Effectiveness and Cost-effectiveness of Outpatient Physiotherapy After Knee Replacement for Osteoarthritis: Study Protocol for a Randomised Controlled Trial

Background: Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Methods/design: Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective. Discussion: This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency.

Transformational Leadership and Job-related Learning

Various empirical studies have examined transformational leadership on the effects of followers and organisations. Transformational leadership has been related to individual attitudes and behaviors such as satisfaction with leaders, organisational citizenship behavior, organisational commitment, motivation, trust in leader, creativity, performance, employee involvement, and empowerment. It has also been linked to such organisational outcomes as innovation, change, productivity, ethical climate, and organisational learning. Organisational learning occurs at three levels: individual, group, and organisational. The focus of the present study is on the individual level—job-related learning. Job-related learning is a measure of individual job behavior pertaining to acquisition of knowledge and skills and enhancement of job performance within the context of the individual’s workplace. It argues that transformational leadership inculcates individuals’ drive to learn. The aim of the study is to examine the relationship between transformational leadership and job-related learning. Transformational leadership is composed of four unique but interrelated facets--idealised influence, individualised consideration, inspirational motivation, and intellectual stimulation. The research results support the hypothesis that transformational leadership is positively related to job-related learning. The implications of the research findings and suggestions for future research are discussed.