Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement

The goal of this study was to investigate a change in physiotherapy provision from a 5- to 7-days-a-week service on both physiotherapy and hospital length of stay (LOS) following total knee (TKR) and total hip (THR) replacement. A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital. There was a significant reduction in physiotherapy LOS from 5.0 days (interquartile range (IQR) 5.0-6.0 days) for a 5-day physiotherapy service, to 5.0 days (IQR 4.0-5.0 days) for 7-day physiotherapy service (U=1443.5, z=-4.62, P=0.001). However, hospital LOS was not reduced (P=0.110). For TKR, physiotherapy LOS decreased significantly by 1 day with a 7-day physiotherapy service (U=518.0, z=-4.20, P=0.001). However, hospital LOS was again no different (P=0.309). For THR there was no difference in physiotherapy LOS (P=0.060) or hospital LOS (P=0.303) between the 5- and 7-day physiotherapy services. Where physiotherapy LOS was less than hospital LOS, delayed discharge was due mainly to non-medical issues (72%) associated with hospital organisational aspects.

Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce hospital LOS. To be effective this must align with other administrative aspects of hospital discharge. What is known about the topic? Previous studies have examined the effect of increasing physiotherapy services following total hip replacement (THR) and total knee replacement (TKR) surgery, with varying reports of decreased or unaffected hospital length of stay (LOS). What does this paper add? This study investigates both hospital and physiotherapy LOS individually for THR and TKR patients after an increase from a 5- to 7-day physiotherapy service. Where physiotherapy LOS decreased and hospital LOS did not, delays in hospital discharge were examined. What are the implications for practitioners? Additional physiotherapy services decrease physiotherapy LOS for TKR patients, but administrative aspects of hospital discharge must improve to decrease hospital LOS.