Assessing Quality of Post-TJR Rehabilitation: Care Gaps and Patient Perspectives
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.031 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".