Original Research

Same-day discharge after early mobilisation and increased frequency of physiotherapy following hip and knee arthroplasty

Retha-Mari Prinsloo, Monique M. Keller
South African Journal of Physiotherapy | Vol 78, No 1 | a1755 | DOI: https://doi.org/10.4102/sajp.v78i1.1755 | © 2022 Retha-Mari Prinsloo, Monique M. Keller | This work is licensed under CC Attribution 4.0
Submitted: 05 December 2021 | Published: 31 May 2022

About the author(s)

Retha-Mari Prinsloo, Department of Physiotherapy, Faculty of Health Science, University of the Witwatersrand, Parktown, South Africa
Monique M. Keller, Department of Physiotherapy, Faculty of Health Science, University of the Witwatersrand, Parktown, South Africa


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Abstract

Background: Advanced rehabilitation pathway (ARP) after hip and knee arthroplasties is popular globally and is gaining ground in South Africa (SA). A multidisciplinary team in Rustenburg, SA, has implemented an ARP with the first same-day discharge (SDD) from hospital. The lack of evidence of physiotherapy protocols within an ARP determined our study.

Objectives: Determine and compare hospital length of stay (LOS) (hours), patient satisfaction (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), patient safety (30-day re-admission) and cost between the two cohorts.

Method: A quantitative prospective patient (treatment) group receiving early mobilisation with increased frequency of physiotherapy on post-operative day zero (POD0) was compared to a conservatively managed retrospective historical (control) group following post-operative elective hip and knee arthroplasties.

Results: Results for the prospective group which were significantly improved relative to the retrospective group included decreased LOS (median 7.650, p < 0.001), less pain at 6 weeks (mean 16.20, standard deviation [SD] = 2.673, p < 0.001), less stiffness (mean 5.82, SD = 1.214, p = 0.007), higher function (mean 54.87, SD = 8.544, p < 0.001), lower hospital cost (mean R43 340, p < 0.001) and physiotherapy cost (mean R1069, p < 0.001), and total costs compared to the retrospective group (mean R117 062, p < 0.001).

Conclusion: Safe and cost-effective SDD is possible in an ARP with earlier mobilisation and increased frequency of physiotherapy on POD0.

Clinical implications: Achieving safe SDD after hip and knee arthroplasty surgeries saved costs and improved patient satisfaction, with a decrease in LOS being beneficial for medical funders and stakeholders including government aiming to implement National Health Insurance (NHI) in the future.


Keywords

length of stay; early mobilisation; physiotherapy; arthroplasty; replacement; hip; knee

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