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.
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.