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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

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 accessi...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398686/
https://www.ncbi.nlm.nih.gov/pubmed/30787073
http://dx.doi.org/10.1136/bmjopen-2018-021614
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author 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
author_facet 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
author_sort Hamilton, David F
collection PubMed
description 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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spelling pubmed-63986862019-03-20 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 BMJ Open Surgery 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. BMJ Publishing Group 2019-02-20 /pmc/articles/PMC6398686/ /pubmed/30787073 http://dx.doi.org/10.1136/bmjopen-2018-021614 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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/.
spellingShingle Surgery
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398686/
https://www.ncbi.nlm.nih.gov/pubmed/30787073
http://dx.doi.org/10.1136/bmjopen-2018-021614
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