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Estimation of Expenditure and Challenges Related to Rehabilitation After Knee Arthroplasty: A Hospital-Based Cross-Sectional Study

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Abstract

Background

Expenditure for rehabilitation following knee arthroplasty for osteoarthritis- and rehabilitation-related challenges following discharge to home after surgery is not available in the Indian context.

Objectives

To estimate cost of rehabilitation and document challenges in following rehabilitation advices, from a patient perspective.

Methods

We conducted a hospital-based cross-sectional study of patients visiting the orthopedic department at a tertiary care public-funded hospital in New Delhi and included those who recently (less than 4 months) underwent primary knee arthroplasty for osteoarthritis. A trained physiotherapist not involved in clinical care collected information on expenditures incurred after discharge from hospital, patient’s ability to recall the advices given by the physician and challenges they experienced using a semi-structured questionnaire. We report median costs by category of direct and indirect cost and used linear regression to explore determinants of cost.

Results

We interviewed 82 consecutive patients (mean age 60.8 years and 68% females) with median time since surgery of 28 days. More than half (52%) sought some support for physiotherapy. The median cost of rehabilitation was INR 18,395 (Interquartile-range 11,325–27,775). Direct medical cost contributed to 74% of total cost (32% fee for services, 21% medications and lab investigations, 21% assistive devices). Twenty percent higher costs were incurred among those undergoing bilateral knee surgery after adjusting for age, sex, income, and type of physiotherapy support sought. Challenges were related to recall of advices, not understanding the recovery process and pain management.

Conclusion

About half patients undergoing knee arthroplasty seek support for rehabilitation after discharge to home contributing to a major portion of expenses incurred during rehabilitation. Cost-effective support mechanism for home-based rehabilitation is required for improving patient rehabilitation experiences.

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References

  1. Artz, N., Elvers, K. T., Lowe, C. M., Sackley, C., Jepson, P., & Beswick, A. D. (2015). Effectiveness of physiotherapy exercise following total knee replacement: Systematic review and meta-analysis. BMC Musculoskeletal Disorders, 16, 15

    Article  Google Scholar 

  2. Pua, Y. H., Seah, F. J., Poon, C. L., Tan, J. W., Liaw, J. S., & Chong, H. C. (2017). Association between rehabilitation attendance and physical function following discharge after total knee arthroplasty: prospective cohort study. Osteoarthritis and Cartilage/OARS, Osteoarthritis Research Society, 25, 462–469

    Article  Google Scholar 

  3. Pisters, M. F., Veenhof, C., Schellevis, F. G., Twisk, J. W., Dekker, J., & De Bakker, D. H. (2010). Exercise adherence improving long-term patient outcome in patients with osteoarthritis of the hip and/or knee. Arthritis Care & Research, 62, 1087–1094

    Article  Google Scholar 

  4. Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Manual Therapy, 15, 220–228

    Article  Google Scholar 

  5. Buhagiar, M. A., Naylor, J. M., Harris, I. A., Xuan, W., Adie, S., & Lewin, A. (2019). Assessment of outcomes of inpatient or clinic-based vs home-based rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. JAMA Network Open, 2, e192810

    Article  Google Scholar 

  6. Medical Advisory Secretariat. (2005). Physiotherapy rehabilitation after total knee or hip replacement: An evidence-based analysis. Ont Health Technol Assess Ser. 5(8), 1–91

    PubMed Central  Google Scholar 

  7. Aseer, P. A. L., Maiya, G. A., Kumar, M. M., & Vijayaraghavan, P. V. (2017). Content validation of total knee replacement rehabilitation protocol in indian population. Journal of Clinical and Diagnostic Research: JCDR, 11, YC05-YC9

    PubMed  PubMed Central  Google Scholar 

  8. Oatis, C. A., Li, W., DiRusso, J. M., Hoover, M. J., Johnston, K. K., Butz, M. K., Phillips, A. L., Nanovic, K. M., Cummings, E. C., Rosal, M. C., Ayers, D. C., & Franklin, P. D. (2014). Variations in delivery and exercise content of physical therapy rehabilitation following total knee replacement surgery: A cross-sectional observation study. International Journal of Physical Medicine and Rehabilitation. https://doi.org/10.4172/2329-9096.S5-002

