Rehabilitation services after total joint replacement in Ontario, Canada: can 'prehabilitation' programs mediate an increasing demand?

Total joint replacements (TJR) have emerged as a critical health policy issue. In particular, Canadian demand for these surgeries is forecast to grow annually by 8.7% in the next decade. Although the medical and surgical aspects of TJR have received considerable attention, very little research has explored the impact of increased TJR on the demand for rehabilitation services. In this study, we conducted seven focus group discussions across the province of Ontario (Canada) with multiple stakeholders (n=50) ranging from clinicians and administrators, to policy makers and researchers. Our results indicate that demand for rehabilitation following TJR is rising sharply and that there are three primary factors affecting such demand: (i) increase in the absolute number of TJR surgeries is increasing demand across the continuum of care; (ii) changing profile of clients whereby 'younger and active' groups are more willing to undergo surgery, and 'older and complex' groups are presenting with increased rates of medical complications and comorbidities; and (iii) widespread use of clinical pathways has increased requirements within the rehabilitation sector, but often without corresponding adjustments in levels of human resources. To align increasing demand with supply in the long term, participants offered strong support for health promotion and prevention programs, but they also highlighted the short-term benefits of implementing 'prehabilitation' programs for clients waiting for surgery. Overall, our results indicate that the demand for rehabilitation services after TJR is increasing and that innovative approaches to care delivery are required to align increasing demand with supply.