsible Party:	Elena Losina, PhD, Principal Investigator, Brigham and Women's Hospital
ClinicalTrials.gov Identifier:	NCT01540851 History of Changes
Other Study ID Numbers:	2010p002597
Study First Received:	February 21, 2012
Last Updated:	January 30, 2015
Health Authority:	United States: Institutional Review Board

Keywords provided by Brigham and Women's Hospital:


Osteoarthritis Total Knee Replacement total Knee Arthroplasty	Post operative recovery, TKA Post-operative recovery TKR Care Navigator

Additional relevant MeSH terms:


Joint Diseases Osteoarthritis Arthritis Musculoskeletal Diseases Rheumatic Diseases

ClinicalTrials.gov processed this record on February 26, 2015

Adding Value in Knee Arthroplasty Post-total Knee Replacement (TKR) Care Navigator Trial (AViKA)