Introduction:There is high emphasis on early inpatient discharge of elective total hip arthroplasty (THA) and total knee arthroplasty (TKA), with Irish guidelines recommending all THA/TKA patients receive physiotherapy (PT) assessment at 3 weeks postoperatively (Health Service Executive, 2015). There is little consensus regarding the optimal nature of outpatient physiotherapy for THA/TKA, and group PT classes may be more resource-efficient than providing individual treatments (Lowe et al., 2007). Currently in Tallaght Hospital, outpatient PT access is variable for TKA and THA patients, with no specific post-operative referral criteria and treatment options restricted to individual PT sessions only.
The aim of this quality improvement project was to:
1. Establish a new TKA/THA group exercise class to improve TKA/THA patient PT access.
2. Determine the effectiveness of a THA/TKA group exercise class, using function, pain, patient experience and PT service provision measures.
Methods:A new physiotherapy THA/TKA circuit-based exercise class was developed. The content of the class was based on evidence gained from literature reviews and communication with other orthopaedic centres nationally and internationally. Primary TKA and THA patients living in the Tallaght Hospital catchment area were referred by the inpatient physiotherapy staff. Patients with cognitive impairment and restricted weight-bearing were excluded. The interactive one-hour group circuit exercise class was held weekly in the physiotherapy gym. Class content included strength, balance and aerobic exercises. Measures captured pre and post the 6-week class explored function (including New Mobility Score), pain (including Visual Analogue Pain Score) and service-user experience using a patient experience questionnaire. The number of PT sessions utilised and attendance rates were obtained. Date were analysed with Microsoft Excel using descriptive statistics.
Results:Postoperative THA/TKA patients were prospectively offered a pilot outpatient PT class from December 2016-February 2017. Twelve patients (mean age 65yrs, range 57-74) were included, and commenced the class on average 4.8 weeks postoperatively. Patients attended an average of 4.6 classes each with a class DNA rate of 3.6%. Mean visual analogue pain score improved from 5.6 to 4.75. New Mobility Score (function) improved from 6.14 to 8.375 out of a maximum score of 9, indicating independent mobility with no aid while outdoor walking and shopping post class. There was a potential saving of 36 PT OPD sessions by offering a group class compared to individual PT sessions over the pilot period. Patient experience was positive (100%, n=12), with high confidence levels reported for physical activity (92%, n=11).
Conclusion:The pilot TKA/TKR class was established successfully and was feasible. This quality improvement initiative enabled timely access to PT for TKR/THA patients in Tallaght Hospital in accordance with national guideline recommendations. It was a positive patient experience, had low DNA rates, and demonstrated improvements in pain, function and exercise confidence. This new resource-effective initiative will continue and may expand to include an education component.
Ethics: Not required for AMNCH/SJH Ethics Committee for clinical audit of quality improvement initiatives.
