Total joint arthroplasty: practice variation of physiotherapy across the continuum of care in Alberta

Abstract

BackgroundComprehensive and timely rehabilitation for total joint arthroplasty (TJA) is needed to maximize recovery from this elective surgical procedure for hip and knee arthritis. Administrative data do not capture the variation of treatment for rehabilitation across the continuum of care for TJA, so we conducted a survey for physiotherapists to report practice for TJA across the continuum of care. The primary objective was to describe the reported practice of physiotherapy for TJA across the continuum of care within the context of a provincial TJA clinical pathway and highlight possible gaps in care.MethodA cross-sectional on-line survey was accessible to licensed physiotherapists in Alberta, Canada for 11 weeks. Physiotherapists who treated at least five patients with TJA annually were asked to complete the survey. The survey consisted of 58 questions grouped into pre-operative, acute care and post-acute rehabilitation. Variation of practice was described in terms of number, duration and type of visits along with goals of care and program delivery methods.ResultsOf the 80 respondents, 26 (33 %) stated they worked in small centres or rural settings in Alberta with the remaining respondents working in two large urban sites. The primary treatment goal differed for each phase across the continuum of care in that pre-operative phase was directed at improving muscle strength, functional activities were commonly reported for acute care, and post-acute phase was directed at improving joint range-of-motion. Proportionally, more physiotherapists from rural areas treated patients in out-patient hospital departments (59 %), whereas a higher proportion in urban physiotherapists saw patients in private clinics (48 %). Across the continuum of care, treatment was primarily delivered on an individual basis rather than in a group format.ConclusionsVariation of practice reported with pre-and post-operative care in the community will stimulate dialogue within the profession as to what is the minimal standard of care to provide patients undergoing TJA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1873-9) contains supplementary material, which is available to authorized users.

Demographic and geographical variability in physiotherapy provision following hip and knee replacement. An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

“…Furthermore, as this was a survey of physiotherapists, these data may reflect how physiotherapists expect to treat patients rather than the realities of what patients are referred for or receive. In other healthcare systems, Jones et al [25] has previously explored practice variations in physiotherapy following THR and TKR, although only within one region of Canada (Alberta). They reported some variability across providers, but this was largely on an individual level rather than at a region level, as assessed in our data.…”

Benchmarking physiotherapists’ usual care for total hip and knee joint arthroplasty in Australia and New Zealand

“…As no validated tool existed for benchmarking management following TJA, a survey was designed using both open-and closed-ended questions. Questions were informed by previous surveys completed documenting physiotherapy management of individuals following TJA (Jones et al, 2016;Naylor et al, 2006). The survey questions were reviewed and piloted by a group of senior physiotherapists and researchers.…”

“…The Royal Australasian College of Surgeons (2018) suggested clinical variation following TJA may be a sign of system inefficiencies and therefore opportunity for improvement. Physiotherapy plays an essential role in the perioperative care of patients undergoing TJAs; however, variations in practice have been described in the acute and sub-acute settings (Artz et al, 2013;Jones et al, 2016). In a cohort of privately funded patients in Australia, patient-related factors explained only 24.6% of the variance in inpatient rehabilitation rates post-TKA with surgeon-or hospitalrelated factors comprising the remaining 75.4% (Schilling et al, 2018).…”

Development of quality indicators for hip and knee arthroplasty rehabilitation

“…Rehabilitation before and after TJA is an important healthcare topic for QI development 25 . The high volume and growing demand for TJA procedures 11e13, 15,16,26 , significant costs to healthcare systems 18,27,28 , high quality evidence to support the effectiveness of rehabilitation on pre-and post-operative patient outcomes 19,20,22e24 and patient satisfaction 29 , together with marked variations in rehabilitation practices 30,31 and outcomes 32,33 , warrant the effort to develop QIs and address care gaps. Furthermore, based on our previous research and clinical experience, we identified a number of opportunities to change clinical practice behaviours and improve quality of care and patient experiences 29 .…”