Researcher's thesis presentation receives award

A research award won by a Braeside Hospital physiotherapist has highlighted HammondCare's commitment to making research accessible to a wide audience and ensuring it is closely integrated with care.

Physiotherapist Mark Buhagiar
HammondCare research

Mark Buhagiar was named the winner of the Three Minute Thesis Competition held at the recent Ingham Institute Research and Teaching Showcase for his presentation of his research into postoperative rehabilitation for total knee replacement.

The competition was judged by an expert panel consisting of CEO of Research Australia, Elizabeth Foley and Professor Guy Mark and Sophie Cooley of Ingham Institute. Mark received a trophy and a $500 prize sponsored by the Rotary Club of Liverpool West.

"The win gives me confidence and assurance that I can translate the findings of my research into language that anyone can understand, an important skill in the conversion of research into practice as well as a handy attribute for grant applications," Mark said.

"This was reinforced last week, when the HCF Foundation approved two grants we had submitted to support my research."

Mark is typical of many researchers at HammondCare who combine a passion for care with a commitment to research. He is involved daily with providing physiotherapy support for patients, as well as undertaking his own research and contributing to the research and education of other staff.

Mark's Three Minute Thesis Presentation

Beryl has lived alone since her husband died three years ago, and struggles to walk to the mailbox or around the shops. Her troubles are due to her arthritis, which has worn away her knee joints, causing bone to rub on bone.

To solve this, she is going to have a total knee replacement, where her worn parts will be replaced with shiny new metal bits. But the replacement is only the beginning of Beryl’s journey.

After surgery she is sent to the orthopaedic ward in her local public hospital to begin rehabilitation. She is there for four days and is then sent home with exercises to do and an outpatient appointment to continue therapy next week.

Now this is where it gets a little more complicated because, if Beryl was a privately insured patient in NSW, it is likely that she would have had 12 days of inpatient rehabilitation before being discharged.

This extra time in hospital would have cost the health service around $8000 more and, with 40,000 knee replacements each year in Australia (the majority done privately), $2.5 billion being put into the private health system each year by the government, and an ageing population, you can see the numbers adding up.

Can this extra cost be justified on any basis? This is where our research comes in. To date there has been no rigorous study done which has established whether inpatient rehabilitation yields better results after a knee replacement when compared to a home-based program, despite the significant difference in the price tag.

Our research will help address this gap by providing high-level evidence comparing intensive inpatient rehabilitation to less intensive modes. However, a further complication looms.

Is conclusive evidence enough to change practice, or do other factors come into play? Does what Beryl wants affect the delivery of services as much as what Beryl needs? Ask yourself, if you fork out money each week for private health insurance, what do you expect in return?

Is it just the best evidence-based treatment, or do benefits such as social convenience, unrelated to outcomes of surgery, also come into the picture? Will private health service providers stop providing inpatient rehabilitation if you and Beryl continue to expect this treatment, even if the evidence were to show no superiority to cheaper alternatives?

With this in mind, a second component of our research looks at the attitudes of consumers, orthopaedic surgeons, rehabilitation specialists and therapists involved in post-operative care, to investigate key factors affecting decision making in this area.

Our research in these areas will be used to shape future, evidence-based but consumer-driven service provision. Evidence from randomised trials should inform future models, but evidence of outcomes alone may not be sufficient to motivate a redesign of how care is delivered in the private sector.

If we let Beryl have the last word, she would say, "My voice shall be heard alongside the evidence, my wants and my knees needs need to be kneaded together for the good of all"

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