A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery

Trudy R. Mallinson, Jillian Bateman, Hsiang Yi Tseng, Larry Manheim, Orit Almagor, Anne Deutsch, Allen W. Heinemann

Research output: Contribution to journalArticlepeer-review

71 Scopus citations

Abstract

Objective: To examine differences in outcomes of patients after lower-extremity joint replacement across 3 postacute care (PAC) rehabilitation settings. Design: Prospective observational cohort study. Setting: Skilled nursing facilities (SNFs; n=5), inpatient rehabilitation facilities (IRFs; n=4), and home health agencies (HHAs; n=6) from 11 states. Participants: Patients with total knee (n=146) or total hip replacement (n=84) not related to traumatic injury. Interventions: None. Main Outcome Measure: Self-care and mobility status at PAC discharge measured by using the Inpatient Rehabilitation Facility Patient Assessment Instrument. Results: Based on our study sample, HHA patients were significantly less dependent than SNF and IRF patients at admission and discharge in self-care and mobility. IRF and SNF patients had similar mobility levels at admission and discharge and similar self-care at admission, but SNF patients were more independent in self-care at discharge. After controlling for differences in patient severity and length of stay in multivariate analyses, HHA setting was not a significant predictor of self-care discharge status, suggesting that HHA patients were less medically complex than SNF and IRF patients. IRF patients were more dependent in discharge self-care even after controlling for severity. For the full discharge mobility regression model, urinary incontinence was the only significant covariate. Conclusions: For the patients in our U.S.-based study, direct discharge to home with home care was the optimal strategy for patients after total joint replacement surgery who were healthy and had social support. For sicker patients, availability of 24-hour medical and nursing care may be needed, but intensive therapy services did not seem to provide additional improvement in functional recovery in these patients.

Original languageEnglish (US)
Pages (from-to)712-720
Number of pages9
JournalArchives of physical medicine and rehabilitation
Volume92
Issue number5
DOIs
StatePublished - May 2011

Keywords

  • Arthroplasty
  • Recovery of function
  • Rehabilitation
  • Skilled nursing facilities
  • hip
  • knee
  • replacement

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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