To examine the effect of a multi-component intervention on pain and function following orthopedic surgery.
Controlled prospective propensity score matched clinical trial.
New York City acute rehabilitation hospital.
249 patients admitted to rehabilitation following hip fracture repair (N=51) hip (N=64) or knee (N=134) arthroplasty.
Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and pre-emptive analgesia prior to PT were implemented on the intervention unit. Control unit patients received usual care.
MAIN OUTCOME MEASURES
Pain, analgesic prescribing, gait speed, transfer time, and percent of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks following discharge.
In multivariable analyses compared to controls, intervention patients were significantly more likely to report no or mild pain at rest (66% versus 49%, P=.004) and with PT (52% versus 38%, P=.02) on average for the first 7 days of rehabilitation; had faster 8 foot walk times on days four (9.3 seconds versus 13.2 seconds, P=.02) and seven (6.9 versus 9.2 seconds, P=.02); received more analgesia (8.0 milligrams of morphine sulfate equivalents/day, P<0.001); were more likely to receive standing analgesia (98% versus 48%, P<.001); and had significantly shorter lengths of stay (10.1 versus 11.3 days, P=.005). At 6 months compared to controls, intervention patients were less likely to report moderate/severe pain with walking (15% versus 4%, P=.02), that pain did not interfere with walking (7% versus 18%, P=.004), and were less likely to be taking analgesics (35% versus 51%, P=.03).
The intervention improved post-operative pain, reduced chronic pain, and improved function.