Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK.
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsburck, Innsbruck, Austria.
BMJ Open. 2019 Feb 20;9(2):e021614. doi: 10.1136/bmjopen-2018-021614.
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.
Prospective, observational, longitudinal cohort study.
Single National Health Service orthopaedic teaching hospital in the UK.
1395 patients undergoing total hip arthroplasty and 1374 patients undergoing total knee arthroplasty.
Self-reported access of post-discharge physiotherapy, the Oxford Hip or Knee Score, EuroQol 5-dimension questionnaire and post-operative surgical episode satisfaction metric.
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.
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.
评估一种针对出院后门诊物理治疗的按需“治疗”模式。具体来说，我们调查了接受全髋关节置换术（THA）和全膝关节置换术（TKA）的患者中有多少比例在出院后接受了物理治疗，接受治疗是否与关节置换术后患者报告的结果相关，以及是否可以从术前数据预测哪些患者会接受出院后物理治疗。
前瞻性、观察性、纵向队列研究。
英国一家单一的国家卫生服务机构骨科教学医院。
1395 例接受全髋关节置换术的患者和 1374 例接受全膝关节置换术的患者。
自我报告的出院后物理治疗的使用情况、牛津髋关节或膝关节评分、欧洲五维健康量表问卷和术后手术满意度指标。
1374 例 TKA 患者中有 662 例（48.2%）和 1395 例 THA 患者中有 493 例（35.3%）接受了额外的出院后物理治疗。在未接受出院后物理治疗的患者中，THA 和 TKA 的患者报告的结果（p<0.001）和手术满意度（p=0.001）均更高。使用术前症状负担和人口统计学数据的回归模型预测 THA 患者的出院后治疗机会的准确率仅比机会高 17%，而 TKA 患者的准确率仅比机会高 7%。
在髋关节和膝关节置换术后按需“治疗”的基于选择的服务模式中，只有三分之一的 THA 和一半的 TKA 患者接受了出院后治疗。未接受物理治疗的患者报告的术后结果更好。这种对出院后物理治疗需求的差异表明，针对康复治疗可能是一种具有成本效益的模式，但无法从术前数据可靠地预测哪些患者会接受出院后物理治疗。
