Journal of Evaluation in Clinical Practice vol:16 issue:1 pages:39-49
Rationale, aims and objectives Clinical pathways are globally used to improve quality and efficiency of care. Total joint arthroplasty patients are one of the primary target groups for clinical pathway development. Despite the worldwide use of clinical pathways, it is unclear which key interventions multidisciplinary teams select as pathway components, which outcomes they measures and what the effect of this complex intervention is. This literature study is aimed at three research questions: (1) What are the key interventions used in joint arthroplasty clinical pathways? (2) Which outcome measures are used? (3) What are
the effects of a joint arthroplasty clinical pathway?
Method Systematic literature review using a multiple reviewer approach. Five electronic databases were searched comprehensively. Reference lists were screened. Experts were
consulted. After application of inclusion and exclusion criteria and critical appraisal, 34 of the 4055 publications were included. Results Joint arthroplasty clinical pathways address pre-admission education, preadmission
exercises, pre-admission assessment and testing, admission and surgical procedure,
postoperative rehabilitation, minimal manipulation, symptoms management, thrombosis prophylaxis, discharge management, primary caregiver involvement, homebased
physiotherapy and continuous follow-up. An overview of target dimensions and corresponding indicators is provided. Clinical pathways for joint arthroplasty could improve process and financial outcomes. The effects on clinical outcome are mixed.
Evidence on team and service outcome is lacking.
Conclusions Aset of key interventions and outcome measures is available to support joint arthroplasty clinical pathways. Team and service outcomes should be further addressed in practice and research. Meta-analysis on the outcome indicators should be performed.
Future studies should more rigorously comply with existing reporting standards.