Physiotherapy postcode lottery scandal revealed in UK research

The amount of physiotherapy available after hip and knee replacement surgery varies wildly depending on where in England or Wales a person lives, says research in Physiotherapy.

London and the north of England has a good provision of physiotherapy after joint replacement operations, with those in the south west of the country less lucky. Gender and ethnicity come into play too.

More than 200,000 hip and knee replacement operations were carried out in England and Wales in 2017. Post-operation physiotherapy is recommended for a minimum of six weeks and includes individual or group-based hydrotherapy, resistance or aerobic exercise.

Now a nationwide study has investigated and mapped the provision of physiotherapy after a knee or hip replacement. The researchers had access to data from over 37,000 people in the first year after surgery. They studied the amount of physiotherapy the patients received, and compared it to factors such as level of disability, geographical location, age, social deprivation, gender and ethnicity.

Key findings

• Physiotherapy provision was greater following knee replacement compared to hip. 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.
• There is substantial variation in the provision of physiotherapy nationally. People are more likely to receive physiotherapy after hip or knee replacement in London and the north of England. Those least likely to receive physiotherapy live in the south west.
• There is substantial rehabilitation inequality dependent on age; young people receive more physiotherapy.
• Women are more likely to receive physiotherapy.
• Non-white people are more likely to receive physiotherapy.

“So younger, female patients in urban areas are accessing more physiotherapy after their operations,” explains lead researcher, Dr Toby Smith. “We hope that organisations who aim for parity in service provision across the UK… will act to correct the patient inequality we have shown.”

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