Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
Physiotherapy. 2020 Mar;106:1-11. doi: 10.1016/j.physio.2019.11.003. Epub 2019 Nov 20.
Total hip (THR) and knee replacement (TKR) are two of the most common elective orthopaedic procedures worldwide. Physiotherapy is core to the recovery of people following joint replacement. However, there remains uncertainty as to physiotherapy provision at a national level.
To examine the relationship between patient impairment and geographical variation on the provision of physiotherapy among patients who undergo primary total hip or knee replacement (THR/TKR).
Population-based observational cohort study.
Patients undergoing THR (n=17,338) or TKR (n=20,260) recorded in the National Joint Registry for England (NJR) between 2009 and 2010 and completed Patient Reported Outcome Measures (PROMs) questionnaires at Baseline and 12 months postoperatively. Data were analysed on the frequency of physiotherapy over the first postoperative year across England's Strategic Health Authorities (SHAs). Logistic regression analyses examined the relationship between a range of patient and geographical characteristics and physiotherapy provision.
Following THR, patients were less likely to receive physiotherapy than following TKR patients ('some' treatment by a physiotherapist within 1st post operative year: 53% vs 79%). People with worse functional outcomes 12 months postoperatively, received more physiotherapy after THR and TKR. There was substantial variation in provision of physiotherapy according to age (younger people received more physiotherapy), gender (females received more physiotherapy) ethnicity (non-whites received more physiotherapy) and geographical location (40% of patients from South West received some physiotherapy compared to 40 73% in London after THR).
There is substantial variation in the provision of physiotherapy nationally. This variation is not explained by differences in the patient's clinical presentation.
全髋关节置换术（THR）和膝关节置换术（TKR）是全球最常见的两种择期骨科手术。物理治疗是关节置换术后患者康复的核心。然而，在全国范围内，物理治疗的提供仍存在不确定性。
检查在接受初次全髋关节或全膝关节置换术（THR/TKR）的患者中，患者的损伤程度与地理位置之间与物理治疗提供之间的关系。
基于人群的观察性队列研究。
2009 年至 2010 年期间，在英格兰国家关节登记处（NJR）中记录了接受 THR（n=17338）或 TKR（n=20260）的患者，并在基线和术后 12 个月完成了患者报告的结局测量（PROM）问卷。在英格兰战略卫生当局（SHA）中，对术后第一年物理治疗的频率进行了数据分析。逻辑回归分析检查了一系列患者和地理位置特征与物理治疗提供之间的关系。
接受 THR 后，患者接受物理治疗的可能性低于接受 TKR 后的患者（术后 1 年内“某些”治疗由物理治疗师进行：53%对 79%）。术后 12 个月功能结局较差的患者，在 THR 和 TKR 后接受了更多的物理治疗。根据年龄（年轻人接受更多的物理治疗）、性别（女性接受更多的物理治疗）、种族（非白人接受更多的物理治疗）和地理位置（接受某些物理治疗的西南地区患者中有 40%，而伦敦有 40-73%的患者接受 THR），物理治疗的提供存在很大差异。
全国范围内物理治疗的提供存在很大差异。这种差异不能用患者临床表现的差异来解释。
