Authors (including presenting author) :
Wong WY(1), CHAN LY(1), Cheung TK(1), Chan WC(1), Tam KL(1), Leung SP(1), Cheung YM(1), Yip PY(1), Chan WY(1), To YL(1), Wong WB(2), Ma CM(2), Li YN(2), Hui FP(3), Tam KT(3), Sun TF(4)
Affiliation :
(1) Physiotherapy Department, (2) Orthopaedics and Traumatology Department, (3) Day Rehabilitation Centre, (4) Hospital Chief Executive Office, North District Hospital
Introduction :
To accommodate the surging demand of TKR operation in Hong Kong, it is imperative to allocate resources effectively. In the past, pre-operative procedures and intensive post-operative rehabilitation has largely taken placed in in-patient settings. This arrangement often leads to extensive hospital stays. In response to this challenge, a series of multi-disciplinary actions have been adopted in North District Hospital (NDH)’s TKR clinical pathway in 2018. These measures include multi-disciplinary pre-operative educational classes, inpatient early mobilization by physiotherapist and post-operation intensive rehabilitation offered in Day Rehabilitation Centre (DRC). The enhanced pathway aims to (1) streamline the pathway of patients who undergo Total Knee Replacement, (2) shorten the length of stay of patients who receive Total Knee Replacement and (3) achieve better clinical outcomes for the patients. Physiotherapists work closely with doctors, nurses and occupational therapists to facilitate patients’ discharge planning. Rehabilitation progress will be discussed in the weekly multidisciplinary case conference in day rehabilitation centre.
Objectives :
To evaluate the length of stay and physiotherapy outcomes of patients who participated in accelerated total knee replacement rehabilitation pathway and compared to conventional program.
Methodology :
This is a retrospective cohort study. Patients who have completed TKR rehabilitation in NDH in recent 2 years (2017-2018) were included. Measured physiotherapy outcomes including active and passive range of movement (AROM and PROM) of knee, modified functional ambulation classification (MFAC) and six-minute walking distance (6MWD). Length of stay and clinical physiotherapy outcomes were compared between conventional and enhanced pathway groups by linear regressions and Mann-Whitney U test respectively.
Result & Outcome :
A total of 94 patients were recruited. 67 patients were female while 27 were male. 34 patients (36%) were in enhanced rehabilitation program with the mean length of hospital stay (LOS) of 10.9 (SD=4.4). 60 patients (64%) were in conventional pathway with the mean LOS of 12.9 (SD=6.9). After adjusting for age, the mean LOS between patients of enhanced rehabilitation program and conventional pathway was not significant (p=0.14). When stratified into genders, significant reduction in mean LOS was found in men (p=0.04), but not in women (p=0.70) in the enhanced pathway. No significant difference in AROM and PROM of knee flexion and extension, MFAC and 6MWD (p≥0.14) was found in the physiotherapy outcomes between the two groups of patients. Conclusion:
The enhanced TKR pathway program was effective in shortening the length of stay among male patients, and therefore reduces unnecessary health cost. The physiotherapy outcomes of the patients in enhanced pathway were not compromised when compared with the conventional pathway.
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