Exploring variation in patient access of post-discharge physiotherapy following total hip and knee arthroplasty under a choice based system in the UK: an observational cohort study

David F Hamilton, Fanny C Loth, Deborah J MacDonald, Gary J Macfarlane, David J Beard, A Hamish RW Simpson, James T Patton, Colin R Howie

Research output: Contribution to journalArticle

1 Citation (Scopus)
6 Downloads (Pure)

Abstract

OBJECTIVES: To assess a targeted 'therapy as required' model of post-discharge outpatient physiotherapy provision. Specifically, we investigated what proportion of patients accessed post-discharge physiotherapy following total hip arthroplasty (THA) and total knee arthroplasty (TKA), whether accessing therapy was associated with post-arthroplasty patient reported outcomes and whether it was possible to predict which patients would access post-discharge physiotherapy from pre-operative data.

DESIGN: Prospective, observational, longitudinal cohort study.

SETTING: Single National Health Service orthopaedic teaching hospital in the UK.

PARTICIPANTS: 1395 patients undergoing total hip arthroplasty and 1374 patients undergoing total knee arthroplasty.

PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported access of post-discharge physiotherapy, the Oxford Hip or Knee Score, EuroQol 5-dimension questionnaire and post-operative surgical episode satisfaction metric.

RESULTS: 662 (48.2%) patients with TKA and 493 (35.3%) patients with THA accessed additional post-discharge physiotherapy. Patient-reported outcomes (p<0.001) and surgical episode satisfaction (p=0.001) in both THA and TKA were higher in patients that did not participate in post-discharge physiotherapy. Regression models using pre-operative symptom burden and demographic data predicted post-discharge therapy access with an accuracy of only 17% greater than chance in patients with THA and 7% greater than chance in patients with TKA.

CONCLUSIONS: In a choice-based service model of 'therapy as required' following hip and knee arthroplasty only a third of THA and half of TKA patients accessed post-discharge therapy. Patients who did not access physiotherapy reported greater post-operative outcomes. This variation in the need for post-discharge physiotherapy suggests that targeting of rehabilitation may be a cost-effective model, however it was not possible to reliably predict which patients would access post-discharge physiotherapy from pre-operative data.

Original languageEnglish
Article numbere021614
JournalBMJ Open
Volume9
Issue number2
Early online date20 Feb 2019
DOIs
Publication statusPublished - 20 Feb 2019

Keywords

  • outcomes
  • physiotherapy
  • total hip arthroplasty
  • total knee arthroplasty
  • REPLACEMENT
  • REHABILITATION
  • OUTCOMES
  • QUESTIONNAIRE
  • CARE
  • PERCEPTIONS

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Exploring variation in patient access of post-discharge physiotherapy following total hip and knee arthroplasty under a choice based system in the UK: an observational cohort study'. Together they form a unique fingerprint.

  • Cite this