Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement
Zoe L. Maidment A B , Brenton G. Hordacre B and Christopher J. Barr B C
+ Author Affiliations
- Author Affiliations
A Queensland Health, Bundaberg Hospital, Bourbong Street, Bundaberg, Qld 4670, Australia. Email: zoe.maidment@health.qld.gov.au
B Flinders University, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, SA 5041, Australia. Email: brenton.hordacre@health.sa.gov.au
C Corresponding author. Email: chris.barr@flinders.edu.au
Australian Health Review 38(3) 265-270 https://doi.org/10.1071/AH13232
Submitted: 5 December 2013 Accepted: 18 February 2014 Published: 8 May 2014
Abstract
Objective The aim of the present study was to investigate a change in physiotherapy provision from a 5- to 7-days-a-week service on both physiotherapy and hospital length of stay (LOS) after total knee (TKR) and total hip (THR) replacement.
Methods A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital.
Results There was a significant decrease in physiotherapy LOS from 5.0 days (interquartile range (IQR) 5.0–6.0 days) for a 5-day physiotherapy service, to 5.0 days (IQR 4.0–5.0 days) for 7-day physiotherapy service (U = 1443.5, z = –4.62, P = 0.001). However, hospital LOS was not reduced (P = 0.110). For TKR, physiotherapy LOS decreased significantly by 1 day with a 7-day physiotherapy service (U = 518.0, z = –4.20, P = 0.001). However, hospital LOS was again no different (P = 0.309). For THR there was no difference in physiotherapy LOS (P = 0.060) or hospital LOS (P = 0.303) between the 5- and 7-day physiotherapy services. Where physiotherapy LOS was less than hospital LOS, delayed discharge was due primarily to non-medical issues (72%) associated with hospital organisational aspects.
Conclusions Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce hospital LOS. To be effective this must align with other administrative aspects of hospital discharge.
What is known about the topic? Previous studies have investigated the effect of increasing physiotherapy services following total hip replacement (THR) and total knee replacement (TKR) surgery, with varying reports of decreased or unaffected hospital length of stay (LOS).
What does this paper add? This study investigates both hospital and physiotherapy LOS individually for THR and TKR patients following an increase from a 5- to 7-day physiotherapy service. Where physiotherapy LOS decreased and hospital LOS did not, delays in hospital discharge were investigated.
What are the implications for practitioners? Additional physiotherapy services decrease physiotherapy LOS for TKR patients, but administrative aspects of hospital discharge must improve to reduce hospital LOS.
References
[1] Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The escalating pandemics of obesity and sedentary lifestyle: a call to action for clinicians. Arch Intern Med 2004; 164 249–58.| The escalating pandemics of obesity and sedentary lifestyle: a call to action for clinicians.Crossref | GoogleScholarGoogle Scholar | 14769621PubMed |
[2] Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999; 282 1523–9.
| The disease burden associated with overweight and obesity.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2Fht1WrsA%3D%3D&md5=bad0a17f1d4cdc6afc376580d281a668CAS | 10546691PubMed |
[3] Burton BT, Foster WR. Health implications of obesity: an NIH consensus development conference. J Am Diet Assoc 1985; 85 1117–21.
| 1:STN:280:DyaL2M3ptVCktw%3D%3D&md5=36f82563694197dca9fd96a97aca08bdCAS | 4031328PubMed |
[4] Segal L, Day SE, Chapman AB, Osborne RH. Can we reduce disease burden from osteoarthritis? An evidence-based priority-setting model. Med J Aust 2004; 180 S11–17.
| 14984357PubMed |
[5] Jones CA, Voaklander DC, Johnston D, Suarez-Almazor ME. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol 2000; 27 1745–52.
| 1:STN:280:DC%2BD3M%2FitlyksA%3D%3D&md5=153e1f3b0cc4edd6b07b70dd641b14fdCAS | 10914862PubMed |
[6] Australian Orthopaedic Association (AOA). Australian Orthopaedic Association National Joint Replacement Registry annual report 2013. Adelaide: AOA; 2013.
[7] Jenkins PJ, Clement ND, Hamilton DF, Gaston P, Patton JT, Howie CR. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. J Bone Joint Surg Am 2013; 95B 115–21.
| Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis.Crossref | GoogleScholarGoogle Scholar |
[8] Peck CN, Foster A, McLauchlan GJ. Reducing incision length or intensifying rehabilitation: what makes the difference to length of stay in total hip replacement in a uk setting? Int Orthop 2006; 30 395–8.
| Reducing incision length or intensifying rehabilitation: what makes the difference to length of stay in total hip replacement in a uk setting?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28nivFWmtQ%3D%3D&md5=c1443adf7d2dc5fa0f7ae93b38b1855aCAS | 16568329PubMed |
[9] Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. Arch Phys Med Rehabil 2009; 90 1652–7.
| Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 19801052PubMed |
[10] Ilfeld BM, Mariano ER, Girard PJ, Loland VJ, Meyer RS, Donovan JF, et al A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards. Pain 2010; 150 477–84.
| A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards.Crossref | GoogleScholarGoogle Scholar | 20573448PubMed |
[11] Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery. A case study of 325 patients. Acta Orthop 2008; 79 174–83.
| Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery. A case study of 325 patients.Crossref | GoogleScholarGoogle Scholar | 18484242PubMed |
[12] Feachem RGA, Dixon J, Berwick DM, Enthoven AC, Sekhri NK, White KL. Getting more for their dollar: a comparison of the NHS with California’s Kaiser Permanente Commentary: funding is not the only factor commentary: Same price, better care Commentary: Competition made them do it. BMJ 2002; 324 135–43.
