Presentation Details
| Surgical Optimization and Readiness with Physical Therapy for Older Adults Undergoing Elective Total Joint Arthroplasty Mehraneh Khalighi1, 2, Amanda L.Olney Biggs3, Ashley A.Buttelmann3, Nhi T.Reighter3, Bret H.Mecham4, Katherine C.Ritchey2.5. 1Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, WA, USA.2University of Washington, Seattle, WA, USA.3Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA, USA.4VA Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.5Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA |
Abstract
BACKGROUND: Individuals with knee and hip osteoarthritis (OA) awaiting joint arthroplasty often experience significant pain and functional limitations. Both group-based and individual prehabilitation can enhance function and prepare patients for surgery. Our institution lacked a formal prehabilitation program for OA patients awaiting total knee or hip arthroplasty, prompting the development of a multidisciplinary presurgical program. We aimed to optimize individuals aged ≥65 with Clinical Risk Analysis Index (RAI-C) scores of 30-36, indicating pre-frailty, and Mini-Cog scores ≥3, indicating low cognitive impairment risk, before elective total joint arthroplasty.
PURPOSE: The Surgical Optimization and Readiness with Physical Therapy (SOAR-PT) program is a six-week initiative consisting of weekly one-hour group physical therapy sessions focusing on leg, core, and balance strengthening, alongside education on pain management, stress reduction, smoking cessation, nutrition, and respiratory muscle training. Table 1 provides a comprehensive overview of the exercises included in the program. Starting level is determined during the initial physical therapy session, with progression to higher levels based on pain and self-reported perceived exertion. Figure 1 illustrates the structure of the weekly one-hour sessions. Exclusion criteria included cognitive impairment (Mini-Cog score <3), significant barriers to group participation, wheelchair dependence >50% of the time, and RAI-C scores <30 (robust) or ≥37 (frail).
RESULTS: Implemented on 10/1/2025, SOAR-PT's effectiveness will be assessed through pre- and post-intervention measures: 30-second sit-to-stand, 4-stage balance test, HOOS Jr. or KOOS Jr. scores, and patient experience data. We will also track SOAR-PT referrals, enrollment, and completion rates. Primary outcome measures include length of postoperative hospital stay, 30-day readmission, 30-day mortality, and surgical delay or cancellation rates.
CONCLUSIONS: The SOAR-PT program aims to improve surgical readiness and outcomes in older adults undergoing total joint arthroplasty. We plan to refine the program based on initial pilot results, with the potential for broader implementation across other surgical subspecialties.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: The Surgical Optimization and Readiness with Physical Therapy (SOAR-PT) program is a six-week initiative consisting of weekly one-hour group physical therapy sessions focusing on leg, core, and balance strengthening, alongside education on pain management, stress reduction, smoking cessation, nutrition, and respiratory muscle training. Table 1 provides a comprehensive overview of the exercises included in the program. Starting level is determined during the initial physical therapy session, with progression to higher levels based on pain and self-reported perceived exertion. Figure 1 illustrates the structure of the weekly one-hour sessions. Exclusion criteria included cognitive impairment (Mini-Cog score <3), significant barriers to group participation, wheelchair dependence >50% of the time, and RAI-C scores <30 (robust) or ≥37 (frail).
RESULTS: Implemented on 10/1/2025, SOAR-PT's effectiveness will be assessed through pre- and post-intervention measures: 30-second sit-to-stand, 4-stage balance test, HOOS Jr. or KOOS Jr. scores, and patient experience data. We will also track SOAR-PT referrals, enrollment, and completion rates. Primary outcome measures include length of postoperative hospital stay, 30-day readmission, 30-day mortality, and surgical delay or cancellation rates.
CONCLUSIONS: The SOAR-PT program aims to improve surgical readiness and outcomes in older adults undergoing total joint arthroplasty. We plan to refine the program based on initial pilot results, with the potential for broader implementation across other surgical subspecialties.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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