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
Introduction
Total hip (THR) and knee replacement (TKR) are two of the most common elective surgical procedures performed worldwide [1], [2]. There were over 200,000 THR and TKR procedures carried out in England and Wales in 2017 [3]. Currently, the UK National Institute for Health and Care Excellence (NICE) recommend that THR and TKR should be offered to patients with end-stage hip or knee osteoarthritis [4]. Both procedures are successful interventions for reducing pain and increasing function [5], [6].
Physiotherapy, principally exercise prescription and gait re-education, is advocated for people after THR and TKR [7], [8]. Previous trials have demonstrated the effectiveness of physiotherapy for both groups of patients [9], [10], [11]. Westby et al. [12] recommended that patients should be provided with a minimum of six weeks physiotherapy after THR and TKR, both for those whose recovery is uneventful and for those with immediately poor outcomes following surgery. Whilst these international recommendations are clear, there remains uncertainty as to what postoperative physiotherapy provision is within healthcare services in the United Kingdom (UK). There is substantial variability in the delivery and content of physiotherapy post joint replacement [13]. This is currently being viewed by clinical commissioners in the UK who seek evidence to support or refute physiotherapy care-pathways for people following joint replacement [14].
No data have been previously reported on the provision of physiotherapy at a national level in the NHS for individuals following THR or TKR. We present the first analysis of the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man (NJR) data to determine: (objective 1) what the current level of physiotherapy provision is across England following primary THR and TKR; and (objective 2) what factors are associated with whether patients receive physiotherapy following THR or TKR.
Section snippets
Patients and methods
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed in the reporting of this comparative prospective cohort study [15].
Characteristics of the population
17,338 people following THR and 20,260 people following TKR were included in the analyses (supplementary Fig. 1). The characteristics of the cohort are presented in Table 1, Table 2.
In total, 4111 people following THR and 4537 people following TKR from the NJR longitudinal PROMs dataset were not included in the analysis due to missing data (supplementary Table 1).
Primary objective: provision of physiotherapy
Across all regions in England, physiotherapy provision was greater following TKR compared to THR (Fig. 1). Within the first
Discussion
This is the first nationwide study to report the provision of physiotherapy in England to people following primary THR and TKR. This has highlighted a difference in physiotherapy provision following THR and TKR, with variation attributed to geographic and patient characteristics. This variation is not explained by the degree of disability experienced. Health care inequality is a major challenge in primary and secondary care [23]. The variation reported in this analysis is of concern, and
Acknowledgements
We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Research Committee and staff at the NJR Centre for facilitating this work. The authors have conformed to the NJR’s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the
References (26)
- et al.
Substantial rise in the lifetime risk of primary total knee replacement surgery for osteoarthritis from 2003 to 2013: an international, population-level analysis
Osteoarthr Cartil
(2017) - et al.
Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review
J Physiother
(2013) - et al.
Development of quality indicators for hip and knee arthroplasty rehabilitation
Osteoarthr Cartil
(2018) - et al.
The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies
J Clin Epidemiol
(2008) - et al.
Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003-2013: a multi-national analysis using national registry data
Arthritis Care Res
(2017) - National Joint Registry (NJR). Stats Online....
Osteoarthritis: care and management. Clinical Guideline CG177
(2017)- et al.
Clinical benefit and cost effectiveness of total knee arthroplasty in the older patient
Eur J Med Res
(2009) - et al.
Characteristics of patients with satisfactory functional gain following total joint arthroplasty in a postacute rehabilitation setting
J Geriatr Phys Ther
(2017) - et al.
Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice?
Musculoskeletal Care
(2014)
Expert consensus on best practices for post-acute rehabilitation after total hip and knee arthroplasty: a Canada and United States Delphi study
Arthritis Care Res
Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis
BMC Musculoskelet Disord
Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthroplasty
Cochrane Database Syst Rev
Cited by (10)
Variation in Utilization of Postoperative Rehabilitation After Total Hip Arthroplasty in Japan
2023, Archives of Physical Medicine and RehabilitationRecovery and the use of postoperative physical therapy after total hip or knee replacement
2022, BMC Musculoskeletal DisordersPhysical therapy as a promising treatment for osteoarthritis: A narrative review
2022, Frontiers in Physiology