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

doi:10.1136/bmjopen-2018-021614

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 language	English
Article number	e021614
Journal	BMJ Open
Volume	9
Issue number	2
Early online date	20 Feb 2019
DOIs	https://doi.org/10.1136/bmjopen-2018-021614
Publication status	Published - 20 Feb 2019

Bibliographical 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.

Keywords

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

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10.1136/bmjopen-2018-021614Licence: CC BY-NC

Exploring variation in patient access of post-discharge physiotherapy following total hip and knee arthroplasty under a choice based system in the UK
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Cite this

Hamilton, D. F., Loth, F. C., MacDonald, D. J., Macfarlane, G. J., Beard, D. J., Simpson, A. H. RW., Patton, J. T., & Howie, C. R. (2019). 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. BMJ Open, 9(2), Article e021614. https://doi.org/10.1136/bmjopen-2018-021614

Hamilton, DF, Loth, FC, MacDonald, DJ, Macfarlane, GJ, Beard, DJ, Simpson, AHRW, Patton, JT & Howie, CR 2019, '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', BMJ Open, vol. 9, no. 2, e021614. https://doi.org/10.1136/bmjopen-2018-021614

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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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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

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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.

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KW - total knee arthroplasty

KW - REPLACEMENT

KW - REHABILITATION

KW - OUTCOMES

KW - QUESTIONNAIRE

KW - CARE

KW - PERCEPTIONS

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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

Abstract

Bibliographical note

Keywords

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