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Group Physical Therapy for Knee OA (Group PT)

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Group physical therapy for Veterans with knee osteoarthritis (Group PT) involves six 1-hour sessions, delivered virtually or in-person and led by trained clinical personnel (e.g., physical therapist, kinesiotherapist, PT assistant). Group PT features evidence-based, progressive exercises (with guidance for patient-specific tailoring) and didactic content. “Ready to go” resources (e.g., delivery toolkit, patient handbook, marketing materials) are available to support sites in delivering the program. By delivering PT in a group format, this program promotes access to care and operational efficiency while improving Veterans’ functional status and building a social support network.

This innovation is replicating across multiple facilities as its impact continues to be validated. See more replicating innovations.

Origin:

August 2015, Durham VA Medical Center

Adoptions:

20 successful, 1 in-progress

Partners:

Health Services Research & Development, Quality Enhancement Research Initiative

Tags:

Outpatient Care Rural Health Telehealth Veteran Experience
Contact Team

Overview

Problem

Knee osteoarthritis (OA) affects about 1 in 4 Veterans and is a major cause of chronic pain and functional limitations. The prevalence of knee OA is projected to rise dramatically over the next several decades, placing increasing demand on the VA to provide evidence-based components of care, including physical therapy (PT), which is a key tool for mitigating ... See more

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A diagnosis of knee osteoarthritis can lead to functional decline, which increases the risk for falls, disability, cardiovascular events, and mortality.

Solution

Delivering PT for knee OA in a group format increases access and efficiency while providing Veterans with evidence-based care. The Group PT for knee OA program consists of 6 sessions that include functional exercises, individual tailoring and guidance on progression, and didactic content (e.g., activity pacing and managing pain with exercise). “Ready to go” ... See more

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Advantages and benefits of Group PT

Group PT potential for clinical time savings

Results

Data from a randomized clinical trial showed that Group PT yielded clinically relevant improvements in pain and function, similar to or greater than changes seen for traditional individual PT. Following the trial, the Durham VAHCS implemented Group PT as a clinical service and found that Veterans experienced improvements in pain and function that were compar ... See more

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WOMAC Score results reported from implementation of Group PT at the Durham VAHCS. WOMAC is a self-reported measure of pain, stiffness and function, with lower scores indicating better health status. The change following Group PT meets criteria for clinically relevant improvement.

Pain intensity results reported from implementation of Group PT at the Durham VAHCS. Patients reported their average daily level of pain on a scale of 0 (no pain) to 10 (worst pain).

Patient Testimonials

Metrics

  • Average patient satisfaction with Group PT across 18 VA sites was 9.2 out of 10 (with 10 being completely satisfied).

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

CA: Martinez VA Medical Center (Martinez)
  • Started adoption on 09/2023.
CT: Newington VA Clinic (Newington)
  • Started adoption on 03/2023.
CT: West Haven VA Medical Center (West Haven)
  • Started adoption on 06/2023.
FL: Jacksonville Navy VA Medical Center (Jacksonville Navy)
  • Started adoption on 01/2023.
FL: Lake City VA Medical Center (Lake City, Florida)
  • Started adoption on 06/2023.
FL: Orlando VA Medical Center (Orlando)
  • Started adoption on 02/2023.
FL: William "Bill" Kling Department of Veterans Affairs Outpatient Clinic (Sunrise)
  • Started adoption on 06/2023.
ID: Boise VA Medical Center (Boise)
  • Started adoption on 05/2023.
KS: Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center (Wichita)
  • Started adoption on 06/2023.
LA: New Orleans VA Medical Center (New Orleans)
  • Started adoption on 04/2023.
MO: Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri)
  • Started adoption on 04/2023.
NC: Durham VA Medical Center (Durham)
  • Started adoption on 08/2015.
NC: W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center (Salisbury)
  • Started adoption on 01/2024.
NM: Raymond G. Murphy Department of Veterans Affairs Medical Center (Albuquerque)
  • Started adoption on 08/2023.
NV: Ioannis A. Lougaris Veterans' Administration Medical Center (Reno)
  • Started adoption on 07/2023.
NY: Rochester Clinton Crossings VA Clinic (Rochester Clinton Crossings)
  • Started adoption on 06/2023.
PA: Pittsburgh VA Medical Center-University Drive (Pittsburgh)
  • Started adoption on 09/2022.
SC: Wm. Jennings Bryan Dorn Department of Veterans Affairs Medical Center (Columbia, South Carolina)
  • Started adoption on 12/2023.
VISN 4 Clinical Resource Hub (Remote)
  • Started adoption on 09/2023.
VISN 22 Clinical Resource Hub (Remote)
  • Started adoption on 02/2023.

FL: James A. Haley Veterans' Hospital (Tampa, Florida)
  • Started adoption on 06/2022.

There are no unsuccessful adoptions for this innovation.

