Researchers warn of NHS ‘postcode lottery’ in care for knee and hip replacements
Patients experience a “postcode lottery” in accessing physiotherapy following a knee or hip replacement, researchers say.
Their new study found that people are more likely to receive physiotherapy if they live in London or the North of England, while those in the South West are the least likely to receive it.
The experts, from the University of East Anglia (UEA), said the results could not just be explained by a difference in the clinical needs of patients.
NHS guidelines currently recommend a minimum of six weeks of physiotherapy after a knee or hip replacement.
This can include hydrotherapy or special strength or aerobic exercises.
For the study, experts looked at data on 37,598 patients from the UK’s National Joint Registry.
They examined how much physiotherapy people received and compared it to the patient’s level of disability, where they lived, their age, social deprivation, gender and ethnicity.
The results showed that those having a hip replacement received less physiotherapy than those having a knee operation, while younger patients and women were more likely to receive physiotherapy.
Lead researcher Dr Toby Smith from UEA’s school of health sciences, said: “In the first year after the operation, 79% of people who had a knee replacement received at least one physiotherapy session compared to only 53% of those who had a hip replacement.
“We also found that there is substantial rehabilitation inequality dependent on age, with young people receiving more physiotherapy.
“Women were also more likely to receive physiotherapy, as well as non-white people.
“So younger, female patients in urban areas are accessing more physiotherapy after their operations.
“What we don’t know yet is exactly what the causes of this disparity are.
“Individual patient willingness to seek and take part in physiotherapy may be part of the problem.”
He said the team found “substantial variation in the provision of physiotherapy nationally” that was “not explained by the severity of a patient’s physical impairment after their operation.”
Professor Karen Middleton, chief executive of the Chartered Society of Physiotherapy, said: “We know that too many people are left to fend for themselves upon leaving hospital, whether it’s after a knee or hip replacement or other conditions such as stroke.
“In some areas the services just don’t exist or are so restricted that people have to wait far too long to be seen after leaving hospital.
“Missing out on essential rehabilitation can have devastating consequences but it’s a scandal that’s often overlooked because it plays out in people’s homes, away from the public glare.
“We’ve joined forces with more than 20 health and social care organisations to call on political parties to end the scandal and ensure everyone has access to high quality community rehabilitation services after leaving hospital.
“The NHS has become extraordinary at saving lives but for too long the quality of those lives has been ignored, and that must end.”
The new study was published in the journal Physiotherapy.
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