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Table 6 Physician subthemes and sample quotes*

From: Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis:a focus group study

Subtheme 1: Pain management

   "I think that GPs think that [patients] shouldn't have pain. Or that the pain is trivial, unless they've had a knee replacement themselves when they know different." [60 M, RHEUM]

   "Patients shouldn't be worried about becoming addicted to narcotics. It's a very rare individual that this is truly a problem for." [62 M, FP]

Subtheme 2: Continuity, coordination and communication

   "...the very nature is that's what we do in the US is we don't really communicate well, is the lack of consistency and the absence of protocols or consensus. Sadly, you know, the paradigm of health care in the US is that there's such a vacuum." [47 M, PHYS]

   "It's a bit of a grey zone and there's a fair amount of variability. So I usually try to gather information from [the patient's] surgeon through the patient and then from their physio...: [41> F, FP]

Subtheme 3: Access to rehab services

   "...as you move out away, things become less and less available, and that applies to both community care as well as outpatient programs. And certainly if you're more in the hinterland access becomes a greater issue." [63 M, PHYS]

   "...transportation is a big limiting factor." [47 M, PHYS]

   "...it's particularly an issue for seniors that are on limited income. They will try to limit their physical therapy appointments because of finances. So they might not be getting quite as good of a result beyond their surgery." [41 F, FP]

Subtheme 4: Different patients, different needs along the continuum

   "It used to be that people would cope with an awful lot and go soldiering on and feel that this is just the way it was. I'm seeing younger people now who come in and say, 'No, I'm not prepared to do this anymore. You know, I want to be able to do X and Y and so on, and I think I need to have something done.'" [60 M, RHEUM]

   "There's considerably less need for rehabilitation in our experience with hips and considerably more for the knees. ... we just find that there tend to be more pain issues and more balance and control issues after total knee than after total hip procedures." [63 M, PHYS]

Subtheme 5: Outcomes

   "Balance is a very important issue that needs to be followed... because safety issues and certainly preventing falls is going to be something that's very important to patients as well as the health care system itself." [63 M, PHYS]

   "It's to get back to work, and then to get back to their activities that they like to do - so golf, swimming. You know, their premorbid activities that they like." [41 F, FP]

  1. * Findings based on 1 focus group and 4 interviews. Legend: Panelists are identified by age, gender (M = male, F = female) and profession (FP = family practitioner, PHYS = physiatrist, RHEUM = rheumatologist