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Introductory insights into patient preferences for outpatient rehabilitation after knee replacement: implications for
Justine M Naylor1, Rajat Mittal, Katherine Carroll
1Orthopaedic Department, Liverpool Hospital, Sydney, New South Wales, Australia. justine.naylor@sswahs.nsw.gov.au
Objectives:
Current perspectives concerning clinical decision making favour inclusion of patient preference for therapy. This exploratory study aimed to forge introductory insights into patient preference for outpatient-based rehabilitation after total knee replacement (TKR).
Methods:
TKR recipients from six public hospitals participating in a prospective, longitudinal study assessing outcomes after surgery were surveyed 1 year after surgery about preferences for rehabilitation. Surveys were conducted face-to-face or via postal questionnaire. Questions included global satisfaction (percentage scale) with therapy received, future preference for therapy and the reasons underpinning preference.
Results:
Ninety-three (93/115) TKR recipients participated [mean age 68 (SD 8) years; 66% female; 75% face-to-face interview]. Group-based (39/93) and one-to-one therapies (38/93) were the most common modes experienced. Most participants (81/93) were highly satisfied (satisfaction ≥ 75%). Future preference was associated with satisfaction with past exposure regardless of mode (P = 0.02), hence no overall preference for one mode emerged. Commonality existed in the reasons why patients preferred specific modes. The most common reason for preferring group-based therapy was psychosocial benefit whilst the more personalized approach was the most common reason for preferring one-to-one therapy.
Conclusions:
Patient global satisfaction is similarly high across different modes of outpatient rehabilitation despite differences in perceived benefits. The association between satisfaction and preference potentially indicates that provided the service is deemed high quality, the actual mode of therapy offered is less important to this patient population. Research is required, however, to establish the relationship between preference and outcome, the stability of preference across time, and the effect of multiple rehabilitation exposures on preference. For now, the quality of current uni-modal programmes could be enhanced by incorporation of features typically associated with alternative modes.
