Knee surgery rehabilitation: new research not the full story

A prominent rehabilitation physician has described new research about home care for knee surgery as promising, but warned against a “one size fits all” approach to rehab.

Epworth Health Care Rehabilitation Physician Dr Steve De Graaff welcomed the new research, which proved simple cases of knee surgery resulted in equally good outcomes for patients as those treated as in patients.

Dr De Graaff said he hoped the article – published in the JAMA this month – would result in private health insurance organisations funding more at home care for straight forward cases.

However, he warned that complex cases, where patients had one or more co-morbidity or were older, would still require in-patient rehabilitation.

“Where a patient post-knee surgery has significant co-morbidities and their health is at risk, discharge into the community would put them further at risk and increases their potential for readmission due to complications. In-patient rehabilitation is the standard treatment of those patients,” he said.

His view was endorsed by Australian Private Hospitals Association CEO Mr Michael Roff who said patients requiring complex knee surgery and significant rehabilitation could be at risk of missing out on care if a blanket approach to rehabilitation in the home was adopted.

Mr Roff said the research funded by private health insurer HCF showing home-based rehabilitation had the same clinical outcomes for patients undergoing uncomplicated knee arthroplasty treated in hospital was over simplified.

“Community and home-based therapy for uncomplicated knee surgery is often undertaken. This is a ploy by insurers in their battle to end mandatory cover for rehabilitation – to suggest in-patient rehabilitation is not necessary is dangerous and may put many thousands of Australians who require intensive rehabilitation following complex surgery at risk of not being able to access it.

“Like most areas of health care this is not a black and white issue and surgery will impact different patients in different ways. For example, elderly patients with co-morbidities may benefit significantly from in-patient rehabilitation and may not recover well from their surgery without it.

“We would rather talk about improving patient care, but if insurance companies are only concerned about profits then they should consider that many times rehabilitation is the difference between recovery and further complications and cost down the track,” Mr Roff said.

Mr Roff said the insurance companies continue to try and restrict rehabilitation cover for members, which is mandatory in all private health insurance policies.

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