To investigate the effect of an acute weekend physiotherapy service compared to no physiotherapy service on short-term outcomes following lower limb joint replacement.
Design:
Pre-post intervention (quasi-experimental) study nested within two stepped-wedge cluster randomized controlled trials.
Setting:
Public tertiary hospital in Melbourne, Australia.
Subjects:
Consecutive patients undergoing hip and knee replacement.
Interventions:
This study analysed a subgroup of one cluster of the parent trials where acute weekend physiotherapy services were sequentially discontinued in random order from one cluster at a time. Intervention (at the ward level) included six months of existing acute weekend physiotherapy services (Phase 1; n = 130) followed by six months when these services were discontinued (Phase 2; n = 146).
Main measures:
Acute hospital length of stay and other short-term patient and hospital measures.
Results:
Availability of weekend physiotherapy was associated with increased odds of discharge directly home (odds ratio (95% confidence interval): 3.151 (1.039–9.555), P = 0.043) and improved mobility (coefficient: 4.301 (1.500–7.101), P = 0.003). However, hospitalization was perceived as less helpful (coefficient: –1.743 (−2.417 to −1.069), P = 0.013) and acute length of stay was longer, only in multivariable analyses (coefficient: 1.003 (0.105–1.890), P = 0.020) than when weekend physiotherapy services were unavailable. Similar results were observed when examining data according to receipt of weekend physiotherapy services rather than the intervention phase to which each patient was allocated.
Conclusion:
The weekend physiotherapy service appears to have had beneficial impacts on discharge destination and patient mobility that may outweigh the unfavourable impacts on acute length of stay and patient-perceived helpfulness of hospitalization.
ChenAGupteCAkhtarKet al. The global economic cost of osteoarthritis: how the UK compares. Arthritis2012; 2012: 698709.
2.
PeelTChengALiewDet al. Direct hospital cost determinants following hip and knee arthroplasty. Arthritis Care Res2015; 67: 782–790.
3.
KhanFNgLGonzalezSet al. Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev2008; 2: CD004957.
4.
HaasRSarkiesMBowlesK-Aet al. Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes: a systematic review and meta-analysis examining allied health service models. Osteoarthritis Cartilage2016; 24: 1667–1681.
5.
MasaracchioMHanneyWJLiuXet al. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: a systematic review with meta-analysis. PLoS ONE2017; 12: e0178295.
6.
ShawKDTaylorNFBruscoNK.Physiotherapy services provided outside of business hours in Australian hospitals: a national survey. Physiother Res Int2013; 18: 115–123.
7.
MitchellDO’BrienLBardoelAet al. Challenges, uncertainties and perceived benefits of providing weekend allied health services – a managers’ perspective. BMC Health Serv Res2017; 17: 118.
8.
O’BrienLMitchellDSkinnerEHet al. What makes weekend allied health services effective and cost-effective (or not) in acute medical and surgical wards? Perceptions of medical, nursing, and allied health workers. BMC Health Serv Res2017; 17: 345.
9.
HainesTPO’BrienLMitchellDet al. Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services. Trials2015; 16: 133.
10.
HainesTPBowlesKMitchellDet al. Impact of disinvestment from weekend allied health services across acute medical and surgical wards: two stepped-wedge, cluster randomised controlled trials. PLoS Med2017; 14: e1002412.
11.
HarrisADMcGregorJCPerencevichENet al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc2006; 13: 16–23.
12.
HoffmannTCGlasziouPPBoutronIet al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Br Med J2014; 348: g1687.
13.
Organisation for Economic Co-operation Development. Health at a glance 2013: OECD indicators. Paris: OECD Publishing, 2013.
14.
Hoogervorst-SchilpJLangelaanMSpreeuwenbergPet al. Excess length of stay and economic consequences of adverse events in Dutch hospital patients. BMC Health Serv Res2015; 15: 1.
15.
ZeidlerJMittendorfTVahldiekGet al. Comparative cost analysis of outpatient and inpatient rehabilitation for musculoskeletal diseases in Germany. Rheumatology2008; 47: 1527–1534.
16.
ShahSVanclayFCooperB.Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol1989; 42: 703–709.
17.
de MortonNADavidsonMKeatingJL.The de Morton Mobility Index (DEMMI): an essential health index for an ageing world. Health Qual Life Outcomes2008; 6: 63.
18.
de MortonNALaneK. Validity and reliability of the de Morton Mobility Index in the subacute hospital setting in a geriatric evaluation and management population. J Rehabil Med2010; 42: 956–961.
19.
FrickeJUnsworthCA.Inter-rater reliability of the original and the modified Barthel Index, and a comparison with the Functional Independence Measure. Aust Occup Ther J1997; 44: 22–29.
20.
CollinCWadeDDaviesSet al. The Barthel ADL Index: a reliability study. Disabil Rehabil1988; 10: 61–63.
21.
HaasRBowlesK-AO’BrienLet al. Patient and therapist agreement on performance rated ability on the de Morton Mobility Index. Arch Phys Med Rehabil2016; 97: 2157–2165.
22.
OemarMJanssenB.EQ-5D-5L user guide basic information on how to use the EQ-5D-5L instrument. Rotterdam: EuroQol Group, 2013, p.28.