    Article  PubMed  Google Scholar 

  9. Artz, N., Dixon, S., Wylde, V., Beswick, A., Blom, A., & Gooberman-Hill, R. (2013). Physiotherapy provision following discharge after total hip and total knee replacement: A survey of current practice at high-volume NHS hospitals in England and wales. Musculoskeletal Care, 11, 31–38

    Article  Google Scholar 

  10. Choudhari, P., Agrawal, U., & Shaikh, T. (2017). Trends in scientific publications of Indian arthroplasty surgeons over 15 years (2001–2015). Journal of Arthroscopy and Joint Surgery, 4, 94–99

    Article  Google Scholar 

  11. Ferket, B. S., Feldman, Z., Zhou, J., Oei, E. H., Bierma-Zeinstra, S. M., & Mazumdar, M. (2017). Impact of total knee replacement practice: cost effectiveness analysis of data from the osteoarthritis Initiative. British Medical Journal, 356, j1131

    Article  Google Scholar 

  12. Losina, E., Paltiel, A. D., Weinstein, A. M., Yelin, E., Hunter, D. J., Chen, S. P., Klara, K., Suter, L. G., Solomon, D. H., Burbine, S. A., Walensky, R. P., & Katz, J. N. (2015). Lifetime medical costs of knee osteoarthritis management in the United States: Impact of extending indications for total knee arthroplasty. Arthritis Care & Research, 67, 203–215

    Article  Google Scholar 

  13. Model tender document for selection of implementation support agency for providing support services for the implementation of Ayushman Bharat—National Health Protection Mission. https://pmjay.gov.in/resources/documents Accessed on 22 Sep 2020

  14. Saleh, K. J., Mulhall, K. J., Bershadsky, B., Ghomrawi, H. M., White, L. E., Buyea, C. M., & Krackow, K. A. (2005). Development and validation of a lower-extremity activity scale. Use for patients treated with revision total knee arthroplasty. The Journal of Bone and Joint Surgery-American Volume, 87, 1985–1994

    Article  Google Scholar 

  15. Lyman, S., Lee, Y. Y., Franklin, P. D., Li, W., Cross, M. B., & Padgett, D. E. (2016). Validation of the KOOS, JR: A short-form knee arthroplasty outcomes survey. Clinical Orthopaedics and Related Research, 474, 1461–1471

    Article  Google Scholar 

  16. Shin, J. T., Park, R., Song, W. I., Kim, S. H., & Kwon, S. M. (2010). The redevelopment and validation of the rehabilitation adherence questionnaire for injured athletes. International Journal of Rehabilitation Research, 33, 64–71

    Article  Google Scholar 

  17. Ong, K. L., Lotke, P. A., Lau, E., Manley, M. T., & Kurtz, S. M. (2015). Prevalence and costs of rehabilitation and physical therapy after primary TJA. The Journal of Arthroplasty, 30, 1121–1126

    Article  Google Scholar 

  18. Büker, N., Akkaya, S., Akkaya, N., Gökalp, O., Kavlak, E., Ök, N., Kıter, A. E., & Kitiş A. (2014). Comparison of effects of supervised physiotherapy and a standardized home program on functional status in patients with total knee arthroplasty: A prospective study. Journal of Physical Therapy Science, 26, 1531–1536

    Article  Google Scholar 

  19. Luo, Z., Zhang, T., Meng, W., Wang, D., Pan, H., & Zhou, Z. (2017). Cost comparing home-based rehabilitation with hospital-based rehabilitation following total joint replacement: Systematic review and meta-analysis. International Journal of Clinical and Experimental Medicine, 10(12), 15825–15833

    Google Scholar 

  20. Li, D., Yang, Z., Kang, P., & Xie, X. (2017). Home-based compared with hospital-based rehabilitation program for patients undergoing total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. American Journal of Physical Medicine and Rehabilitation, 96, 440–447

    Article  Google Scholar 

  21. Naylor, J. M., Hart, A., Mittal, R., Harris, I., & Xuan, W. (2017). The value of inpatient rehabilitation after uncomplicated knee arthroplasty: A propensity score analysis. The Medical Journal of Australia, 207, 250–255

    Article  Google Scholar 

  22. Westby, M. D., & Backman, C. L. (2010). Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis: A focus group study. BMC Health Services Research, 10, 119

