Journal of Rehabilitation Medicine 51-10 | Page 53

Joint replacement rehabilitation and role of funding source
years). There were slightly fewer women (45.0%) than
men (55.0%); the sample was predominantly New Zea-
land European (90.0%); 70.5% reported high-school
or tertiary level qualifications and 43% of participants
were in either full- or part-time employment at the
time of surgery.
When demographic and clinical variables were
examined by funding source, the analyses indica-
ted participants privately funded were, on average,
younger than publicly funded participants (mean
difference (MD) = 4.4, 95% CI 2.9–5.9, p < 0.01) and
had higher levels of education (high-school or tertiary
qualifications: χ 2 (3) = 18.8, odds ratio (OR) 1.6, 95%
CI 1.2–2.1, p < 0.01). They were also more likely to be
in either full- or part-time employment (χ 2 (3) = 37.6,
OR (in employment) 1.8, 95% CI 1.5–2.2, p < 0.01).
Those with private funding had lower levels of comor-
bidity (χ 2 (3) = 16.5, OR (ASA score 1) 1.4, 95% CI
1.1–1.8, p < 0.01), spent less time on a surgical wait-list
(MD = 42.9 weeks, 95% CI 36.1–49.7, p < 0.01) and
demonstrated better outcomes in terms of reduced pain
and improved function and quality of life, compared
with publicly funded participants (total Oxford score:
MD = 2.0, 95% CI 0.7–3.3, p < 0.01; WHOQOL-8 total
score: MD = 1.9, 95% CI 1.1–2.8, p < 0.01). There were
no other significant differences between the 2 groups.
These results are also shown in Table I.
Extent of rehabilitation (intensity, duration, type)
and funding source
Table II shows the breakdown of pre- and post-operati-
ve rehabilitation on the basis of funding source. These
analyses indicate that privately funded participants
were less likely to participate in rehabilitation before
surgery than publicly funded participants (χ 2 (1) = 11.3,
OR 1.5, 95% CI 1.2–2.0, p < 0.01), but there were no
differences in use of rehabilitation between the groups
following surgery. However, privately funded parti-
cipants participated in more weeks of rehabilitation
post-operatively (weeks of post-operative rehabilita-
tion: MD = 1.8, 95% CI 0.4–3.2, p < 0.05), and had
more post-operative surgical follow-up (post-operative
surgical reviews: MD = 0.5, 95% CI 0.3–0.7, p < 0.01).
There were no significant differences in terms of
funding or use of rehabilitation on the basis of ethni-
city. However, almost 90% of the sample was of New
Zealand European ethnicity, with New Zealand Māori
making up just 5.0%. The low numbers of non-New
Zealand European participants prevented meaningful
evaluation of associations (see Table I). As shown in
Table I, there were no significant differences on the
basis of geography and those receiving private or
public funding for surgery for the sample as a whole,
773
although there were differences when groups were
examined separately on the basis of the joint replaced
(see below and Tables III–V).
Total hip replacement. Table III shows the breakdown
of demographic, clinical and rehabilitation characte-
ristics for participants with THR (n = 189). Privately
funded THR participants were younger than their
publicly funded counterparts (MD = 5.4, 95% CI
2.6–8.2, p < 0.01), and were more likely to be working
(χ 2 (1) = 24.1, OR 2.6, 95% CI 1.7–3.9, p < 0.01). They
spent less time on the surgical waiting list (MD = 36.8
weeks, 95% CI 28.8–44.7, p < 0.01), and reported less
pain, improved function and quality of life outcomes at
6-months after surgery (total Oxford: MD = 2.2, 95%
CI 0.2–4.2, p < 0.05; WHOQOL-8: MD = 2.2, 95% CI
0.8–3.7, p < 0.01). In terms of use of rehabilitation,
privately funded participants were less likely to have
used rehabilitation before surgery (χ 2 (1) = 5.6, OR
1.7, 95% CI 1.1–2.7, p < 0.01), but were just as likely
to have participated in rehabilitation after surgery as
publicly funded participants. There were no other dif-
ferences between the groups.
Total knee replacement. Table IV shows the breakdown
of demographic, clinical and rehabilitation characte-
ristics for participants with TKR (n = 273). Privately
funded TKR participants were younger than their pu-
blicly funded counterparts (MD 3.8, 95% CI 2.0–5.7,
Table II. Pre- and post-rehabilitation characteristics by funding
type (n = 522)
Funding source
Private
(n = 213) Public
(n = 309)
49 (23.1) 114 (37.0)
5 (9.3) 14 (12.2)
27 (50.0) 65 (56.5)
Pre-operative rehabilitation characteristics
Any rehabilitation before surgery, yes, n (%) a *
Type of rehabilitation, n (%) a
Occupational therapy
Physiotherapy
22 (40.7) 35 (30.4)
12.9 (32.4) 13.0 (30.7)
7.7 (15.9) 6.2 (8.0)
174 (81.7) 240 (77.7)
Occupational therapy 21 (14.6) 22 (7.7)
Physiotherapy 105 (72.9) 237 (83.2)
Other 18 (12.5)
Other
Pre-operative rehabilitation intensity, mean (SD) b
Number of weeks of pre-operative rehabilitation,
mean (SD) b
Post-operative rehabilitation characteristics
Any rehabilitation after surgery, yes, n (%) a
Type of rehabilitation, n (%) a
Post-operative rehabilitation intensity, mean (SD) b 8.8 (9.5)
Number of weeks of post-operative rehabilitation,
mean (SD) b *
9.0 (7.3)
Post-operative surgical reviews, mean ±SD, 95%
2.1 (1.1)
CI b *
2.4 (4.4)
Time to rehabilitation start, weeks, mean (SD) b
26 (9.1)
7.3 (8.4)
7.6 (5.7)
1.6 (1.0)
2.7 (3.3)
*p  < 0.05.
a 2
χ tests.
b
independent-samples t-tests.
Rehabilitation intensity: number of hours per week/number of weeks of
rehabilitation.
J Rehabil Med 51, 2019