Academic journal article Australian Health Review

Physiotherapy-Led Arthroplasty Review Clinic: A Preliminary Outcomes Analysis

Academic journal article Australian Health Review

Physiotherapy-Led Arthroplasty Review Clinic: A Preliminary Outcomes Analysis

Article excerpt

Introduction

Osteoarthritis (OA) is the leading cause of pain and disability among the elderly.1,2 Orthopaedic surgery can help some patients to increase mobility, joint function and decrease pain. OA coupled with increased obesity rates, longer life expectancy and the continuation of rigorous physical activity at older ages has seen an increase in the volume of total knee and hip replacement surgical procedures performed over recent decades.1,3 The growth in demand for joint replacement surgery has impacted on the ability of the health system to consult patients in a timely manner and determine the most appropriate care options. In response to this increasing demand for Orthopaedic surgery, the focus of planning has been to improve efficiency across the entire care spectrum, including exploring models for improving workforce capability and capacity.

Multidisciplinary care and planning that challenges traditional models of Orthopaedic care delivery could potentially play a key role in improving access to services by reducing waiting times. This can involve substitution for certain healthcare roles and recognition of the dynamic nature of the professional boundaries of the healthcare workforce.4 Physiotherapists have become involved in many extended scope roles within public health care.5-12 Research emerging internationally suggests that patients are highly satisfied with their care in these types of clinics.13-15 Two studies specifically identifying the outcomes of physiotherapy-led review arthroplasty clinics have found that it is a time-effective alternative to orthopaedic surgeon reviews16 while maintain a high level of patient satisfaction.17

The aim of a post-operative review is to monitor patient progress and recovery after surgery and re-focus patient's rehabilitative needs as required. Patients who have had joint replacements are typically reviewed by an orthopaedic surgeon at 6 weeks, 3 months, 6 months and 12 months post operatively, with further reviews at 2, 5, 7 and 10 years post surgery. The Arthroplasty Society of Australia have strongly recommended the long-term follow up of patients with a joint replacement in situ.18 Traditionally, the surgeon has undertaken this important aspect of post operative care; however, as demand for services continue to grow, the capacity of the surgical team to respond will be challenging. Physiotherapists are ideally placed to recognise if there is divergence from the expected path of post operative recovery for patients who undergo joint replacement surgery. Inclusion of the physiotherapist into the post operative review phase would enable the consulting surgeon to see an increased number of new patients, thereby providing expeditious orthopaedic consultation while being responsive to current and increasing wait times across the specialist clinic system.

The physiotherapy (PT) clinic was implemented at a large tertiary teaching hospital as a pilot proj ect in July 2009. The aim of this study was to conduct a safety analysis and determine the effectiveness of physiotherapy-led review of patients after arthroplasty surgery compared with 'usual care' (i.e. orthopaedic surgeon (OS) review).

Methods

Study design

The present study was a retrospective case-controlled audit using a comprehensive database.

Setting

The study was carried out at a large tertiary teaching hospital. A PT clinic was established on a trial basis in 2009, to operate in conjunction with the orthopaedic elective surgery access service (ESAS) clinic. The clinic provided reviews for patients at 3, 6 and 12 months and 2, 5, 7 and 10 years post surgery. All patients were reviewed initially at 6 weeks post surgery by the orthopaedic surgeon.

Participants

Data was routinely collected for the ongoing database for all patients who had undergone joint replacement surgery. Review appointments (other than the initial 6-week surgical review) were allocated by the outpatient clerk to outpatient clinics, including the PT clinics. …

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