Assessing Quality of Post-TJR Rehabilitation: Care Gaps and Patient Perspectives
Notice bibliographique
Résumé
Objectives Patients’ access to and experiences with rehabilitation care after total hip (THR) and knee (TKR) replacement surgery vary greatly across Canada. To better understand these differences and increase access to acceptable, effective and equitable care, we developed quality indicators (QIs). The 10 QIs based on literature reviews and a Delphi consensus process,[1,2] reflect the minimum standard of rehabilitation care that patients should expect to receive after THR and TKR. Methods To capture patients’ perspectives and care experiences, we created a patient QI questionnaire and co-tested its usability with patient partners, to ensure clarity and ease of use. Patients indicated whether they received the QI-specific assessment or intervention (5-point ordinal scale) and rated its importance to them (4-point scale). We collected demographic and treatment information and explored respondents’ rehabilitation experiences and satisfaction with outcomes. The English survey was administered through REDCap and fully launched January 2024 for individuals who had a recent THR or TKR and completed their supervised rehabilitation. A French language version will be launched shortly. We performed descriptive data analysis (means, standard deviation, percentages). Results To date, 192 individuals completed the full questionnaire with representation from all provinces and territories (Table 1). On average, respondents reported that 45.1% (SD 23.8%) and 43.4% (SD 28.2%) of the QIs were met for THR and TKR respectively. Adherence was lowest for QI-2 (comprehensive physical exam) and highest for QI-6 (assessing/supporting physical activity). The QI with highest importance ratings related to QI-9 (exercise interventions) for both procedures. We found discordance between patients’ ratings of what was done (QI met) and what was important. For example (TKR), QI-3 (use of standardized patient-reported outcome measure for function), was met for 40% of patients yet 63% rated this as very important. Overall satisfaction with outcomes of surgery and rehabilitation (satisfied/very satisfied) were the same for THR (91%) and TKR (90%); however, a higher proportion of individuals with a THR (56%) were very satisfied compared to TKR (48%). Overall experience ratings (good/excellent) were similar (THR 77%, TKR 82%). Additional analyses of associations between respondent demographics, QI adherence, and rehab care experience and satisfaction will be presented. Table 1 Select participant demographics for English language survey Conclusion From the patient perspective, there is low overall physiotherapist adherence to the 10 THR and TKR rehabilitation QIs. Patients’ importance ratings for many of these QIs highlight the need for change in clinical practice and further testing of the QIs to assess their impact on patient outcomes and care experiences. [1.] Westby M. Osteoarthritis Cartilage 2018;26:370-82. [2.] Westby M. Physiother Canada 2022;e20220083.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,018 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».