    Article  Google Scholar 

  23. Zacharia, B., Paul, M., & Thanveeruddin, S. M. (2016). Patient-based outcome analysis is important to determine the success of total knee arthroplasty: Result of a focus group discussion. Medical Devices: Evidence and Research, 9, 125–130

    Google Scholar 

  24. Buus, A. A. O., Hejlsen, O. K., Bjornes, C. D., & Laugesen, B. (2019). Experiences of pre- and postoperative information among patients undergoing knee arthroplasty: A systematic review and narrative synthesis. Disabil Rehabil. 43(2):150–162. https://doi.org/10.1080/09638288.2019.1615997

    Article  PubMed  Google Scholar 

  25. Jiang, S., Xiang, J., Gao, X., Guo, K., & Liu, B. (2018). The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 24, 257–262

    Article  Google Scholar 

  26. Wang, X., Hunter, D. J., Vesentini, G., Pozzobon, D., & Ferreira, M. L. (2019). Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 20, 506

    Article  Google Scholar 

  27. Fusco, F., & Turchetti, G. (2016). Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care. British Medical Journal Open, 6, e009964

    Google Scholar 

  28. Nelson, M., Russell, T., Crossley, K., Bourke, M., & McPhail, S. (2019). Cost-effectiveness of telerehabilitation versus traditional care after total hip replacement: A trial-based economic evaluation. J Telemed Telecare. https://doi.org/10.1177/1357633X19869796

    Article  PubMed  Google Scholar 

  29. Harvey, L. A., Brosseau, L., & Herbert, R. D. (2014). Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. 6:(2):CD004260. https://doi.org/10.1002/14651858.CD004260.pub3

    Article  PubMed  Google Scholar 

  30. Yang, X., Li, G. H., Wang, H. J., & Wang, C. Y. (2019). Continuous passive motion after total knee arthroplasty: A systematic review and meta-analysis of associated effects on clinical outcomes. Archives of Physical Medicine and Rehabilitation, 100, 1763–1778

    Article  Google Scholar 

  31. Volpato, H. B., Szego, P., Lenza, M., Milan, S. L., Talerman, C., & Ferretti, M. (2016). Femoral quadriceps neuromuscular electrical stimulation after total knee arthroplasty: A systematic review. Einstein (São paulo) 14, 77–98

    Article  Google Scholar 

  32. Skoffer, B., Dalgas, U., & Mechlenburg, I. (2015). Progressive resistance training before and after total hip and knee arthroplasty: A systematic review. Clinical Rehabilitation, 29, 14–29

    Article  Google Scholar 

  33. Gibson, A. J., & Shields, N. (2015). Effects of aquatic therapy and land-based therapy versus land-based therapy alone on range of motion, edema, and function after hip or knee replacement: A systematic review and meta-analysis. Physiotherapy Canada, 67, 133–141

    Article  Google Scholar 

  34. Davila Castrodad, I. M., Recai, T. M., Abraham, M. M., et al. (2019). Rehabilitation protocols following total knee arthroplasty: A review of study designs and outcome measures. Annals of Translational Medicine, 7, S255

    Article  Google Scholar 

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Authors and Affiliations

  1. Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot 47, Sec 44, Institutional Area, Gurgaon, 122002, India

    Isha V. Malik, Niveditha Devasenapathy, Hardik Dogra & Shomik Ray

  2. Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar (East), New Delhi, 110029, India

    Ajit Kumar, Deepak Gautam & Rajesh Malhotra

Authors
  1. Isha V. Malik
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  2. Niveditha Devasenapathy
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  3. Ajit Kumar
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  4. Hardik Dogra
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Contributions

Study conceptualisation and design: ND, DG, RM, IVM. Data acquisition: IVM, HD, AK. Data analysis: IVM, ND, SR. Manuscript: First draft IVM and ND. All authors contributed in revising the manuscript and agreed to the final version.

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Correspondence to Rajesh Malhotra.

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Malik, I.V., Devasenapathy, N., Kumar, A. et al. Estimation of Expenditure and Challenges Related to Rehabilitation After Knee Arthroplasty: A Hospital-Based Cross-Sectional Study. JOIO 55, 1317–1325 (2021). https://doi.org/10.1007/s43465-021-00405-6

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  • DOI: https://doi.org/10.1007/s43465-021-00405-6

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