Sunday Physiotherapy Reduces Inpatient Stay in Knee Arthroplasty: A Retrospective Cohort Study

Pua Y-H, Ong P-H, Chong H-C, Lo N-N. Sunday Physiotherapy Reduces Inpatient Stay in knee arthroplasty: a retrospective cohort study. Arch Phys Med Rehabil 20112011;92:880-5. Objective: To evaluate, in patients treated with knee arthroplasty, whether providing Sunday (7d/wk) physiotherapy intervention could decrease length of stay (LOS) without affecting discharge knee functional outcomes. Design: Retrospective cohort study. Setting: A tertiary hospital. Participants: Patients (N=229) who underwent total or unicompartmental knee arthroplasty. Interventions: In October 2009, we implemented a Sunday physiotherapy intervention program for patients undergoing knee arthroplasty on Friday or Saturday. Prior to this initiative, physiotherapy intervention was provided from Monday to Saturday. LOS and discharge knee outcomes were compared between patients seen during the 4-month intervention period (n=73) and patients seen in the 4 months prior to the intervention (n=82). To control for secular trends, LOS during the intervention period was compared with LOS during the same 4 months in the prior year (n=74). Main Outcome Measures: LOS and discharge knee functional outcomes comprising (1) passive knee flexion range of motion, (2) the proportion of patients who were able to perform an unassisted straight-leg raise, and (3) the proportion of patients who ambulated safely with the use of a single walking stick or quadstick. Results: During the Sunday physiotherapy intervention period, median LOS significantly reduced (5-4d). Controlling for secular trends in LOS revealed similar results. The number needed to treat for 1 additional patient to achieve a LOS 4 days or shorter with Sunday physiotherapy intervention was between 3 and 4. There were no significant changes in knee functional outcomes. Conclusions: Sunday physiotherapy intervention was associated with a modest reduction in LOS and a faster short-term knee recovery.