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

Study Description

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Brief Summary:

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:

1. To establish whether "Care Navigator" intervention improves functional outcomes as compared with the "Usual Care" treatment six months after TKA surgery.
2. To establish whether "Care Navigator" intervention is cost effective six months after TKA surgery.

The investigators hypothesize that:

1. 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.
2. Addition of a Care Navigator is cost-effective.

Condition or disease	Intervention/treatment	Phase
Osteoarthritis; Degenerative Joint Disease	Behavioral: Care Navigator; Other: Standard Post-Operative TKA Care	Not Applicable

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.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	308 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Double (Investigator, Outcomes Assessor)
Primary Purpose:	Treatment
Official Title:	Adding Value in Knee Arthroplasty Post TKR Care Navigator Trial
Actual Study Start Date :	July 24, 2011
Actual Primary Completion Date :	May 10, 2014
Actual Study Completion Date :	May 10, 2014

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
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 discharge from the hospital for 5 months after their total knee replacement.
Active Comparator: Usual Care Group; Subjects in the Usual Care group receive the current standard post-operative TKA care	Other: Standard Post-Operative TKA Care; Subjects assigned to the Standard Post-Operative TKA Care group will receive the current standard of care for post-operative care

Outcome Measures

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. Change in WOMAC Physical Function [ Time Frame: Change in functional status from baseline to 6 months ]
   The change in functional status will be measured using the WOMAC Physical Function scale at Baseline and 6 months

Secondary Outcome Measures :

1. Satisfaction [ Time Frame: Measured at 6 months post TKA ]
   Percentage of patients in each study arm who reported being very satisfied with the results of TKA
2. Range of Motion [ Time Frame: 6 months after TKA ]
   Percentage of participants able to bend knee at least 120 degrees

Eligibility Criteria

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	40 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
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

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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

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications of Results:

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.

Other 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
First Posted:	February 29, 2012
Results First Posted:	February 19, 2016
Last Update Posted:	February 9, 2018
Last Verified:	January 2018

Keywords provided by Elena Losina, 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:

Osteoarthritis; Joint Diseases; Arthritis; Musculoskeletal Diseases; Rheumatic Diseases