Physiotherapy-Based Rehabilitation after Total Hip or Knee Arthroplasty. CURRENT AUSTRALIAN PRACTICE Hart AJ, Chua MJ, Naylor JM, Mittal R, Harris IA

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Madeleine Morton
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1 Physiotherapy-Based Rehabilitation after Total Hip or Knee Arthroplasty CURRENT AUSTRALIAN PRACTICE Hart AJ, Chua MJ, Naylor JM, Mittal R, Harris IA

2 Acknowledgements and Funding Funding: HCF Research Foundation Acknowledgments: Helen Badge, Project Manager EPOC (Evidence-Based Processes and Outcomes of Care) Carolyn Gray-Robens, Shirley Cross, Kristen Kovacic, Kelly Wheeler, Nidhi Jain, Catherine Belousoff, Rahul Nair (data collection/and or entry)

and Outcomes of Care) Carolyn Gray-Robens, Shirley Cross, Kristen Kovacic,

3 What we know Arthroplasty numbers keep increasing Physiotherapy is beneficial after arthroplasty Home-based rehabilitation is just as beneficial as supervised rehabilitation, including inpatient rehabilitation

Home-based rehabilitation is just as beneficial as

4 What we don t know 1. The proportions of Australia arthroplasty patients receiving home-based program 2. Differences in physiotherapy participation between the public and private sector 3. The costs associated with physiotherapy participation to the funding system

5 Methods A multicentre prospective observational study, EPOC (Evidence-Based Processes and Outcomes of Care) involving 19 high volume public and private orthopaedic centres in Australia Enrolled primary total hip (THA) or total knee (TKA) arthroplasty patients with osteoarthritis Demographic details, medical history, baseline function and surgical data were obtained preoperatively with standardised pro-formae Telephone follow-up conducted at 35 and 90 days post-surgery evaluated rehabilitation received (type, duration, frequency) and complications information

Demographic details, medical history, baseline function and surgical data were obtained preoperatively with standardised pro-formae

6 Methods -continued Physiotherapy could be Inpatient rehabilitation only Inpatient rehabilitation and supervised outpatient sessions Supervised Outpatient sessions only Home-based program, monitored (up to two supervised session) or un-monitored Costs (2014/15 AUD) Inpatient rehabilitation per day = $ (Australian Public Hospital Cost Report, 2013) Supervised outpatient per session = $74.90 (Commcare, 2015)

two supervised session) or un-monitored Costs (2014/15 AUD) Inpatient rehabilitation per day = $967.

7 Results Cohort of 1618 patients Hip Replacement (THA) Knee Replacement (TKA) Public Funding Private Insurance Total n=1618 Majority were female, elderly, overweight and had co-morbidities in both THA and TKA groups Public patients had higher BMI, shorter median lengths of stay after the procedure and more other lower limb and back problems. In the TKA group, public patients also had greater level of comorbidity. No differences were noted in age, gender, ASA score or surgical hip approach between public and private patients

shorter median lengths of stay after the procedure and more other lower limb and back problems.

8 Results whole cohort Any Inpatient Home-based program only Baseline Oxford Knee Score, median, IQR Cost of supervised therapy, median, IQR Hip Replacement n=785 Knee Replacement n=833 Public Pubic n=283 Private n=502 P value Public n=329 Private n=504 P Value 13 (4.6%) 178 (35.5%) < (10.0%) 300 (59.5%) < (52.7%) 223 (44.4%) (20.7%) 69 (13.7%) [11] 23 [12] < [10] 24 [11] <0.001 $375 [$421] $7071 <0.001 $449 [$524] $10384 <0.001 [$12018} [$14001]

Private n=504 P Value 13 (4.6%) 178 (35.5%) <0.001 33 (10.0%) 300 (59.5%) <0.001 149 (52.7%) 223 (44.4%) 0.027 68 (20.

9 Results whole cohort Any Inpatient Home-based program only Baseline Oxford Score, median, IQR Cost of supervised therapy, median, IQR Hip Replacement n=785 Knee Replacement n=833 Public n=283 Private n=502 P value Public n=329 Private n=504 P Value 13 (4.6%) 178 (35.5%) < (10.0%) 300 (59.5%) < (52.7%) 223 (44.4%) (20.7%) 69 (13.7%) [11] 23 [12] < [10] 24 [11] <0.001 $375 [$421] $7071 [$12018} <0.001 $449 [$524] $10384 [$14001] <0.001

10 Results Whole Cohort cont. No difference in major post-discharge complications between patients who had home based programs and those who had supervised therapy (11.7% vs. 9.8%, p=0.498). Public patients had fewer outpatient sessions, but longer lengths of stay in inpatient rehabilitation Curiously, 18% of THA and 34% of TKA patients were continuing supervised physiotherapy at 10 weeks (no difference between public/private).

who had supervised therapy (11.7% vs. 9.8%, p=0.498).

11 Are there reasons to have supervised therapy???

12 Results Uncomplicated cohort Hip Replacement n=708 Knee Replacement n=627 Public n=247 Private n=461 P value Public n=253 Private n=374 P Value Any Inpatient Home-based program only Baseline Oxford Score, median, IQR Cost of supervised therapy, median, IQR 9 (3.6%) 158 (34.3%) < (7.9%) 210 (56.1%) < (55.1%) 210 (45.6%) (20.2%) 58 (15.5%) [11] 23 [12] < [11] 25 [10] <0.001 $375 [$375] $7071 [$11805] <0.001 $449 [$468} $9754 [$13685] <0.001

therapy, median, IQR 9 (3.6%) 158 (34.3%) <0.001 20 (7.9%) 210 (56.1%) <0.001 136 (55.1%) 210 (45.6%) 0.016 51 (20.

13 What does it mean? A minority of patient receive the physiotherapy recommended by best practice evidence This costs Australian health systems millions of dollars Reconciling this evidence-practice gap is important in maintaining the sustainability of both public and private health systems in the face of increasing numbers of joint replacements

This costs Australian health systems millions of dollars Reconciling this

Naylor JM, Descallar J, Grootemaat M, Badge H, Simpson G, Harris IA, Jenkin D Funding: HCF Research Foundation 2013-2015

Is satisfaction with the acute-care experience higher amongst consumers treated in the private sector? A survey of public and private sector arthroplasty recipients Naylor JM, Descallar J, Grootemaat M,