Journal of Rehabilitation Medicine 51-10 | Page 55

Joint replacement rehabilitation and role of funding source
weeks, 95% CI 33.9–56.2, p < 0.01) and self-reported
higher quality of life outcomes 6 months after surgery
than their publicly funded counterparts (WHOQOL-8:
MD = 1.5, 95% CI 0.3–2.7, p < 0.05). In terms of use
of rehabilitation, privately funded participants were
less likely to have used rehabilitation after surgery (χ 2
(1) = 4.1, OR 1.5, 95% CI 1.1–2.1, p < 0.05) and reported
more reviews with their surgeon post-operatively than
publicly funded participants (MD = 0.5, 95% CI 0.3–0.8,
p < 0.01). However, privately funded participants who
did use post-operative rehabilitation, participated in
more weeks of rehabilitation than publicly funded par-
ticipants (MD = 3.0, 95% CI 1.2–4.9, p < 0.01). There
were no other differences between the groups.
Unicompartmental knee replacement
Table V shows the breakdown of demographic, clinical
and rehabilitation characteristics for participants with
UKR (n = 60). Privately funded UKR participants were
younger than their publicly funded counterparts (MD
4.3, 95% CI 0.0–8.7, p = 0.05); and were more likely
to be working (χ 2 (1) = 4.7, OR 1.9, 95% CI 1.0–3.6,
p < 0.05). They spent less time on the surgical waiting
list (MD = 57.6 weeks, 95% CI 36.4–78.7, p < 0.01) and
self-reported higher quality of life outcomes 6 months
after surgery (WHOQOL-8: MD = 3.0, 95% CI 0.6–5.4,
p < 0.05). In terms of use of rehabilitation, although
the numbers are small, privately funded participants
775
were less likely to have used rehabilitation before
surgery, but were just as likely to have participated in
rehabilitation after surgery as publicly funded partici-
pants. Privately funded participants also reported more
follow-up visits with their surgeon post-operatively
than their publicly funded counterparts (MD = 0.7, 95%
CI 0.0–1.4, p = 0.05). There were no other differences
between the groups.
DISCUSSION
This study examined associations between funding
source (private vs public), use of rehabilitation and
outcomes before and after hip or knee replacement,
and how these associations varied with education, so-
cioeconomic status, geography and ethnicity. Although
there was some variation based on the joint replaced, a
pattern of differences based on surgery funding source
was evident. It was found that participants who had
surgery funded in the private sector were more likely
to be younger, have higher levels of education, be
employed, and have lower rates of comorbidities at
the time of surgery. These participants also reported
spending less time on the surgical waiting list and were
less likely to participate in pre-surgical rehabilitation.
Privately funded participants using rehabilitation fol-
lowing surgery reported more weeks of rehabilitation
and better patient-reported outcomes in terms of pain,
Table V. Demographic, clinical and rehabilitation characteristics of participants with unicompartmental knee replacement on the basis
of funding type (n =  60)
Funding source
Demographic characteristics
Age, years, mean (SD)
Sex, male, n (%)
Ethnicity, NZ European, n (%)
Educational qualifications, high-school or tertiary, n (%)
Work status at time of surgery, employed, n (%)
Geographical variables, lives in large city a , n (%)
Clinical characteristics
Wait list for surgery, weeks, mean (SD)
Body mass index, mean (SD)
ASA classification, ASA 1 (healthy), n (%)
Total Oxford score, mean (SD) d
WHOQOL-8, mean (SD) d
Rehabilitation characteristics
Any rehabilitation before surgery, yes, n (%)
Pre-operative rehabilitation intensity, mean (SD)
Weeks of pre-operative rehabilitation, mean (SD)
Any rehabilitation after surgery, yes, n (%)
Post-operative rehabilitation intensity, mean (SD)
Weeks of post-operative rehabilitation, mean (SD)
Post-operative surgical reviews, mean (SD)
Time to rehabilitation start, weeks, mean (SD)
Private Public Odds Ratio/ Mean Difference c Significance
(95% confidence Interval)
p b
63.3 (8.0)
17 (60.7)
27 (96.4)
22 (78.6)
20 (71.4) 67.6 (8.7)
19 (59.4)
32 (100.0)
23 (71.9)
14 (43.8) 4.34
1.03
0.46
1.22
1.91
(0.02–8.67)
(0.59–1.80)
(0.35–0.60)
(0.61–2.43)
(1.01–3.63)
0.05
0.92
0.28
0.55
0.03
10 (37.0) 18 (56.3) 1.54 (0.85–2.77)
0.14
5.7 (7.1)
27.9 (5.0)
10 (35.7) 63.2 (54.1)
29.6 (3.9)
6 (26.7) 57.56 (36.43–78.68)
1.68 (0.88–4.25)
1.53 (0.91–2.57)
0.00
0.19
0.14
42.1 (5.5) 38.5 (8.7) 3.59 (–0.19–7.37)
0.07
34.7 (2.9) 31.7 (5.7) 3.01 (0.60–5.43)
0.01
3 (10.7)
21.2 (24.1)
4.3 (1.5)
24 (85.7)
7.9 (5.8)
8.2 (5.8)
2.2 (1.4)
1.8 (2.0) 10 (31.3)
7.2 (5.4)
6.8 (3.7)
23 (71.9)
5.3 (4.1)
6.7 (3.5)
1.5 (1.0)
2.6 (3.0) 2.31 (0.82–6.44)
13.95 (–44.12–72.02)
2.42 (–2.74–6.03)
0.60 (0.25–1.43)
2.62 (–0.75–5.99)
1.53 (–1.51–4.58)
0.72 (0.01–1.43)
0.80 (–0.77–2.39)
0.05
0.42
0.32
0.19
0.12
0.31
0.05
0.31
a
Urban/city (> 50,000 people).
Statistical tests: χ 2 or independent-samples t-tests. Significant results in bold for clarity.
Odds rations presented with respect privately funded services.
d
Oxford and WHOQOL scores at 6 months after surgery.
UKR: unicompartmental knee replacement; NZ: New Zealand; ASA: American Society for Anaesthesiologists classification. WHOQOL-8: World Health Organization
Disability Assessment Schedule-8 item version.
b
c
J Rehabil Med 51, 2019