Current Australian practice in pre-operative physiotherapy prior to total knee replacement surgery

Objectives To determine the types of pre-operative physiotherapy programmes offered to patients awaiting total knee replacement surgery in Australian public hospitals.

Design A postal questionnaire survey of clinical practice.

Setting 51 Metropolitan public hospitals in Australia.

Main outcome measures A 14-item questionnaire was designed specifically to elicit information about current programmes.

Results An 86% response rate was achieved. Nine hospitals reported that they currently run pre-operative physiotherapy programmes for this patient group. All of these programmes have run for 5 years or less, were supervised by a physiotherapist and were provided at no cost to the patient. Programmes lasted 8 weeks or less, and most included aerobic exercises, balance activities, lower limb strengthening and lower limb stretching. All physiotherapists from hospitals where programmes were running considered that functional outcome after surgery was improved by the programme. An increase in the participant’s general confidence was thought to be the greatest improvement, followed by increased knee strength, general endurance and cardiovascular fitness. Eight additional hospitals have plans to introduce programmes. The greatest perceived barriers to establishing these programmes were cost and funding issues and a lack of evidence to support their use.

Conclusions This survey provides valuable information about the types of pre-operative physiotherapy programmes currently in place in Australia, and shows that other hospitals plan to introduce these programmes despite insufficient evidence to justify their use.