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Rationale: While there are numerous tools available to inform if and when to use total knee arthroplasty (TKA), very few tools exist to help guide the recovery period after surgery., Aims and Objectives: We piloted a decision support tool that promotes a "people-like-me" (PLM) approach to rehabilitation after total knee arthroplasty (TKA). The PLM approach encourages person-centered care by "using historical outcomes data from similar (past) patients as a template of what to expect for a new patient". In this study, we evaluated how successfully the PLM tool was implemented and examined contextual factors that may have influenced its implementation., Methods: Two outpatient physical therapy clinics (Clinics A and B) piloted the PLM tool from September 2020 - December 2022. We gathered data related to its implementation from multiple sources including the electronic health record (EHR), the tool itself, and surveys and interviews with patients and clinicians. We used an explanatory sequential mixed methods design to analyze the data overall and separately by each clinic., Results: Overall, the clinics met most pre-specified implementation targets, but did not use the tool as frequently as intended. Both clinics identified time, technology, and scheduling barriers to using the tool, but Clinic A scored higher in nearly every implementation outcome. Clinic A's success may have been related to its clinicians' higher level of experience, more positive attitudes towards the tool, and more active approach to implementation compared to Clinic B., Conclusions: The clinics met most of our implementation targets, but Clinic A experienced more success than Clinic B. Future efforts to implement this PLM tool should (1) engage clinicians as active participants in the implementation process, (2) explore whether incorporating treatment recommendations into the PLM tool and/or using alternative training strategies can enhance its ability to alter clinician behavior, (3) integrate the tool within the EHR to complement existing workflows and mitigate implementation barriers, and (4) include randomized controlled trials that evaluate the tool's effectiveness and scalability across diverse clinical settings., (© 2025 John Wiley & Sons Ltd.)

Background: Older veterans with multimorbidity experience physical and social vulnerabilities that complicate receipt of and adherence to physical rehabilitation services. Thus, traditional physical rehabilitation programs are insufficient to address this population's heterogenous clinical presentation., Objective: To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity., Design: Randomized controlled cross-over feasibility study., Setting: Telehealth from Veterans Affairs Medical Center to participants' homes., Participants: Fifty U.S. military veterans, age ≥60 years (mean ± SD; 69.2 ± 6.7) with ≥3 comorbidities (6.0 ± 1.9), and impaired physical function were randomized and allocated equally to two groups., Intervention: The MCTR program consisted of high-intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education group started the MCTR program after 12 weeks., Main Outcome Measures: The primary outcome was combined adherence (>75% of participants attending ≥80% sessions). Acceptability was measured by the Acceptability of Intervention Measure. Secondary outcomes included safety, participant surveys, and physical function. Patient-level outcomes were collected at baseline, 12 (primary time point), and 24 weeks., Results: Of 50 participants, 39 adhered to total session attendance (0.78 [95% confidence interval: 0.64-0.88], p = .76), 45 adhered to individual sessions (0.90 [95% confidence interval: 0.78-0.97], p = .01), and 48 rated the program as acceptable (0.96 [95% confidence interval: 0.85-0.99], p < .001). Thirty-five participants reported 78 safety events, and 12 (15%) had some degree of relatedness to the protocol. Most patient-level outcomes were similar between groups at 12-weeks., Conclusions: The MCTR program was feasible based on high adherence to individual sessions and high acceptability. Adherence results were consistent with previous exercise studies in older adults. Most in-session safety events were related to underlying medical conditions and consistent with in-person physical rehabilitation safety events. These results can inform use of telerehabilitation for similar populations., (Published 2025. This article is a U.S. Government work and is in the public domain in the USA.)