Implementation

Timeline

  • Preparing for program launch (3 months or longer)
    o Gather your team (e.g., key stakeholders, implementation team, and champions to promote Group PT)
    o Review the Group PT Toolkit/delivery guide and determine how you want to tailor your program (e.g., delivery format, patient enrollment, involved personnel)
    o Develop a plan for educating and marketing to referring providers and patients
    o Conduct a test Group PT class, making it as realistic as possible
    o Acquire any additional resources you need for program delivery
  • Program Launch
    o Evaluate and enroll patients
    o Conduct your Group PT classes
    o Develop communication strategies among involved implementation staff to facilitate smooth delivery
  • Program Sustainment
    o Work with your team to address challenges, identify assets, and determine ongoing resources or staffing needs
    o Continue campaign and marketing efforts
    o Celebrate successes

Departments

  • Physical medicine and rehabilitation
  • Physical therapy, occupational therapy and kinesiothology

Core Resources

Resource type Resource description
PEOPLE
  • One clinical personnel who can conduct an initial patient evaluation and oversee program delivery. Personnel leading the class can be physical therapists, physical therapy assistants, kinesiotherapists, kinesiotherapy assistants, exercise physiologists or recreation therapists.
PROCESSES
  • Time allocated for clinical personnel to prepare for Group PT implementation (prior to delivering the first class). This time will be used to market the program, educate providers, determine electronic health record documentation process, practice leading a class, and establish any new workflows (e.g., scheduling).
  • Time allocated for one clinical personnel to deliver the Group PT class and assist patients with issues outside of class (potentially including technical issues for sites offering virtual Group PT). Estimated time 1 hr/week for delivering 1 Group PT class plus any additional time outside of class as needed for scheduling, assisting patients, and documentation.
TOOLS
  • Physical space to conduct the class and accommodate up to 10 Veterans if the class is being delivered in person. If the class is being delivered via telehealth, there is no additional space requirement.
  • For in-person delivery, patients should have access to equipment typically stocked in a physical therapy gym, such as chairs, therabands, step-ups. For virtual delivery, the clinician leading the Group PT class should have access to this same equipment to demonstrate exercises as needed.
  • Additional IT support for sites conducting virtual Group PT classes (e.g., access to telehealth equipment and any needed IT support to conduct group sessions over telehealth).

Links

Optional Resources

Resource type Resource description
PEOPLE
  • While the class can be conducted by one trained clinician, it can be beneficial for a second clinician to assist with monitoring patients and answering questions, especially when offering virtual Group PT.
  • When delivering virtual Group PT, sites have reported that it is helpful to have a designated Telehealth Clinical Technician (TCT) to support and manage telehealth operations (e.g., establishing and maintaining video conferencing connections, making introductions between patient site and provider site, and following instructions of a clinician to facilitate an effective clinical encounter).
PROCESSES
  • When delivering virtual Group PT, there may be situations when a Veteran does not have a device to access the class from their home. In such cases, an iPad or Laptop would need to be provided. Requests for these materials can typically be obtained by entering a Digital Divide ticket.
TOOLS
  • Facilities may choose to send supplies to patients to use at home, such as therabands and printed patient materials, which would be an extra cost (cost of supplies, printing, binding, shipping).
  • For either in-person or virtual delivery, a timer is useful for the clinician leading the class to help keep pace of the exercise intervals; however, most phones have a timer function which works fine as well.

Support Resources

Resource type Resource description
PEOPLE
  • Facilities implementing Group PT have the flexibility to adapt the program so it is a best fit for their facility, staff, and patient population. With that in mind, there are a variety of clinical personnel that can deliver this program (e.g., physical therapists, PTAs, kinesiotherapists, KTAs, recreation therapists).
TOOLS
  • The Function QUERI team at the Durham VA can provide access to resources (e.g., delivery toolkit, patient handbook, CPRS templates) if your site is interested in implementing Group PT!

Files

Risks and mitigations

Risk Mitigation
Obtaining referrals Focus on communication and education for providers and continuing to creatively market the program via multiple methods to referring providers and patients.
Establishing new workflow Plan and communicate with involved personnel when planning to launch. Continue to evaluate and adjust as needed.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Physical Therapy Assistant) Innovation adopter posted

Our outpatient PT team is interested in implementing this program. How can we get involved?

Email

Email with questions about this innovation.

About

Origin story

Group PT started as a randomized controlled trial (RCT) in Durham, and then became a regularly offered program at the Durham VA. We are now working with 19 facilities implementing Group PT as part of the Optimizing Function and Independent Quality Enhancement Research Initiative ("Function QUERI").

Original team

Kelli Allen

Research Health Scientist

Brandon Sheets

Outpatient PT Supervisor in Durham

Helen Hoenig

Rehabilitation & Extended Care Lead

Susan N. Hastings

Director, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)

Sara E. Webb

Project Coordinator

Search tags

Outpatient Care Rural Health Telehealth Veteran Experience