Variation in rehabilitation setting after uncomplicated total knee or hip arthroplasty: a call for evidence-based guidelines.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968565 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2474 (Electronic) Linking ISSN: 14712474 NLM ISO Abbreviation: BMC Musculoskelet Disord Subsets: MEDLINE

Original Publication: London : BioMed Central, [2000-

Professional Practice Gaps*; Arthroplasty, Replacement, Hip/*rehabilitation ; Arthroplasty, Replacement, Knee/*rehabilitation ; Osteoarthritis, Hip/*rehabilitation ; Osteoarthritis, Knee/*rehabilitation; Aged ; Australia ; Evidence-Based Medicine/methods ; Evidence-Based Medicine/standards ; Female ; Humans ; Insurance Coverage/statistics & numerical data ; Male ; Middle Aged ; Osteoarthritis, Hip/surgery ; Osteoarthritis, Knee/surgery ; Practice Guidelines as Topic ; Prospective Studies ; Treatment Outcome

Background: High-level evidence consistently indicates that resource-intensive facility-based rehabilitation does not provide better recovery compared to home programs for uncomplicated knee or hip arthroplasty patients and, therefore, could be reserved for those most impaired. This study aimed to determine if rehabilitation setting aligns with evidence regardless of insurance status.
Methods: Sub-study within a national, prospective study involving 19 Australian high-volume public and private arthroplasty centres. Individuals undergoing primary arthroplasty for osteoarthritis participated. The main outcome was the proportion participating in each rehabilitation setting, obtained via chart review and participant telephone follow-up at 35 and 90 days post-surgery, categorised as 'facility-based' (inpatient rehabilitation and/or ≥ four outpatient-based sessions, including day-hospital) or 'home-based' (domiciliary, monitored or unmonitored home program only). We compared characteristics of the study cohort and rehabilitation setting by insurance status (public or private) using parametric and non-parametric tests, analysing the knee and hip cohorts separately.
Results: After excluding ineligible participants (bilateral surgeries, self-funded insurance, participation in a concurrent rehabilitation trial, experience of a major acute complication potentially affecting their rehabilitation pathway), 1334 eligible participants remained. Complete data were available for 1302 (97%) [Knee: n = 610, mean age 68.7 (8.5) yr., 51.1% female; Hip: n = 692, mean age 65.5 (10.4) yr., 48.9% female]; 26% (158/610) of knee and 61% (423/692) of hip participants participated predominantly in home-based programs. A greater proportion of public recipients were obese and had greater pre-operative joint impairment, but participated more commonly in home programs [(Knee: 32.9% (79/240) vs 21.4% (79/370) (P = 0.001); Hip: 71.0% (176/248) vs 55.6% (247/444) (P <  0.001)], less commonly in inpatient rehabilitation [Knee: 7.5% (18/240) vs 56.0% (207/370) P (< 0.001); Hip: 4.4% (11/248) vs 33.1% (147/444) (P <  0.001], and had fewer outpatient treatments [Knee: median (IQR) 6 (3) vs 8 (6) (P < 0.001); Hip: 6 (4) vs 8 (6) (P < 0.001)].
Conclusions: Facility-based programs remain the norm for most knee and many hip arthroplasty recipients with insurance status being a major determinant of care. Development and implementation of evidence-based guidelines may help resolve the evidence-practice gap, addressing unwarranted practice variation across the insurance sectors.

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IHIIAMR2012073043) HCF Research Foundation; IHIIAMR2012073043 HCF Research Foundation

Keywords: Arthroplasty, hip: rehabilitation; Arthroplasty, knee; Physical therapy

Date Created: 20190517 Date Completed: 20191118 Latest Revision: 20200225

20240104

PMC6521339

10.1186/s12891-019-2570-8

31092230