Objective: Compare the rehabilitation outcomes of patients who had a hip or knee replacement.

Design: Prospective observational cohort study

Setting: Some 11 inpatient rehabilitation facilities (IRFs) 8 skilled nursing facilities (SNFs), and 1 hybrid facility (HBF) from across the U.S.

Participants: 2,152 consecutively enrolled patients; 1,401 knee replacement patients and 751 hip replacement patients.

Interventions: No new interventions; examination of existing practice patterns.

Main outcome measures: Functional Independence Measure (FIM) motor score, discharge to community.

Results: Typical joint replacement patient was a woman in her early 70s; average body mass index (BMI) in the low 30s (BMI 30 = obese). IRF patients presented a somewhat more severe medical and functional profile upon admission compared to SNF patients. SNF and IRF patients presented similar rates of diabetes, hypertension, and ischemic heart disease. The average length of stay for SNF patients, hip and knee combined, was 14.1 days; for HBF patients 8.8 days; and for IRF patients about 9-10 days. SNF and IRF patients received similar types and amounts of physical and occupational therapy; IRF patients received more intensive therapy, i.e., more hours per day. Controlling for patient differences, IRF patients achieved somewhat higher FIM gains and achieved them in a shorter period of time-the largest spread was 3.6 FIM points between medium-volume IRFs and low-volume SNFs.

Conclusions: While IRF patients had somewhat better outcomes than did SNF patients, there are other important factors that also shape outcome. Earlier and more intense rehabilitation is associated with better outcomes. The volume of joint replacement patients seen by a facility also plays a part: Medium volume facilities among both SNF and IRFs had better outcomes.

Key Words: Joint replacement; Knee arthroplasty; Hip arthroplasty; Rehabilitation; Functional outcomes; Skilled nursing facilities; Inpatient rehabilitation facilities.

Principal Investigator: Gerben DeJong, PhD

Title: Senior Fellow

E-mail: gerben.dejong@medstar.net

Phone: 202-877-1960

Fax: 202-726-7521

Affiliations/partners: ICOR (Institute for Clinical Outcomes Research), Salt Lake City, UT.

Funding Source: The HealthSouth Corporation, ARA Research Institute of the American Rehabilitation Providers Association, Brooks Health, National Rehabilitation Hospital, American Hospital Association, the Federation of American Hospitals, and others.

Project Website