Evidence map›Paper›PMID 30787073›Full record

Observational studyBMJ open2019

Exploring variation in patient access of post-discharge physiotherapy following total hip and knee arthroplasty under a choice based system in the UK: an observational cohort study.

David F Hamilton, Fanny C Loth, Deborah J MacDonald, Gary J MacFarlane, David J Beard, A Hamish Rw Simpson, James T Patton, Colin R Howie

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
2.9field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Trial
  5. Observational
  6. Review
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

David F HamiltonDepartment of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK.ORCID 0000-0001-9060-9255
Fanny C LothDepartment of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsburck, Innsbruck, Austria.
Deborah J MacDonaldDepartment of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK.
Gary J MacFarlaneEpidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
David J BeardNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
A Hamish Rw SimpsonDepartment of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK.
James T PattonDepartment of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK.
Colin R HowieDepartment of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK.
University of Edinburgh · GBInnsbruck Medical University · ATNuffield Orthopaedic Centre · GBUniversity of Aberdeen · GB

Funding

Arthritis Research UK 71000
6 · The paper itself

Abstract

objectivesTo assess a targeted 'therapy as required' model of post-discharge outpatient physiotherapy provision. Specifically, we investigated what proportion of patients accessed post-discharge physiotherapy following total hip arthroplasty (THA) and total knee arthroplasty (TKA), whether accessing therapy was associated with post-arthroplasty patient reported outcomes and whether it was possible to predict which patients would access post-discharge physiotherapy from pre-operative data.

designProspective, observational, longitudinal cohort study.

settingSingle National Health Service orthopaedic teaching hospital in the UK.

participants1395 patients undergoing total hip arthroplasty and 1374 patients undergoing total knee arthroplasty. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported access of post-discharge physiotherapy, the Oxford Hip or Knee Score, EuroQol 5-dimension questionnaire and post-operative surgical episode satisfaction metric.

results662 (48.2%) patients with TKA and 493 (35.3%) patients with THA accessed additional post-discharge physiotherapy. Patient-reported outcomes (p<0.001) and surgical episode satisfaction (p=0.001) in both THA and TKA were higher in patients that did not participate in post-discharge physiotherapy. Regression models using pre-operative symptom burden and demographic data predicted post-discharge therapy access with an accuracy of only 17% greater than chance in patients with THA and 7% greater than chance in patients with TKA.

conclusionsIn a choice-based service model of 'therapy as required' following hip and knee arthroplasty only a third of THA and half of TKA patients accessed post-discharge therapy. Patients who did not access physiotherapy reported greater post-operative outcomes. This variation in the need for post-discharge physiotherapy suggests that targeting of rehabilitation may be a cost-effective model, however it was not possible to reliably predict which patients would access post-discharge physiotherapy from pre-operative data.

Indexed as

AgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeFemaleHealth Services AccessibilityHumansLongitudinal StudiesMaleMiddle AgedPatient SatisfactionPhysical Therapy ModalitiesProspective StudiesSurveys and QuestionnairesUnited Kingdomoutcomesphysiotherapytotal hip arthroplastytotal knee arthroplasty

Identifiers

PMID30787073
PMCPMC6398686
OpenAlexW2916397581

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.