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Evidence to Improve Care

Update on Physiotherapy Rehabilitation After Total Knee or Hip Replacement

Ontario Health Technology Advisory Committee Recommendation

  • OHTAC recommends the health system support the move towards community-based physiotherapy after primary total knee or hip replacement and discharge from acute care. In regards to location of physiotherapy within the community, the health system should allow for flexibility, depending on the local care context and the patients’ needs. Current initiatives that are underway in the province to improve allocation of physiotherapy services for primary hip and knee replacement patients should be supported by the health care system.

  • For patients who could attend an outpatient physiotherapy clinic, consideration may be given to a self-managed home exercise program with a physiotherapist monitoring through phone calls.

  • The full benefit of a preoperative exercise program is not as yet realized.

Read the Full Ontario Health Technology Advisory Committee Recommendation Report Here

In 2005, Health Quality Ontario (then the Medical Advisory Secretariat) published an evidence-based analysis to determine where, when, and how physiotherapy rehabilitation is best delivered for people undergoing total hip or knee replacement, and to determine the economic impact of the best delivery strategy.

Total joint replacement is indicated for disabling hip or knee pain and functional impairment as a result of advanced osteoarthritis, rheumatoid arthritis, or other joint diseases when nonsurgical treatments have failed. Total hip replacement and total knee replacement are two of the most commonly performed surgeries in Ontario. The overall rates of both procedures are increasing, along with wait times to receive surgery.

Physiotherapy rehabilitation after total hip or knee replacement is considered a standard and essential treatment. It has four components: therapeutic exercise, transfer training, gait training, and instruction in activities of daily living. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may receive inpatient or outpatient physiotherapy. Inpatient physiotherapy is delivered in a rehabilitation hospital or specialized hospital unit. Outpatient physiotherapy is done either in an outpatient clinic (clinic-based) or in the person’s home (home-based). Physiotherapy rehabilitation may be administered immediately postoperatively (within the first 5 days after surgery) or in the early recovery period (within the first 3 months after surgery).

In 2013, the Ontario Health Technology Advisory Committee updated its recommendation on physiotherapy rehabilitation after total knee or hip replacement to better reflect current accessibility and the current practice of physiotherapy services after hip and knee replacement in Ontario.

Quality-Based Procedures: Clinical Handbook for Primary Hip and Knee Replacement
February 2014

Related Resources

Physiotherapy Rehabilitation After Total Knee or Hip Replacement: An Evidence-Based Analysis
June 2005

OHTAC Recommendation: Physiotherapy Rehabilitation after Total Knee or Hip Replacement
June 2005

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These recommendations are included in the Clinical Handbook for Primary Hip and Knee Replacement, which is a publicly funded quality-based procedure (QBP). Post-surgery home care rehabilitation is funded through this QBP, and Local Health Integration Networks have the flexibility to use these funds for hospital outpatient community-based physiotherapy as needed.

The Ministry of Health and Long-Term Care has provided the following response: The Ministry has a standardized process in place to review Health Quality Ontario recommendations. This takes into consideration Ministry priorities, implementation options, the need for consultation with impacted stakeholders, and funding considerations.

Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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