[AVBC 2025] Value-Based Rehab: Optimizing Resource Allocation - Therapy Support Associates in Post-TKR Care
Applied/Translational Research
Care Process & Redesign
Workforce Transformation
Appropriate & Value-based Care Conference
SingHealth
5 December 2025
This study aimed to evaluate the clinical effectiveness and cost-efficiency of Therapy Support Associates (TSA)-led. Implementation of TSA-led rehabilitation classes maintained clinical outcomes while delivering significant cost savings.
Year Submitted: 2025
Published Date: 05 December 2025
Tags: Care Process ＆ Redesign, Workforce Transformation, Applied/Translational Research, Quality Improvement, Functional Outcome, Operational Management, Resource Allocation, Productivity, Cost Saving, Workforce Performance, Workforce Productivity, Quantitative Research
About this Content
Aims
This study aimed to evaluate the clinical effectiveness and cost-efficiency of Therapy Support Associates (TSA)-led rehabilitation classes compared to conventional physiotherapist-led sessions for post-TKR patients, with the goal of optimizing workforce allocation while maintaining quality of care.
Background
The increasing demand for rehabilitation services necessitates innovative delivery models that balance resource optimization with quality care.
Methods
A retrospective cohort study compared two groups: Physiotherapist-led rehabilitation classes (July - December 2023, n=257) and TSA-led classes (July - December 2024, n=338). Both groups conducted classes five days weekly. Primary outcome measures included Modified Barthel Index (MBI) improvements and length of stay (LOS). Statistical analysis employed Unpaired t-tests to compare mean values, and 95% confidence intervals were calculated. Statistical significance was set at p 0.05. Cost analysis evaluated cost per rehabilitation efficiency unit and operational savings.
Results
The study demonstrated non-inferior clinical outcomes between TSA-led and therapist-led groups. Mean LOS was comparable (Therapist-led: 15.95 days; TSA-led: 16.70 days; mean difference: 0.76; 95% CI: -0.56 to 2.07; p = 0.259), as were MBI-based rehabilitation efficiency scores (Therapist-led: 1.57; TSA-led: 1.48; mean difference: -0.10; 95% CI: -0.28 to 0.09; p = 0.318). Cost-efficiency analysis revealed that TSA-led sessions delivered similar recovery outcomes at lower operational cost, with a cost per rehabilitation efficiency unit of SGD $50.54 compared to SGD $78.67 for therapist-led groups, with monthly operational savings of SGD $3,900.
Conclusion
Implementation of TSA-led rehabilitation classes maintained clinical outcomes while delivering significant cost savings. This model enables more efficient resource allocation, allowing physiotherapists to focus on complex cases requiring specialized interventions. The findings support sustainable workforce optimization in alignment with value-based healthcare principles, offering a scalable solution for inpatient rehabilitation services.
Lessons Learnt
The implementation of TSA-led rehabilitation classes maintained clinical outcomes while delivering significant cost savings. This model enables more efficient resource allocation, allowing physiotherapists to focus on complex cases requiring specialized interventions.
Keywords
Value-based healthcare, rehabilitation, workforce optimization, total knee replacement
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | SingHealth |
Organization(s) Involved | Singhealth Community Hospitals |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Allied Health |
Applicable Specialty or Discipline | Rehabilitation Therapy, Clinical Research |
Project Lead(s) | Ganeshan Karthikeyan |
Project Member(s) | Ganeshan Karthikeyan |
Connect with this contributor!
Ganeshan Karthikeyan - ganeshan.karthikeyan@singhealthch.com.sg