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De Roo AC, Ha J, Regenbogen SE, Hoffman GJ. Impact of Medicare eligibility on informal caregiving for surgery and stroke. Health Serv Res 2023; 58:128-139. [PMID: 35791447 PMCID: PMC9836945 DOI: 10.1111/1475-6773.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65. DATA SOURCES Health and Retirement Study survey data (1998-2018). STUDY DESIGN We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts. A regression discontinuity design compared the self-reported likelihood of any care receipt, weekly hours of overall informal care, and intensity of informal care (hours among those receiving any care) at Medicare eligibility. DATA COLLECTION Not applicable. PRINCIPAL FINDINGS A total of 2270 individuals were included; 1674 (73.7%) stroke, 240 (10.6%) heart surgery, and 356 (15.7%) joint surgery patients. Mean (SD) care received was 20.0 (42.1) weekly hours. Of the 1214 (53.5%) patients who received informal care, the mean (SD) care receipt was 37.4 (51.7) weekly hours. Mean (SD) overall weekly care received was 23.4 (45.5), 13.9 (35.8), and 7.8 (21.6) for stroke, heart surgery, and joint surgery patients, respectively. The onset of Medicare eligibility was associated with a 13.6 percentage-point decrease in the probability of informal care received for stroke patients (p = 0.003) but not in the other acute care cohorts. Men had a 16.8 percentage-point decrease (p = 0.002) in the probability of any care receipt. CONCLUSIONS Medicare coverage was associated with a substantial decrease in family and friend caregiving use for stroke patients. Informal care may substitute for rather than complement restorative care, given that Medicare is known to expand the use of postacute care. The observed spillover effect of Medicare coverage on informal caregiving has implications for patient function and caregiver burden and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity.
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Affiliation(s)
- Ana C. De Roo
- Department of SurgeryUniversity of MichiganAnn ArborMichiganUSA
- Center for Healthcare Outcomes and PolicyUniversity of MichiganAnn ArborMichiganUSA
- Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
| | - Jinkyung Ha
- Division of Geriatric and Palliative Medicine, Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Scott E. Regenbogen
- Department of SurgeryUniversity of MichiganAnn ArborMichiganUSA
- Center for Healthcare Outcomes and PolicyUniversity of MichiganAnn ArborMichiganUSA
- Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
| | - Geoffrey J. Hoffman
- Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
- Department of Systems, Populations and LeadershipUniversity of Michigan School of NursingAnn ArborMichiganUSA
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Elhage KG, Awad ME, Irfan FB, Lumbley J, Mostafa G, Saleh KJ. Closed-incision negative pressure therapy at -125 mmHg significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta-analysis of randomized controlled trials. Health Sci Rep 2022; 5:e425. [PMID: 35229037 PMCID: PMC8865069 DOI: 10.1002/hsr2.425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Closed-incision negative pressure wound therapy (ciNPT) has shown promising effects for managing infected wounds. This meta-analysis explores the current state of knowledge on ciNPT in orthopedics and addresses whether ciNPT at -125 mmHg or -80 mmHg or conventional dressing reduces the incidence of surgical site complications in hip and knee arthroplasty. METHODS This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines and Cochrane Handbook. Prospective randomized controlled trials (RCTs) with ciNPT use compared to conventional dressings following hip and knee surgeries were considered for inclusion. Non-stratified and stratified meta-analyses of six RCTs were conducted to test for confounding and biases. A P value less than .05 was considered statistically significant. RESULTS The included six RCTs have 611 patients. Total hip and knee arthroplasties were performed for 51.7% and 48.2% of the included population, respectively. Of 611 patients, conventional dressings were applied in 315 patients and 296 patients received ciNPT. Two ciNPT systems have been used across the six RCTs; PREVENA Incision Management System (-125 mmHg) (63.1%) and PICO dressing (-80 mmHg) (36.8%). The non-stratified analysis showed that the ciNPT system had a statistically significant, lower risk of persistent wound drainage as compared to conventional dressing following total hip and knee arthroplasties (OR = 0.28; P = .002). There was no difference between ciNPT and conventional dressings in terms of wound hematoma, blistering, seroma, and dehiscence. The stratified meta-analysis indicated that patients undergoing treatment with high-pressure ciNPT (120 mmHg) displayed significantly fewer overall complications and persistent wound drainage (P = .00001 and P = .002, respectively) when compared to low-pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. (P = .005). CONCLUSION When compared to conventional wound dressing and -80 mmHg ciNPT, the use of -125 mmHg ciNPT is recommended in patients undergoing total joint arthroplasty.
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Affiliation(s)
- Kareem G. Elhage
- FAJR ScientificNorthvilleMichigan48167USA
- Wayne State University, School of MedicineDetroitMichiganUSA
| | - Mohamed E. Awad
- FAJR ScientificNorthvilleMichigan48167USA
- NorthStar Anesthesia‐Detroit Medical centerDetroitMichiganUSA
- Michigan State University, College of Osteopathic MedicineDetroitMichiganUSA
| | - Furqan B. Irfan
- Michigan State University, College of Osteopathic MedicineDetroitMichiganUSA
| | - Joshua Lumbley
- NorthStar Anesthesia‐Detroit Medical centerDetroitMichiganUSA
| | - Gamal Mostafa
- Wayne State University, School of MedicineDetroitMichiganUSA
- Surgical Outcomes Research Institute, John D. Dingell VA Medical CenterDetroitMichiganUSA
| | - Khaled J. Saleh
- FAJR ScientificNorthvilleMichigan48167USA
- