Physiotherapy availability dependent on ‘postcode lottery’

New research led by the University of East Anglia has revealed that the amount of physiotherapy available following hip and knee replacements comes down to a 'postcode lottery’.

In collaboration with the universities of Bristol and Oxford, the team at UEA says that patients are more likely to receive physiotherapy after hip or knee replacement in London and the North of England, whilst patients in the South West are the least likely to receive physiotherapy.

Hip and knee replacements are two of the most common surgical procedures performed worldwide., with more than 200,000 carried out in England and Wales in 2017. Post-operation physiotherapy is recommended for a minimum of six weeks, with recovery plans often including hydrotherapy, resistance or aerobic exercise.

But the study, believed to be the first nationwide study of its kind, says that there is substantial variability in the delivery and content of physiotherapy across NHS trusts. Looking at data collected about more than 37,000 patients in their first year after surgery, researchers studied the amount of physiotherapy received  and compared it to factors such as the patient’s level of disability, geographical location, age, social deprivation, gender and ethnicity.

Dr Toby Smith, from UEA's School of Health Sciences, said: "Generally we found that physiotherapy provision was greater following a knee replacement compared to a hip. In the first year after the operation, 79 per cent of people who had a knee replacement received at least one physiotherapy session compared to only 53 per cent of those who had a hip replacement.

"But we found that there is substantial variation in the provision of physiotherapy nationally. And this variation is not explained by the severity of a patient's physical impairment after their operation. 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. But we hope that organisations who aim for parity in service provision across the UK, such as NHS England, Nice and the Quality Care Commission, will act to correct the patient inequality we have shown."

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