23.
Von KorffMDeyoRACherkinDet al. Back pain in primary care: outcomes at 1 year. Spine1993; 18: 855–862.
24.
State Government of Victoria Australia. Victorian patient satisfaction monitor annual report July 2011 to June 2012. Melbourne, VIC, Australia: Department of Health Victoria, 2011–2012.
25.
GuerraMLSinghPJTaylorNF.Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clin Rehabil2015; 29: 844–854.
26.
OldmeadowLBMcBurneyHRobertsonVJ.Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty. J Arthroplasty2003; 18: 775–779.
27.
SarkiesMNBowlesKASkinnerEHet al. Do daily ward interviews improve measurement of hospital quality and safety indicators? A prospective observational study. J Eval Clin Pract2016; 22: 792–798.
28.
SussmanJBHaywardRA.An IV for the RCT: using instrumental variables to adjust for treatment contamination in randomised controlled trials. Br Med J2010; 340: c2073.
29.
KinoshitaSMomosakiRKakudaWet al. Association between seven days per week rehabilitation and functional recovery of acute stroke patients: a retrospective cohort study based on Japan Rehabilitation Database. Arch Phys Med Rehabil2017; 98: 701–706.
30.
KennedyDMHannaSEStratfordPWet al. Preoperative function and gender predict pattern of functional recovery after hip and knee arthroplasty. J Arthroplasty2006; 21: 559–566.
31.
NilsdotterAKLohmanderLS.Age and waiting time as predictors of outcome after total hip replacement for osteoarthritis. Rheumatology2002; 41: 1261–1267.
32.
VanVoorhisCWMorganBL.Understanding power and rules of thumb for determining sample sizes. Tutor Quant Methods Psychol2007; 3: 43–50.
33.
CampbellLBunstonRColangeloSet al. The provision of weekend physiotherapy services in tertiary-care hospitals in Canada. Physiother Can2010; 62: 347–354.
34.
BoxallASayersACaplanGA.A cohort study of 7 day a week physiotherapy on an acute orthopaedic ward. J Orthopaedic Nursing2004; 8: 96–102.
35.
MaidmentZLHordacreBGBarrCJ.Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement. Aust Health Rev2014; 38: 265–270.
36.
PengasIKhanWBennettCet al. Impact of weekend physiotherapy service on the cost effectiveness of elective orthopaedic hip and knee arthroplasty. Open Orthop J2015; 9(suppl 2: M11): 515–519.
37.
HughesKKuffnerLDeanB.Effect of weekend physical therapy treatment on postoperative length of stay following total hip and total knee arthroplasty. Physiother Can1993; 45: 245–249.
38.
PuaY-HOngP-HChongH-Cet al. Sunday physiotherapy reduces inpatient stay in knee arthroplasty: a retrospective cohort study. Arch Phys Med Rehabil2011; 92: 880–885.
39.
CarterEMPottsHW.Predicting length of stay from an electronic patient record system: a primary total knee replacement example. BMC Med Inform Decis Mak2014; 14: 26.
40.
ForrestGPRoqueJMDawoduST.Decreasing length of stay after total joint arthroplasty: effect on referrals to rehabilitation units. Arch Phys Med Rehabil1999; 80: 192–194.
41.
LangC.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 Ther1998; 28: 15–22.
42.
van der PeijlIDVliet VlielandTPVersteeghMIet al. Exercise therapy after coronary artery bypass graft surgery: a randomized comparison of a high and low frequency exercise therapy program. Ann Thorac Surg2004; 77: 1535–1541.
43.
PeirisCLTaylorNFShieldsN.Patients value patient-therapist interactions more than the amount or content of therapy during inpatient rehabilitation: a qualitative study. J Physiother2012; 58: 261–268.
44.
RuffRMYarnellSMarinosJM.Are stroke patients discharged sooner if in-patient rehabilitation services are provided seven V six days per week?Am J Phys Med Rehabil1999; 78: 143–146.
45.
PashikantiLVon AhD. Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature. Clin Nurse Spec2012; 26: 87–94.
46.
KneafseyRCliffordCGreenfieldS.What is the nursing team involvement in maintaining and promoting the mobility of older adults in hospital? A grounded theory study. Int J Nurs Stud2013; 50: 1617–1629.
47.
LiangMHCullenKELarsonMGet al. Effects of reducing physical therapy services on outcomes in total joint arthroplasty. Med Care1987; 25: 276–85.
48.
CraigPDieppePMacintyreSet al. Developing and evaluating complex interventions: the new Medical Research Council guidance. Br Med J2008; 337: a1655.
49.
Independent Hospital Pricing Authority. National hospital cost data collection cost report: Round 19 financial year 2014–15. Sydney, NSW, Australia: Independent Hospital Pricing Authority, 2017
HartABergeronSGEpureLet al. Comparison of US and Canadian perioperative outcomes and hospital efficiency after total hip and knee arthroplasty. JAMA Surg2015; 150: 990–998.
53.
JonasSCSmithHKBlairPSet al. Factors influencing length of stay following primary total knee replacement in a UK specialist orthopaedic centre. Knee2013; 20: 310–315.
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