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Large Joints Feature

Source: Wikimedia Commons and Stephenie Wade

First Indicators for Benchmarking Postsurgical Hip, Knee Rehab

Elizabeth Hofheinz, M.P.H., M.Ed. • Thu, January 25th, 2018

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Researchers from Canada have developed the first set of indicators for total joint replacement (TJR) rehabilitation which define what exact quality indicators (QI) are important and valid in rehabilitation care.

Their study, “Development of quality indicators for hip and knee arthroplasty rehabilitation,” appears in the December 29, 2017 edition of Osteoarthritis and Cartilage.

Marie Westby, P.T., Ph.D.

Marie Westby, P.T., Ph.D., co-author on the study with the Centre for Hip Health and Mobility at the Vancouver Coastal Health Research Institute in British Columbia, told OTW, “Rehabilitation (and pre-hab before surgery) is often overlooked in the larger TJR surgical process yet there is good quality evidence showing the benefits of supervised, appropriately dosed and progressive therapeutic exercise (the mainstay of TJR rehabilitation) on patient outcomes (i.e., pain, anxiety, function, physical activity), experiences and satisfaction after surgery.”

“My earlier research explored the views of patients, health professionals and surgeons on rehabilitation after hip and knee replacement and revealed that many surgeons were skeptical about the need for and benefits of supervised physical therapy and some held the view that referring patients to post-operative rehabilitation was like ‘…sending them into a dark, black hole.’ I wanted to tackle this perception and help surgeons, rehab providers and patients better understand what constitutes quality rehabilitation for TJR surgery.”

“To develop the QIs, we used the well-established RAND-UCLA [University of California] Delphi approach with the only difference being we conducted much of the consensus and discussion process online.”

“Our expert panel this time consisted of orthopaedic surgeons, physical therapists, occupational therapists, orthopaedic nurses, patients and methodologists from across Canada because we were generating QIs that reflected the mostly publicly funded Canadian healthcare system.”

“Based on high quality evidence and broad stakeholder input, we developed the first set of indicators (31 for hip and 36 for knee replacement) for rehabilitation reflecting important and valid aspects of quality rehabilitation care.”

“These quality indicators represent a starting point for establishing the minimum standard of rehab care for TJR and for providing a set of measures to assess, track, and report care processes and establish benchmarks for local and national comparisons.”

“It’s important to understand that these indicators were developed within a Canadian context and surgeons and rehab providers will need to determine which indicators are relevant to their local contexts, payment systems, models of care and patient population. A good and necessary starting point is to assess whether any care gaps exist and in what phase along the continuum (pre, acute, post-acute) so clinicians and managers can prioritize and target their quality improvement efforts. The quality indicators can be used to assess and track rehab care during each care phase and may help to highlight where a clinic, program or facility is performing well and where there is room for improvement.”

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