News and Media Research Centre
University of Canberra
Building 9, Level C, Room 10
10/06/2024 |
Faculty of Health
Care for Knees
Many Canberrans are living with knee osteoarthritis, which can significantly impact a person’s quality of life, productivity, and health, and some see surgery as their only option. Many of these people do not need a knee replacement at all as knee osteoarthritis does not progress in most cases. Only 10% of people with knee osteoarthritis will need a knee replacement but General Practitioners are quick to refer to surgeons. Only 5% of patients are referred to physiotherapy and only 50% of people waiting for a knee replacement have tried any kind of physiotherapy or exercise intervention – despite physiotherapy successfully supporting 70% of people avoiding knee replacement.
- Only 10% of people with knee osteoarthritis will need a knee replacement
- Only 5% of patients are referred to physiotherapy
- Only 50% of people waiting for a knee replacement have tried any kind of physiotherapy or exercise intervention
- Physiotherapy is 70% successful in people avoiding knee replacement
The high volume of public patient referrals to see a surgeon can extend wait lists for knee replacement surgery. While they are waiting for a consultation with a surgeon, these people miss opportunities for very effective non-surgical programs that will help them avoid surgery. While patients wait for surgical consultation and surgery, they often deteriorate, losing capacity for physical activity and work, which can significantly affect their quality of life.
Evidence from the UK and Australia shows that advanced musculoskeletal physiotherapy clinics improve accurate referral to surgery and facilitate the use of non-surgical programs in the waiting period.
UC researchers from the Clinical Research Rehabilitation and Translation Group, partnered with Canberra Health Services, assist Canberra Health Services to expand the musculoskeletal pre-surgical triage and assessment clinic to service patients in the ACT. The clinic, staffed by Advanced Practice Physiotherapists screen the patients to ensure they get the expert advice quickly and are directed to the appropriate interventions. The team funnels patients who need surgery into surgical consultation or to management for knee osteoarthritis through exercise, education, diet and pain management in community care. Patients are referred to the clinic by their GP.
Timing for knee replacements is important: the best results from surgery are achieved if patients have good strength and movement to aid recovery. There is a Goldilocks zone, not too early, not too late. The project aims to improve patient outcomes by enabling access to better chronic-care management and appropriately timing knee replacements for those that need them. By mapping hidden waiting times, costs, and stakeholder and patient experiences, researchers and health services are working together to overcome the current barriers.
Impact
While the research is still underway, with findings due to be delivered in late 2024, researchers have already reported that wait times for treatment are shorter than in previous years and more people are able to access public physiotherapy.
Category 2 patients (medium urgency condition) should be seen within 90 days. In 2020, these patients waited median 200 days for a consultation. Category 2 patients average wait times have been reduced to median 69 days to consultation.
Category 3 (minimal urgency condition) patients should be seen within 365 days. In 2020, these patients waited median 800 days for consultation. The average wait time for these patients is now median 47 days. In 2023, all category 3 patients were seen in the screening clinic by the Advanced Physiotherapists for expert advice.
In 2022, surgeons discharged 27% of patients following consultation, this improved to 10% of patients being discharged after consultation in 2023.
Some patients join waitlists “in case I need it in 4 years’ time”, however a pre-surgical triage and assessment clinic gives people confidence they will get treatment when they need it.
“I went away feeling that she [the Advanced Practice Physio] had a good handle on my situation. I didn't feel that, you know, I was being shunted down the line by not seeing an orthopaedic surgeon”
– Sally (patient)
In this program, UC researchers and CHS team members are listening to the needs of patients and the community. CHS is able to respond by changing systems. It’s an example of University of Canberra research assisting in partnership with CHS to improve the ACT’s health systems and clinical practice.
Funding
HCF Research Foundation Translational Research Grants
“We’re proud to help turn research into reality through support of the pre-surgical triage and assessment clinic, which will deliver real-world benefits for Australians suffering from knee pain,” HCF Research Foundation Chair, Professor Claire Jackson via UC News, 2022.
Research team
Researchers from Clinical Research Rehabilitation and Translation Group
- Jennie Scarvell
- Angie Fearon
- Theo Niyonsenga
- Nick Brown Queensland University of Technology
Canberra Health Services
- Jo Morris
- Paul Smith
- Tom Ward
- Joe Lynch
- Judy Stone
- Danealle Gilfillan
Other partners:
- Rebecca Davey – Arthritis ACT
- Christian Barton – La Trobe University
- Kirsty Douglas – General Practice and ANU
Learn more
‘New project to tackle orthopaedic waiting list’ Canberra Doctor (page 12; Feb/Mar 2023)
‘New direction for knee OA care pathway’ Physiotherapy In Motion, 2024
‘Research examines painful truth about knee OA’ Physiotherapy In Motion, 2024
WIN News Riverina 2024
‘UC and Canberra Health Services lead development of new Canberra Hospital clinic for knee osteoarthritis patients’ UC News 2022
