Developing visit usage recommendations for outpatient rehabilitation after total knee arthroplasty: A Delphi study

Objective No consensus recommendations exist for rehabilitation visit usage (i.e., visit timing, visit frequency, duration of care) after total knee arthroplasty. In the absence of guiding evidence, rehabilitation visit usage varies considerably in the US, especially in the outpatient setting. We sought to develop expert consensus for visit usage recommendations in outpatient rehabilitation after total knee arthroplasty. Methods We used a 2-round Delphi process to develop expert consensus for visit usage recommendations. The Delphi panel consisted of surgeons, physical therapists, and advanced practice providers (N=29) with clinical and research expertise in recovery after total knee arthroplasty. Results The panel reached consensus on eight visit frequency recommendations for use in the first three months after total knee arthroplasty. These recommendations are responsive to patients’ time since surgery and their recovery status relative to expected. Twelve additional complementary recommendations were developed to be used with the visit frequency recommendations. Conclusions We used the Delphi process to develop expert recommendations for visit usage in outpatient rehabilitation after total knee arthroplasty. We envision these recommendations may help to facilitate a more preference-sensitive approach to postoperative rehabilitation.