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

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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

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Knee Replacement Arthroplasties
Observational Studies
Hip
Cohort Studies
Arthroplasty
Therapeutics
National Health Programs
Teaching Hospitals
Orthopedics
Longitudinal Studies
Knee
Outpatients
Rehabilitation

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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

In: BMJ Open, Vol. 9, No. 2, e021614, 20.02.2019.

Research output: Contribution to journalArticle

Hamilton, David F ; Loth, Fanny C ; MacDonald, Deborah J ; Macfarlane, Gary J ; Beard, David J ; Simpson, A Hamish RW ; Patton, James T ; Howie, Colin R. / 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. In: BMJ Open. 2019 ; Vol. 9, No. 2.
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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.",
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note = "This work was supported by Arthritis Research UK [ref 71000] and an institutional award from Stryker to the University of Edinburgh (ref RB0412). The funders had no role in the study design, collation or analysis of data, interpretation of data nor writing of the manuscript.",
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T1 - Exploring variation in patient access of post-discharge physiotherapy following total hip and knee arthroplasty under a choice based system in the UK

T2 - an observational cohort study

AU - Hamilton, David F

AU - Loth, Fanny C

AU - MacDonald, Deborah J

AU - Macfarlane, Gary J

AU - Beard, David J

AU - Simpson, A Hamish RW

AU - Patton, James T

AU - Howie, Colin R

N1 - This work was supported by Arthritis Research UK [ref 71000] and an institutional award from Stryker to the University of Edinburgh (ref RB0412). The funders had no role in the study design, collation or analysis of data, interpretation of data nor writing of the manuscript.

PY - 2019/2/20

Y1 - 2019/2/20

N2 - 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.

AB - 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.

KW - outcomes

KW - physiotherapy

KW - total hip arthroplasty

KW - total knee arthroplasty

KW - REPLACEMENT

KW - REHABILITATION

KW - OUTCOMES

KW - QUESTIONNAIRE

KW - CARE

KW - PERCEPTIONS

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U2 - 10.1136/bmjopen-2018-021614

DO - 10.1136/bmjopen-2018-021614

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VL - 9

JO - BMJ Open

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SN - 2044-6055

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