Patients' access to and experiences with rehabilitation care after total hip (THA) and knee (TKA) arthroplasty vary greatly across Canada. With the aim of improving the consistency and quality of rehabilitation care, we developed quality indicators (QIs). The 10 QIs based on literature reviews and a Delphi consensus process1,2, reflect the minimum standard of rehabilitation care that patients should expect to receive along the THA and TKA contiuum of care. The purpose of this study was to capture patients' perspectives and rehabilitation care experiences in the post-acute phase after elective THA and TKA for osteoarthritis (OA). We conducted an online, cross-sectional survey between January-September 2024 of patients who underwent elective THA/TKA for OA and had recently completed their supervised rehabilitation. Respondents were asked to indicate whether they received the QI-specific assessment or intervention (5 point ordinal scale) and rated its importance (4 point ordinal scale). We collected demographic and treatment information and explored respondents' rehabilitation experiences and satisfaction with outcomes. The English survey was administered through REDCap and initial data analysis performed in Excel. A French language questionnaire was created and data collection will be completed in December 2024. We performed descriptive data analysis (means, standard deviation, percentages). A total of 192 individuals completed the English questionnaire with representation from all provinces and territories. (See Table 1) On average, respondents reported that 45.1% (SD 23.8%) and 43.4% (SD 28.2%) of the QIs were met for THR and TKR respectively. Adherence was lowest for QI-2 (comprehensive physical exam) and highest for QI-6 (assessing/supporting physical activity). The QI with highest importance ratings related to QI-9 (exercise interventions) for both procedures. We found discordance between patients' ratings of what was done (QI met) and what was important. For example (TKR), QI-3 (use of standardized patient reported outcome measure), was met for 40% of patients yet 63% rated this as very important. Overall satisfaction ratings (satisfied/very satisfied) were the same for THR (91%) and TKR (90%); however, a higher proportion of individuals with a THR (56%) were very satisfied compared to TKR (48%). Overall experience ratings (good/excellent) were similar (THR 77%, TKR 82%). Survey results confirm the marked practice variation in rehabilitation care after THA and TKA in Canada. From the patient perspective, there is low to moderate physiotherapist adherence to the 10 rehabilitation QIs and several care caps. Coupled with patients' importance ratings for many of these QIs, this study highlights the need for changes in rehabilitation practice and suggests potential topics to focus continuing education efforts. For any figures or tables, please contact the authors directly.
Westby et al. (Wed,) studied this question.