Is Early Discharge Rehabilitation Programme Feasible for Patients with Total Knee Replacement? Preliminary Review by Physiotherapist

Abstract

Introduction: Fast-track surgery with intensive rehabilitation has become the standard management for patients receiving total knee replacement (TKR), which aims to facilitate early re-integration to the community. A new rehabilitation programme was implemented from May to July 2013 in the MacLehose Medical Rehabilitation Centre (MMRC). This paper aimed at reviewing the preliminary result from the perspective of physiotherapist. Materials and Methods: Consecutive patients who were transferred to MMRC for primary TKA rehabilitation from May to July 2013 were recruited for the study. Patients who only met the pre-defined discharge criteria after rehabilitation were discharged. The new rehabilitation programme aimed to discharge patients within 1 week of rehabilitation after unilateral TKR and 2 weeks of rehabilitation after bilateral TKR. Physical impairment and functional outcomes of the patients, and the reasons for non-compliance to the scheduled discharge were analysed. Results: A total of 32 (25 unilateral and 7 bilateral) patients were included. The functional outcomes of all the patients improved significantly after rehabilitation, though 14 (44%) of the patients were not discharged according to schedule. The main barriers were psychosocial aspects including inadequate social support from caregiver at home, lack of confidence in self-management of daily activities and fear of fall, and medical co-morbidities delaying progress of the rehabilitation. Discussion and Conclusion: This preliminary review showed that the present programme is feasible for some patients. To enhance the compliance rate, reinforcement of training in home exercises and self-management strategies, as well as addition of day rehabilitation programme and community social support services may be considered.