Journal of Rehabilitation Medicine 51-10 | Page 50

J Rehabil Med 2019; 51: 770–778 ORIGINAL REPORT JOINT REPLACEMENT REHABILITATION AND THE ROLE OF FUNDING SOURCE Deborah L. SNELL, PhD 1 , Jennifer A. DUNN, PhD 1 , K. Anne SINNOTT, MPty 2 , C. Jean HSIEH, PhD 3 , Gerben DE JONG, PhD 4,5 , and Gary J. HOOPER, MD, FRACS 1 From the 1 Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, 2 Burwood Academy of Independent Living, Burwood Hospital, Christchurch, New Zealand, 3 Agency for Healthcare Research and Quality, Rockville, MD, 4 Department of Rehabilitation Medicine, Georgetown University School of Medicine, and 5 MedStar National Rehabilitation Hospital, Washington DC, USA Objective: To examine associations between funding source, use of rehabilitation and outcomes after to- tal joint replacement and to evaluate variations ba- sed on demographic characteristics. Design: Cross-sectional, questionnaire-based natio- nal survey. Subjects: Participants aged 45 years or older (n  = 522) who received either private or public fun- ding for their surgery, were recruited from the New Zealand Joint Registry 6 months after a total hip, to- tal knee or unicompartmental knee replacement. Results: The cohort was predominantly New Zealand European (90%), aged 68 years, with more men (55%) than women (45%). Privately funded partici- pants were younger, had higher levels of education and employment, and lower rates of comorbidities at the time of surgery. Privately funded participants also reported spending less time on the surgical wai- ting list, were less likely to participate in pre-surgical rehabilitation, but reported more weeks of post-sur- gical rehabilitation and better patient-reported out- comes in terms of pain, function and quality of life, compared with their publicly funded counterparts. Conclusion: Factors already known to impact on joint replacement outcomes were associated with funding source in this cohort. Socio-economic dif- ferences and inequities between private and public systems exist consistent with limited available prior research. In this cross-sectional study, no clinical- ly significant differences in outcomes between the groups were identified. Prospective research will help to clarify whether funding source directly af- fects joint replacement rehabilitation outcomes. Key words: total hip replacement; total knee replacement; rehabilitation. Accepted Aug 30, 2019; Epub ahead of print Sep 10, 2019 J Rehabil Med 2019; 51: 770–778 Correspondence address: Deborah Snell, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christ- church, New Zealand. E-mail: [email protected] J oint replacement is an effective elective surgical intervention for degenerative joint disease, such as osteoarthritis (1–3). In New Zealand, as in other countries, the rates of primary hip and knee repla- cement are increasing (4, 5). Given the increasing prevalence of age-related joint disease, joint replace- LAY ABSTRACT This study investigated whether the source of funding influences the use of rehabilitation services and patient outcomes after hip and knee replacement surgery. Pa- tients who received either private insurance or public funding for their joint replacements were identified from a national joint register in New Zealand (n  = 522) and invited to complete a survey 6 months after their opera- tion. Study participants were mostly New Zealand Eu- ropean (90%), aged 68 years, with more men (55%) than women (45%). Privately-funded participants were younger, had more education, and were more likely to be employed than publicly-funded participants. Privat- ely-funded participants also reported waiting less time for their operation, had more rehabilitation after their surgery, and reported better outcomes in terms of pain, function and quality of life, compared with their public- ly-funded counterparts. There appear to be systematic differences between patients receiving public vs private insurance for joint replacement surgery, which raises concerns about unequal access to health services. ment demands are likely to continue to increase as the population ages and gains weight (3, 6). This, in turn, will increase the demand for associated health services, such as pre- and post-operative rehabilitation. A number of factors have been described as drivers for the uptake of elective surgical procedures, such as total joint replacement (TJR). These include age, sex, ethnicity, and socioeconomic status (7, 8). Other rela- ted variables that may influence the use of such health interventions include education and health literacy, alt- hough these have been little studied (7). There is some evidence of inequities in the basis of surgery funding source (8), but little discussion regarding whether this funding source impacts the use of associated services, such as rehabilitation. In addition, research capturing drivers and outcomes of surgery and associated servi- ces funded in the private sector is limited (7). Use of rehabilitation services after TJR may also be impacted by other socio-economic barriers, including geography (9), where access to health services might depend on where a person lives and their employment status. A recently published study evaluated equitable use of publicly funded hip and knee joint replacements in New Zealand (10). In this study the authors reviewed hospital discharge data for people undergoing TJR This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-5600 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977