Authors (including presenting author) :
Wong WY(1), Cheung TK(1), Yam TF(1), Tam KL(1), Leung SP(1), Chan WY(1), To YL(1), Lui TH(2), Mok CK(2), Lo CY(2), Li YN(2), Hui FP(3), Tam KT(3), Sun TF(4)
Affiliation :
(1)Physiotherapy Department, (2) Orthopaedics and Traumatology Department, (3)Day Rehabilitation Centre, (4) Hospital Chief Executive Office, North District Hospital
Introduction :
To accommodate the surging demand of TKR operation in Hong Kong, it is imperative to allocate resources effectively. In the past, pre-operative procedures and intensive post-operative rehabilitation has largely taken place in in-patient settings. This arrangement often leads to extensive hospital stays. In response to this challenge, a series of multi-disciplinary actions have been adopted in North District Hospital (NDH)’s TKR clinical pathway in 2018. These measures include multi-disciplinary pre-operative educational classes, inpatient early mobilization by physiotherapist and post-operation intensive rehabilitation offered in Day Rehabilitation Centre (DRC). The enhanced pathway aims to (1) streamline the pathway of patients who undergo Total Knee Replacement, (2) shorten the length of stay of patients who receive Total Knee Replacement and (3) achieve better clinical outcomes for the patients. Physiotherapists work closely with doctors, nurses and occupational therapists to facilitate patients’ discharge planning. Rehabilitation progress will be discussed in the weekly multidisciplinary case conference in day rehabilitation center.
Objectives :
To evaluate the length of stay and physiotherapy outcomes of patients who participated in enhanced total knee replacement rehabilitation pathway and compared to conventional program.
Methodology :
This is a retrospective cohort study. Patients who have completed TKR rehabilitation in NDH in recent 3 years (2017-2019) were included. Measured physiotherapy outcomes including active and passive range of movement (AROM and PROM) of knee, Modified Functional Ambulation Classification (MFAC), six-minute walking distance (6MWD) and Oxford Knee Score(OKS). Length of stay and clinical physiotherapy outcomes were compared between conventional and enhanced pathway groups by linear regressions and Pearson’s Chi square trend test, depending on types of variables.
Result & Outcome :
A total of 209 patients were recruited, of which 145 patients were female while 64 were male. The mean length of hospital stay (LOS) in enhanced rehabilitation program (n=125) was 8.8 (SD=4.6) whereas that in conventional pathway (n=84) was 12.5 (SD=7.6). After adjusting for the age and gender, the mean LOS in patients of enhanced rehabilitation program was significantly lower than that of the conventional pathway (p< 0.01). No significant difference was found in physiotherapy outcomes including MFAC (p=0.50), knee flexion AROM (p=0.20) and PROM (p=0.82), knee extension AROM (p=0.50) and PROM (p=0.45), 6MWD (p=0.76) and OKS (p=0.477) after adjusting for the age and gender. The enhanced TKR pathway program was effective in shortening the length of stay among male patients, and therefore reduced unnecessary health cost. The physiotherapy outcomes of the patients in enhanced pathway were not compromised when compared with the conventional pathway.
