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Race Differences in Functional Outcomes and Physical Therapy Utilization after Total Knee Arthroplasty

Bove, Allyn (2020) Race Differences in Functional Outcomes and Physical Therapy Utilization after Total Knee Arthroplasty. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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It is well-known that race disparities exist in the utilization of total knee arthroplasty (TKA). Some studies have suggested there are also race disparities in short-term outcome measures following TKA. Current research is lacking regarding whether disparities exist in functional outcomes following TKA, and if the amount or type of post-operative physical therapy (PT) plays a role in any such disparity.
The aims of this dissertation study include: (1) to determine if race is a significant predictor of functional outcome following TKA; (2) to determine if there are race differences in post-acute PT utilization following TKA; and (3) to qualitatively explore race differences in satisfaction with the rehabilitation experience following TKA. To accomplish these aims, we prospectively recruited 104 black/African-American and white/Caucasian non-Hispanic individuals scheduled to undergo unilateral TKA. Participants completed pre-operative and twelve weeks post-operative questionnaires regarding their physical function, reported information regarding PT received across several settings, and investigators reviewed participants’ outpatient PT records following TKA.
We found that race was not a substantial independent predictor of patient-reported function after TKA. White participants reported slightly better function at both the pre- and post-operative time points, but these differences were not statistically significant. When examining post-acute PT utilization, we observed a non-significant trend that black and white participants tended to receive PT in different settings, but the overall amount of post-acute PT received was similar between the groups. In focus groups exploring participants’ experience with rehabilitation following TKA, participants largely reported positive views of their PT experience despite some barriers to completing post-operative rehabilitation. There were minor differences in the TKA experience described by white and black participants.
This is the first study to examine both PT utilization and functional outcomes in a sample of individuals undergoing TKA. This work adds to the literature regarding the role of race in physical function and rehabilitation use after TKA, but continued gaps in the literature exist. Future studies should use large data sets containing both functional measurements and rehabilitation utilization on a diverse group of patients to fully illuminate the relationships between demographic factors, rehabilitation use, and functional outcomes following TKA.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Bove, Allynams453@pitt.eduams453
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairFitzgerald, G.
Committee MemberPiva,
Committee MemberBrach,
Committee MemberHausmann,
Committee MemberLewis,
Date: 19 June 2020
Date Type: Publication
Defense Date: 29 January 2020
Approval Date: 19 June 2020
Submission Date: 11 February 2020
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 124
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: knee physical therapy arthroplasty surgery disparities outcomes
Date Deposited: 26 Aug 2020 12:44
Last Modified: 19 Jun 2021 05:15


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