| Getting more for their dollar: a comparison of the NHS with California’s Kaiser Permanente Commentary: funding is not the only factor commentary: Same price, better care Commentary: Competition made them do it.Crossref | GoogleScholarGoogle Scholar |
[13] Brusco NK, Paratz J. The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review. Physiother Theory Pract 2006; 22 291–307.
| The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review.Crossref | GoogleScholarGoogle Scholar | 17166820PubMed |
[14] Pua YH, Ong PH, Chong HC, Lo NN. Sunday physiotherapy reduces inpatient stay in knee arthroplasty: a retrospective cohort study. Arch Phys Med Rehabil 2011; 92 880–5.
| Sunday physiotherapy reduces inpatient stay in knee arthroplasty: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 21621663PubMed |
[15] Freburger JK. An analysis of the relationship between the utilization of physical therapy services and outcomes of care for patients after total hip arthroplasty. Phys Ther 2000; 80 448–58.
| 1:STN:280:DC%2BD3c3ltlCjug%3D%3D&md5=73f8875ac9ff4c6592cad4079f07d560CAS | 10792855PubMed |
[16] Hughes K, Kuffner L, Dean B. Effect of weekend physical therapy treatment on postoperative length of stay following total hip and total knee arthroplasty. Physiother Can 1993; 45 245–9.
| 1:STN:280:DyaK2c7gsFSntA%3D%3D&md5=c5e5f328d875468240bb02f25c9d57e5CAS | 10130908PubMed |
[17] Lang CE. Comparison of 6- and 7-day physical therapy coverage on length of stay and discharge outcome for individuals with total hip and knee arthroplasty. J Orthop Sports Phys Ther 1998; 28 15–22.
| Comparison of 6- and 7-day physical therapy coverage on length of stay and discharge outcome for individuals with total hip and knee arthroplasty.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czhslGksQ%3D%3D&md5=63b01d81a3c816b93ebe824926867a4dCAS | 9653686PubMed |
[18] Boxall AM, Sayers A, Caplan GA. A cohort study of 7 day a week physiotherapy on an acute orthopaedic ward. Orthop Nurs 2004; 8 96–102.
| A cohort study of 7 day a week physiotherapy on an acute orthopaedic ward.Crossref | GoogleScholarGoogle Scholar |
[19] Cullen DJ, Apolone G, Greenfield S, Guadagnoli E, Cleary P. ASA physical status and age predict morbidity after three surgical procedures. Ann Surg 1994; 220 3–9.
| ASA physical status and age predict morbidity after three surgical procedures.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c3ps1Wluw%3D%3D&md5=92328f0dd608e37fc137a957b093206dCAS | 8024356PubMed |
[20] Epps CD. Length stay, discharge disposition, and hospital charge predictors. AORN J 2004; 79 975–97.
| Length stay, discharge disposition, and hospital charge predictors.Crossref | GoogleScholarGoogle Scholar | 15176446PubMed |
[21] Hayes JH, Cleary R, Gillespie WJ, Pinder IM, Sher JL. Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplasty 2000; 15 448–52.
| Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2Fks1Chsg%3D%3D&md5=9bde3d6dcc4c2225ad5e75910293ee1aCAS | 10884204PubMed |
[22] Chung WK, Liu D, Foo LS. Mini-incision total hip replacement: surgical technique and early results. J Orthop Surg (Hong Kong) 2004; 12 19–24.
| 1:STN:280:DC%2BD2crhtFWgsA%3D%3D&md5=0de074955e415276e6d40193d15dd5eaCAS |
[23] Parker A, Lord R, Needham D. Increasing the dose of acute rehabilitation: is there a benefit? BMC Med 2013; 11 199
| Increasing the dose of acute rehabilitation: is there a benefit?Crossref | GoogleScholarGoogle Scholar | 24228867PubMed |
[24] Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial. BMC Med 2013; 11 198
| Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 24228854PubMed |
[25] Peiris C, Taylor N, Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review. Arch Phys Med Rehabil 2011; 92 1490–500.
| 21878220PubMed |
[26] Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, Orav EJ, Stähelin HB, Willett WC, et al Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med 2010; 170 813–20.
| Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXntlOntLY%3D&md5=99cbe40e964e8f262b18fdd863063c00CAS | 20458090PubMed |
[27] Lenssen AF, Crijns YH, Waltje EM, van Steyn MJ, Geesink RJ, van den Brandt PA, et al Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: an RCT. BMC Musculoskelet Disord 2006; 7 71
| 16942627PubMed |
[28] Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, et al Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop 2012; 36 2261–7.
| Predictors for moderate to severe acute postoperative pain after total hip and knee replacement.Crossref | GoogleScholarGoogle Scholar | 22842653PubMed |
[29] de Beer J, Petruccelli D, Adili A, Piccirillo L, Wismer D, Winemaker M. Patient perspective survey of total hip vs total knee arthroplasty surgery. J Arthroplasty 2012; 27 865–9.e5.
| Patient perspective survey of total hip vs total knee arthroplasty surgery.Crossref | GoogleScholarGoogle Scholar | 22333864PubMed |
[30] Naylor J, Harmer A, Fransen M, Crosbie J, Innes L. Status of physiotherapy rehabilitation after total knee replacement in australia. Physiother Res Int 2006; 11 35–47.
| Status of physiotherapy rehabilitation after total knee replacement in australia.Crossref | GoogleScholarGoogle Scholar | 16594314PubMed |
[31] Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, et al What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 2010; 130 263–8.
| What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark.Crossref | GoogleScholarGoogle Scholar | 19633865PubMed |
[32] Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop 2011; 82 679–84.
| Why still in hospital after fast-track hip and knee arthroplasty?Crossref | GoogleScholarGoogle Scholar | 22066560PubMed |
