Impact of a physiotherapy general rehabilitation class on patient outcomes with lower limb pathology

Purpose

The aim of the service evaluation was to assess the impact of a 6 week general rehabilitation class has on patient functional and pain experience outcomes.

Approach

215 patients (mean age 60.4 years) were referred to the general rehabilitation class (GRC) for conditions including symptomatic osteoarthritis, post joint replacement or arthroscopic surgery, tendinopathy, post soft tissue injury, including; anterior knee pain, hip or ankle impingement and non-specific mechanical joint pain. Once inducted, patients attended the GRC once a week for six weeks, supervised by a qualified physiotherapist and a technician to assist with exercise progression and/or exercise adaptations. The class involved a patient specific warm up followed by anaerobic based exercises that lasted up to 60 minutes. Prior to starting the GRC, all patients completed a patient specific functional score (PSFS) to assess the impact of their problem on function, and a visual analogue scale (VAS) to assess the impact on their pain. These measures were completed at the end of the 6 week course.

Outcomes

Over a 6 month period, people attending the GRC showed significant improvements in PSFS across all lower limb conditions (mean 4.0, SD± 1.7), with OA hip showing the greatest improved functional change of 7.0 and total hip replacements (THR) showing the least at 2.2. Tendinopathies and total knee replacements additionally showed an improved functional improvement of 5.1 and 5.5. Pain scores showed no clinically meaningful change across all conditions (1.4 ± 1.03). Pain scores for people following THR showed no change in VAS at all.

Post-class questionnaires showed that 85% of people went on to self-manage with an ongoing exercise program, 12% were referred onto a local gym, 3% referred back to the physiotherapist. A total of 24 patients did not complete the full course (average attendance of 5 sessions).

Implications

The results show that the 6 week GRC is an appropriate intervention for improving function in people with various lower limb pathologies. However, it does not seem to improve pain, except for tendinopathies, soft tissue injury and impingement conditions. Further in depth data collection is required to explore this, though it may reflect the fact that people are in less pain when they start the class, having had treatment beforehand for that.

This service evaluation has suggested that pain may not be an appropriate outcome to measure for the GRC. As a result, we plan to trial the use of a quality of life outcome tool, the Brighton musculoskeletal patient reported outcome (BmPROM) to assess the impact on a patient's quality of life alongside the PSFS. This service evaluation demonstrates the benefit of structured outcome measure data collection and the potential benefits for both the service and the service users.

Fund acknowledgements

This work was not funded.

Additional notes

This work was presented at Physiotherapy UK 2018.