Authors (including presenting author) :
Tang CL, Fong IC, Kwok ML, Man WK, Fung YH
Affiliation :
(1)Out-patient Department, Department of Physiotherapy, Caritas Medical Centre
Introduction :
Peri-operative programme for total knee replacement (TKR) was launched in Caritas Medical Centre (CMC) in October 2020 which aims at enhancing recovery after surgery and reducing post-op complications. Peri-operative physiotherapy at CMC features a seamless approach where a case therapist coordinates the rehabilitation journey of the patient from patient recruitment all the way to post-op outpatient training which is drastically different from the relatively fragmented conventional approach lacking in coordination. This study aims to evaluate the effectiveness of the approach in terms of functional and subjective outcomes, attendance rate, ambulatory status and length of stay for TKR cases.
Objectives :
(1)To evaluate the effectiveness of a seamless peri-operative physiotherapy programme in terms of functional and subjective outcomes. (2)To evaluate the potential of the programme in shortening TKR patients’ length of stay. (3)To evaluate the effectiveness of the programme in improving TKR patients’ out-patient physiotherapy attendance rate. (4)To evaluate the ambulatory status of TKR patients after the programme.
Methodology :
From April to October 2021, 26 patients completed the peri-operative programme. Early recruitment of TKR cases was done at peri-op clinic to a group-based out-patient physiotherapy class. The programme featured pre-op optimization, structured group class, early out-patient appointment (within one week after discharge) and seamless transition of training coordinated by a case therapist whereas cases were handled by different therapists in conventional method. By adopting coordinated service under the new approach, continuity of care, close progress monitoring, reduction in clinical handover and better inter-rater reliability could be achieved.
Result & Outcome :
Length of stay of the patients, out-patient physiotherapy attendance rate and Modified Functional Ambulation Classification (MFAC)were evaluated upon discharge from the programme. Quadriceps strength, Timed Up-and-go (TUG) Test, 30-second sit-to-stand test, Oxford Knee Score and Insall Score were also evaluated at initial pre-operative and final post-operative stages. Direct discharge from acute ward was achieved given the coordinated post-op out-patient service whereas extended stay at rehabilitation bed was necessary under conventional approach. The average length of stay significantly reduced from 17.1±5.51 days to 6.7±5.13 days under the new approach compared to data from conventional approach in 2017 (p<0.05). Attendance rate under the new approach (96%) was significantly higher than that under conventional approach (84%)(p<0.05). All patients achieved MFAC 6 upon discharge from the programme and 75% achieved MFAC 7. The patients demonstrated significant improvement (p<0.05) in quadriceps strength (11.37 to 13.9kg), 30-second sit-to-stand test (8.42 to 10.77 repetitions), TUG test (16.97 to 13.58 seconds), Oxford Knee Score (25.46 to 33.31) and Insall Score (70.96 to 83.35) after the programme.
