Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis:a focus group study

Abstract

BackgroundThere is worldwide variation in rehabilitation practices after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and no agreement on which interventions will lead to optimal short and long term patient outcomes. As a first step in the development of clinical practice guidelines for post-acute rehabilitation after THA and TKA, we explored experiences and attitudes about rehabilitation practices and outcomes in groups of individuals identified as key stakeholders.MethodsSeparate focus groups and interviews were conducted with patients (THA or TKA within past year) and three health professional groups: allied health professionals (AHPs), orthopaedic surgeons, and other physicians, in Canada and the United States. Pairs of moderators led the focus groups using a standardized discussion guide. Discussions were audiotaped and transcribed verbatim. A content analysis within and across groups identified key themes.ResultsEleven focus groups and eight interviews took place in six sites. Patients (n = 32) varied in age, stage of recovery, and surgical and rehabilitation experiences. Health professionals (n = 44) represented a range of disciplines, practice settings and years of experience. Six key themes emerged: 1) Let's talk (issues related to patient-health professional and inter-professional communication); 2) Expecting the unexpected (observations about unanticipated recovery experiences); 3) It's attitude that counts (the importance of the patient's positive attitude and participation in recovery); 4) It takes all kinds of support (along the continuum of care); 5) Barriers to recovery (at patient, provider and system levels), and 6) Back to normal (reflecting diversity of expected outcomes). Patients offered different, but overlapping views compared to health professionals regarding rehabilitation practices and outcomes following THA and TKA.ConclusionResults will inform subsequent phases of guideline development and ensure stakeholders' perspectives shape the priorities, content and scope of the guidelines.

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…The inclusion of individualised exercise specific to each patient aims to increase self-efficacy and empower patients to take an active role as recommended by patient focus groups. 626 Higher levels of self-efficacy at 3 months have been associated with a greater level of functional activity at 9 months after joint replacement, 627 and may enhance adherence to continued home exercise. Involving patients in the design of their rehabilitation may result in better long-term outcome and forms the basis of this function-based group intervention.…”

Examining older patient preferences for quality of care in postacute transition care and day rehabilitation programs

“…However with the Australian government planning to introduce a personally controlled electronic health record system in mid-2012 [24], participants may have had some exposure to this concept via the media. The importance of inter-professional communication was also noted by Westby during focus groups conducted with rehabilitation patients, which revealed that poor communication between health care settings may negatively impact on patient satisfaction, clinical outcomes, and service coordination [25]. Eldar has also identified the interaction between multidisciplinary professionals as a potential influence on quality of care [6].…”

Abstracts of scientific papers and sessions, CPA Congress 2010

“…This is even more evident in joint arthroplasty clinical practice (Westby 2010) and in physiotherapy practice in general (Jette 2009). Barriers to routine use of outcome measures are multi-faceted and include personal (practitioner) and environmental factors such as access to resources, organizational policies and the practice context (Rivard 2010).…”

“…This is not the case with our novel electrode. Relevance to Physiotherapy Practice: A recent study found that near 40% of patients presenting to a specialized osteoporosis service reported having UI at least once per week (1). This is important because UI can significantly limit a woman's ability to be physically active and is an independent risk factor for falls and low trauma fractures in older women.…”

“…It is becoming increasingly recognized that trauma to the levator ani (LA) ('avulsion' injury) is significantly associated with pelvic floor muscle dysfunction (1). Magnetic resonance imaging (MRI) and pelvic floor ultrasound (US) can visualize avulsion injuries whereas manual palpation appears to require substantial training (2).…”