Physiotherapy-led arthroplasty review clinic: a preliminary outcomes analysis
Kate E. Large A , Carolyn J. Page A , Kim Brock A D , Michelle M. Dowsey B C and Peter F. M. Choong B CA Physiotherapy Department, St Vincent’s Hospital, PO Box 2900, Fitzroy, Vic. 3065, Australia. Email: katelarge@live.com.au; Carolyn.Page@svhm.org.au
B Department of Orthopaedics, St Vincent’s Hospital, PO Box 2900, Fitzroy, Vic. 3065, Australia. Email: Michelle.Dowsey@svhm.org.au; Peter.Choong@svhm.org.au
C Department of Surgery, The University of Melbourne, Vic. 3010, Australia.
D Corresponding author. Email: Kim.Brock@svhm.org.au
Australian Health Review 38(5) 510-516 https://doi.org/10.1071/AH13238
Submitted: 12 December 2013 Accepted: 4 August 2014 Published: 9 October 2014
Abstract
Objective With the rising demand for Orthopaedics in the healthcare sector, service delivery innovations need to be explored to accommodate the increasing workload. Senior Musculoskeletal Physiotherapists have the specialised skills in the assessment of musculoskeletal conditions to determine the impact of surgery on patient outcomes. The aim of the present study was to compare outcomes between a physiotherapy-led arthroplasty review clinic (PT clinic) and the traditional model of orthopaedic surgeon review (OS clinic) after hip and knee replacement.
Methods This study was a retrospective case-controlled audit using a comprehensive database. Twenty-four patients who had a hip arthroplasty and 52 patients who had a knee arthroplasty were reviewed solely by the PT clinic at 3, 6 and 12 months after surgical reviews. These patients were matched 1 : 2 against patients seen only by the OS clinic. The outcome measures included International Knee Score (IKS), Harris Hip Score (HHS) and the Short Form (SF)-12.
Results There were no significant differences in HHS or SF-12 scores for patients after hip arthroplasty. Significant differences for knee arthroplasty were observed favouring the PT clinic; IKS, PT clinic 147.6 (37.07), OS clinic 135.4 (35.68), P ≤ 0.01, and physical component of the SF-12, PT clinic 41.98 (10.45), OS clinic 37.20 (10.44), P < 0.01.
Conclusion Implementation of a physiotherapy-led arthroplasty review clinic appears to be a safe and effective service alternative to reviews conducted by orthopaedic surgeons.
What is known about the topic? Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability and the burden of the disease is rapidly increasing. Joint arthroplasty surgery is the mainstay of treatment for people with end-stage OA; it is a high-cost, high-volume procedure that dominates surgical wait lists around Australia. Long-term follow up is encouraged by the Arthroplasty Society of Australia and endorsed by the Australian Orthopaedics Association, but it is acknowledged that it is impossible to achieve this with solely orthopaedic surgeon reviews, an issue that is only going to worsen with the increased demand for surgery. Physiotherapists have become involved in many advanced scope roles within public health care, and emerging research suggests that patients are highly satisfied with their care in these types of clinics.
What does this paper add? Although it has been shown that patients are satisfied in physiotherapy-led advanced clinics, there is a paucity of evidence in the outcomes of patients attending these clinics. Implementation of a physiotherapy-led arthroplasty review clinic demonstrated that outcome measures in this patient cohort were not compromised and, following knee joint arthroplasty, may even be improved.
What are the implications for practitioners? The findings of this study indicate that joint review clinics involving physiotherapists acting in an advanced scope role are unlikely to compromise patient outcomes. The use of this role substitution on a broader scale can be recommended.
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