Large Kate E, Page Carolyn J, Brock Kim, Dowsey Michelle M, Choong Peter F M
Physiotherapy Department, St Vincent's Hospital, PO Box 2900, Fitzroy, Vic. 3065, Australia. Email: ;
Department of Orthopaedics, St Vincent's Hospital, PO Box 2900, Fitzroy, Vic. 3065, Australia. Email: ;
Aust Health Rev. 2014 Nov;38(5):510-6. doi: 10.1071/AH13238.
With the rising demand for Orthopaedics in the healthcare sector, service delivery innovations need to be explored to accommodate the increasing workload. Senior Musculoskeletal Physiotherapists have the specialised skills in the assessment of musculoskeletal conditions to determine the impact of surgery on patient outcomes. The aim of the present study was to compare outcomes between a physiotherapy-led arthroplasty review clinic (PT clinic) and the traditional model of orthopaedic surgeon review (OS clinic) after hip and knee replacement.
This study was a retrospective case-controlled audit using a comprehensive database. Twenty-four patients who had a hip arthroplasty and 52 patients who had a knee arthroplasty were reviewed solely by the PT clinic at 3, 6 and 12 months after surgical reviews. These patients were matched 1:2 against patients seen only by the OS clinic. The outcome measures included International Knee Score (IKS), Harris Hip Score (HHS) and the Short Form (SF)-12.
There were no significant differences in HHS or SF-12 scores for patients after hip arthroplasty. Significant differences for knee arthroplasty were observed favouring the PT clinic; IKS, PT clinic 147.6 (37.07), OS clinic 135.4 (35.68), P≤0.01, and physical component of the SF-12, PT clinic 41.98 (10.45), OS clinic 37.20 (10.44), P<0.01.
Implementation of a physiotherapy-led arthroplasty review clinic appears to be a safe and effective service alternative to reviews conducted by orthopaedic surgeons. WHAT IS KNOWN ABOUT THE TOPIC?: Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability and the burden of the disease is rapidly increasing. Joint arthroplasty surgery is the mainstay of treatment for people with end-stage OA; it is a high-cost, high-volume procedure that dominates surgical wait lists around Australia. Long-term follow up is encouraged by the Arthroplasty Society of Australia and endorsed by the Australian Orthopaedics Association, but it is acknowledged that it is impossible to achieve this with solely orthopaedic surgeon reviews, an issue that is only going to worsen with the increased demand for surgery. Physiotherapists have become involved in many advanced scope roles within public health care, and emerging research suggests that patients are highly satisfied with their care in these types of clinics. WHAT DOES THIS PAPER ADD?: Although it has been shown that patients are satisfied in physiotherapy-led advanced clinics, there is a paucity of evidence in the outcomes of patients attending these clinics. Implementation of a physiotherapy-led arthroplasty review clinic demonstrated that outcome measures in this patient cohort were not compromised and, following knee joint arthroplasty, may even be improved. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: The findings of this study indicate that joint review clinics involving physiotherapists acting in an advanced scope role are unlikely to compromise patient outcomes. The use of this role substitution on a broader scale can be recommended.
随着医疗保健领域对骨科服务需求的不断增加，需要探索服务提供创新方式以应对日益增加的工作量。高级肌肉骨骼物理治疗师具备评估肌肉骨骼疾病的专业技能，能够确定手术对患者预后的影响。本研究旨在比较物理治疗主导的关节置换术后复查诊所（PT诊所）与传统骨科医生复查模式（OS诊所）在髋关节和膝关节置换术后的预后情况。
本研究是一项回顾性病例对照审计，使用了一个综合数据库。24例接受髋关节置换术的患者和52例接受膝关节置换术的患者在术后3个月、6个月和12个月仅由PT诊所进行复查。这些患者与仅由OS诊所诊治的患者按1:2进行匹配。结局指标包括国际膝关节评分（IKS）、哈里斯髋关节评分（HHS）和简短健康调查问卷（SF-12）。
髋关节置换术后患者的HHS或SF-12评分无显著差异。膝关节置换术后观察到有利于PT诊所的显著差异；IKS，PT诊所147.6（37.07），OS诊所135.4（35.68），P≤0.01；SF-12的身体成分评分，PT诊所41.98（10.45），OS诊所37.20（10.44），P<0.01。
实施物理治疗主导的关节置换术后复查诊所似乎是一种安全有效的服务方式，可替代骨科医生进行的复查。关于该主题已知的情况是什么？：骨关节炎（OA）是肌肉骨骼疼痛和残疾的主要原因，且该疾病的负担正在迅速增加。关节置换手术是终末期OA患者的主要治疗方法；这是一种高成本、高工作量的手术，在澳大利亚各地的手术等候名单中占主导地位。澳大利亚关节置换协会鼓励进行长期随访，并得到澳大利亚骨科协会的认可，但人们认识到仅靠骨科医生复查无法实现这一点，而且随着手术需求的增加，这个问题只会变得更糟。物理治疗师已参与到公共医疗保健中的许多高级职责范围内，并且新出现的研究表明患者对这类诊所的护理非常满意。本文补充了什么内容？：尽管已表明患者对物理治疗主导的高级诊所感到满意，但关于这些诊所患者预后的证据却很少。实施物理治疗主导的关节置换术后复查诊所表明，该患者队列的结局指标并未受到影响，而且在膝关节置换术后甚至可能得到改善。对从业者有什么启示？：本研究结果表明，由物理治疗师担任高级职责的联合复查诊所不太可能影响患者预后。可以推荐在更广泛范围内采用这种职责替代方式。
