Group Physical Therapy for Knee OA (Group PT)
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Share PrintGroup 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.
Origin:
August 2015, Durham VA Medical Center
Adoptions:
20 successful, 1 in-progress
Partners:
Health Services Research & Development, Quality Enhancement Research Initiative
Recent Updates
Overview
The 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
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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 functional decline. Access to outpatient PT is a pervasive challenge in the VA and one of the most common reasons for referrals to community care, which is costly; knee OA is one of the most common conditions treated in outpatient PT.
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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.
The 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”
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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” resources (e.g., delivery toolkit, patient handbook, marketing materials) are available for sites ready to launch a Group PT program!
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Advantages and benefits of Group PT
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Group PT potential for clinical time savings
The 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
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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 comparable those observed in the trial.
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Images
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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.
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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).
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Patient Testimonials
Files
- Clinical trial study results Group versus individual physical therapy for veterans with knee osteoarthritis: randomized clinical trial.
- Implementation study results Implementation of a group physical therapy program for Veterans with knee osteoarthritis
- Protocol paper describing implementation intensification for Group Physical Therapy for Veterans with Knee OA Group physical therapy for knee osteoarthritis: protocol for a hybrid type III effectiveness-implementation trial
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)
Implementation
Timeline
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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 patientso Conduct a test Group PT class, making it as realistic as possibleo Acquire any additional resources you need for program delivery -
Program Launch
o Evaluate and enroll patientso Conduct your Group PT classeso 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 needso Continue campaign and marketing effortso Celebrate successes
Departments
- Physical medicine and rehabilitation
- Physical therapy, occupational therapy and kinesiothology
Core Resources
| Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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TOOLS |
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Links
- Link to Function QUERI program information Function QUERI Website
Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
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Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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TOOLS |
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Files
- Short Group PT program description for facility leadership Group PT program brief
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. |
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
Comment
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