膝关节置换术后康复相关费用估计及挑战：一项基于医院的横断面研究
Estimation of Expenditure and Challenges Related to Rehabilitation After Knee Arthroplasty: A Hospital-Based Cross-Sectional Study.
作者信息
Malik Isha V, Devasenapathy Niveditha, Kumar Ajit, Dogra Hardik, Ray Shomik, Gautam Deepak, Malhotra Rajesh
机构信息
Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot 47, Sec 44, Institutional Area, Gurgaon, 122002 India.
Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar (East), New Delhi, 110029 India.
出版信息
Indian J Orthop. 2021 May 2;55(5):1317-1325. doi: 10.1007/s43465-021-00405-6. eCollection 2021 Oct.
BACKGROUND
Expenditure for rehabilitation following knee arthroplasty for osteoarthritis- and rehabilitation-related challenges following discharge to home after surgery is not available in the Indian context.
OBJECTIVES
To estimate cost of rehabilitation and document challenges in following rehabilitation advices, from a patient perspective.
METHODS
We conducted a hospital-based cross-sectional study of patients visiting the orthopedic department at a tertiary care public-funded hospital in New Delhi and included those who recently (less than 4 months) underwent primary knee arthroplasty for osteoarthritis. A trained physiotherapist not involved in clinical care collected information on expenditures incurred after discharge from hospital, patient's ability to recall the advices given by the physician and challenges they experienced using a semi-structured questionnaire. We report median costs by category of direct and indirect cost and used linear regression to explore determinants of cost.
RESULTS
We interviewed 82 consecutive patients (mean age 60.8 years and 68% females) with median time since surgery of 28 days. More than half (52%) sought some support for physiotherapy. The median cost of rehabilitation was INR 18,395 (Interquartile-range 11,325-27,775). Direct medical cost contributed to 74% of total cost (32% fee for services, 21% medications and lab investigations, 21% assistive devices). Twenty percent higher costs were incurred among those undergoing bilateral knee surgery after adjusting for age, sex, income, and type of physiotherapy support sought. Challenges were related to recall of advices, not understanding the recovery process and pain management.
CONCLUSION
About half patients undergoing knee arthroplasty seek support for rehabilitation after discharge to home contributing to a major portion of expenses incurred during rehabilitation. Cost-effective support mechanism for home-based rehabilitation is required for improving patient rehabilitation experiences.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-021-00405-6.
背景
在印度，骨关节炎患者膝关节置换术后的康复费用以及术后出院回家后与康复相关的挑战尚无相关数据。
目的
从患者角度估算康复费用，并记录遵循康复建议过程中遇到的挑战。
方法
我们在新德里一家三级护理公立资助医院的骨科对前来就诊的患者进行了一项基于医院的横断面研究，纳入了近期（不到4个月）因骨关节炎接受初次膝关节置换术的患者。一名未参与临床护理的训练有素的物理治疗师使用半结构化问卷收集了出院后产生的费用信息、患者回忆医生所给建议的能力以及他们遇到的挑战。我们按直接成本和间接成本类别报告中位数成本，并使用线性回归来探究成本的决定因素。
结果
我们连续采访了82名患者（平均年龄60.8岁，68%为女性），术后中位时间为28天。超过一半（52%）的患者寻求了某种物理治疗支持。康复的中位数成本为18395印度卢比（四分位间距为11325 - 27775）。直接医疗成本占总成本的74%（32%为服务费用，21%为药物和实验室检查费用，21%为辅助设备费用）。在调整年龄、性别、收入和寻求的物理治疗支持类型后，双侧膝关节手术患者的费用高出20%。挑战与建议的回忆、对恢复过程的不理解以及疼痛管理有关。
结论
约一半接受膝关节置换术的患者出院回家后寻求康复支持，这占康复期间产生费用的很大一部分。需要有成本效益的居家康复支持机制来改善患者的康复体验。
补充信息
在线版本包含可在10.1007/s43465 - 021 - 00405 - 6获取的补充材料。
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