Can 365-day Physiotherapy Service Improve the Outcome of Patients with Total Knee Arthroplasty?

Introduction

Physiotherapy to patients with Total Knee Arthroplasty (TKA) has been extended to daily service in Queen Mary Hospital since 1st Oct 2017 .

Objectives

We sought to evaluate the 365-day physiotherapy service to TKA patients by analyzing the Hospital Length of Stay (LOS). Timed-up & go test (TUGT), Active Range of Motion (AROM) and Lower Extremity Functional Scale (LEFS).

Methodology

Patients with primary unilateral TKA performed between 1 October 2016 and 31 September 2018 who were directly discharged home from Queen Mary Hospital were reviewed. They were divided into 2 groups: before (Pre-365 group) and after the daily physiotherapy service started (365 group). LOS, TUGT, AROM and LEFS were compared.

Results & Outcome

There were 80 patients in Pre-365 group and 81 patients in 365 group. Baseline assessment of both groups was similar. The LOS of Pre-365 group was 7.7 ± 2.0 days and 365 group was 6.6 ± 1.7 days. The difference between the two groups was statistically significant (p=0.001). The TUGT upon discharge for 365 group (33.3 ± 15.7 seconds) was statistically lower than that of Pre-365 groups (43.5 ± 28.1 seconds) (p=0.01). The TUGT on 2 weeks after the operation for 365 group (22.2 ± 12.7 seconds) was also found to be statistically lower than that of the pre-365 group (29.1 ± 21.7 seconds)(p=0.024). Both LEFS and AROM were similar and no statistical significant differences were found in both groups. The enhancement in provision of physiotherapy service was associated with the improvement in the mobility of patient (TUGT upon discharge and 2 weeks after the operation) and shortening of hospital LOS. This echoed with previous studies which had found that increasing therapy dose was effective in reducing LOS and improving patient outcomes. In conclusion, the service enhancement was effective in managing patients with TKA.