Efficient Rehabilitation Care for Joint Replacement Patients

Tian, Weijun; DeJong, Gerben; Horn, Susan D.; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E.

doi:10.1177/0272989x11403488

Cited by 29 publications

(35 citation statements)

References 14 publications

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“…In the absence of conclusive evidence, the journey from the post-operative acute care setting to inpatient rehabilitation services is presumably guided by the consumers and clinicians involved, with various opportunities for the expression of preferences as decisions. While taking into account variances in the preferences of clinicians regarding rehabilitation alternatives [15], decisions around rehabilitation types utilised after arthroplasty are likely to be multi-dimensional. They may be guided by reasons related to a patient’s clinical status, but other factors, such as patient expectations, healthcare professionals’ personal preferences and related conveniences may also play a part [8, 16].…”

Section: Introductionmentioning

confidence: 99%

Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector

Buhagiar

Naylor

Simpson

et al. 2017

BMC Health Serv Res

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BackgroundTo understand private consumer and clinician preferences towards different rehabilitation modes following knee or hip arthroplasty, and identify factors which influence the chosen rehabilitation pathway.MethodsMixed methods cross-sectional study involving 95 semi-structured interviews of consumers (patients and carers) and clinicians (arthroplasty surgeons, physiotherapists and rehabilitation physicians) in Sydney, Australia, during 2014–2015. Participants were asked about the acceptability of different modes of rehabilitation provision, and factors influencing their chosen rehabilitation pathway. Interviews were in person or via the telephone. Qualitative analysis software was used to electronically manage qualitative data. An analytical approach guided data analysis.ResultsPre-operative preferences strongly influenced the type of rehabilitation chosen by consumers. Key factors that influenced this were both intrinsic and extrinsic, including; the previous experience of self or known others, the perceived benefits of the chosen mode, a sense of entitlement, the role of orthopaedic surgeons and influence of patient preference, a patient’s clinical status post-surgery, the private hospital business model and insurance provider involvement. The acceptability of rehabilitation modes varied between clinician groups.ConclusionsNo one rehabilitation mode provided following arthroplasty is singularly preferred by stakeholders. Factors other than the belief that a particular mode was more effective than another appear to dominate the pathway followed by private arthroplasty consumers, indicating evidence-based policies around rehabilitation provision may have limited appeal in the private sector.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2379-9) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector

Buhagiar

Naylor

Simpson

et al. 2017

BMC Health Serv Res

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“… 4 – 8 However, there remains no definitive evidence to favor rehabilitation in a skilled nursing facility (SNF) over inpatient rehabilitation facilities, home health care, or outpatient settings. 2 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

Gait Training in Patients Discharged to a Skilled Nursing Facility Following Total Joint Arthroplasty

Haghverdian

Wright

Doan

et al. 2016

Geriatr Orthop Surg Rehabil

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Background:Expenditures for postacute care in total joint arthroplasty (TJA) have risen dramatically over recent decades. Therefore, efforts are underway to better identify cost savings in postacute rehabilitation centers, such as skilled nursing facilities (SNFs). The primary purpose of this study was to analyze gait training achievements in post-TJA patients in the interval between hospital discharge and the patients’ first 4 days at the SNF. Identification of potential losses in therapeutic progress may lead the way for improved patient care, outcomes, and cost savings. Our hypothesis is that patients discharged to an SNF will have a decline in gait achievements upon transfer from the hospital.Methods:A total of 68 patients who underwent TJA were included. The total distance ambulated during physical therapy (PT) was recorded for the last day of hospital therapy and the first 4 days at the SNF as well as the reported visual analog scale (VAS) pain scores.Results:There was a 73% decline in distance ambulated on SNF day 0 (Hospital: 138.6 ft vs SNF: 37.9 ft; P < .001) and a 50% decline on SNF day 1 (Hospital: 103.0 ft; SNF vs 51.1 ft; P < .001) compared to the last hospital session. There were no significant differences in distance walked on SNF days 3 and 4 relative to the last hospital session. The VAS pain scores did not significantly differ on SNF days 0 and 1 compared to the last hospital day but began to significantly decline on SNF day 3 (Hospital: 4.9; SNF: 3.3; P = .02) and day 4 (Hospital: 3.9; SNF: 2.3; P = .03).Conclusion:There was a significant decline in ambulatory proficiency in post-TJA patients on the day of and the day following hospital discharge to an SNF. These deficits cannot be attributed to heightened pain levels. Early and progressive ambulation is a recognized component of appropriate PT following TJA. This study therefore highlights the transition from hospital to SNF as a crucial and novel target for improvement in post-TJA care.

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“…3–10 Unlike acute injuries or trauma, such as stroke or hip fracture, joint replacement is typically an elective procedure, where the patients expect to achieve better physical functioning following surgery and rehabilitation. Relatively few studies, however, have compared longer-term functional outcomes between total hip and total knee replacement patients following inpatient rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Trajectories in functional recovery for patients receiving inpatient rehabilitation for unilateral hip or knee replacement

Bindawas

Graham

Karmarkar

et al. 2014

Archives of Gerontology and Geriatrics

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The purpose of this study was to explore trajectories of recovery in patients with lower extremity joint replacements receiving post-acute rehabilitation. A retrospective cohort design was used to examine data from the Uniform Data System for Medical Rehabilitation for 7,434 patients with total knee replacement and 4,765 patients with total hip replacement who received rehabilitation from 2008–2010. Functional Independence Measure (FIM)™ instrument ratings were obtained at admission, discharge, and 80–180 days after discharge. Random coefficient regression analyses using linear mixed models were used to estimate mean ratings for items within the four motor subscales (self-care, sphincter control, transfers, and locomotion) and the cognitive domain of the FIM instrument. Mean improvements at discharge for motor items ranged from 1.16 (95% confidence interval [CI]: 1.14, 1.19) to 2.69 (95% CI: 2.66, 2.71) points for sphincter control and locomotion, respectively. At follow-up mean motor improvements ranged from 2.17 (95% CI: 2.15, 2.20) to 4.06 (95% CI: 4.03, 4.06) points for sphincter control and locomotion, respectively. FIM cognition yielded smaller improvements: discharge = 0.47 (95% CI: 0.46, 0.48); follow-up = 0.83 (95% CI: 0.0.81, 0.0.84). Persons who were younger, female, non-Hispanic white, unmarried, with fewer comorbid conditions, and who received a total knee replacement demonstrated slightly higher functional motor ratings. Overall, patients with unilateral knee or hip replacement experienced substantial improvement in motor functioning both during and up to six months following inpatient rehabilitation.

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Efficient Rehabilitation Care for Joint Replacement Patients

Cited by 29 publications

References 14 publications

Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector

Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector

Gait Training in Patients Discharged to a Skilled Nursing Facility Following Total Joint Arthroplasty

Trajectories in functional recovery for patients receiving inpatient rehabilitation for unilateral hip or knee replacement

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