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 R.W. 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 R.W. Simpson, James T. Patton, Colin R. Howie

^*Corresponding author for this work

Podiatry

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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

Keywords

outcomes
physiotherapy
total hip arthroplasty
total knee arthroplasty

ASJC Scopus subject areas

General Medicine

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10.1136/bmjopen-2018-021614

Hamilton, D. F. et al (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
© 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/.
Final published version, 537 KBLicence: CC BY-NC

Cite this

Hamilton, D. F., Loth, F. C., MacDonald, D. J., MacFarlane, G. J., Beard, D. J., Simpson, A. H. R. W., 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

@article{dfc6532af0084263a5c443f792734d38,

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",

abstract = "Objectives: To assess a targeted {\textquoteleft}therapy as required{\textquoteright} 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 {\textquoteleft}therapy as required{\textquoteright} 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.",

keywords = "outcomes, physiotherapy, total hip arthroplasty, total knee arthroplasty",

author = "Hamilton, {David F.} and Loth, {Fanny C.} and MacDonald, {Deborah J.} and MacFarlane, {Gary J.} and Beard, {David J.} and Simpson, {A. Hamish R.W.} and Patton, {James T.} and Howie, {Colin R.}",

note = "Funding Information: This work was supported by Arthritis Research UK [ref 71000] and an institutional award from Stryker to the University of Edinburgh (ref RB0412). Publisher Copyright: {\textcopyright} 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.",

year = "2019",

month = feb,

day = "20",

doi = "10.1136/bmjopen-2018-021614",

language = "English",

volume = "9",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "2",

}

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

TY - JOUR

T1 - 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

AU - Hamilton, David F.

AU - Loth, Fanny C.

AU - MacDonald, Deborah J.

AU - MacFarlane, Gary J.

AU - Beard, David J.

AU - Simpson, A. Hamish R.W.

AU - Patton, James T.

AU - Howie, Colin R.

N1 - Funding Information: This work was supported by Arthritis Research UK [ref 71000] and an institutional award from Stryker to the University of Edinburgh (ref RB0412). Publisher Copyright: © 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.

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

U2 - 10.1136/bmjopen-2018-021614

DO - 10.1136/bmjopen-2018-021614

M3 - Article

C2 - 30787073

AN - SCOPUS:85061977669

SN - 2044-6055

VL - 9

JO - BMJ Open

JF - BMJ Open

IS - 2

M1 - e021614

ER -

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

Keywords

ASJC Scopus subject areas

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