Effectiveness of a weekend physiotherapy service on short-term outcomes following hip and knee joint replacement surgery: a quasi-experimental study

Abstract

Objective:

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.

Keywords

Arthroplasty total knee replacement physiotherapy quantitative study total hip replacement

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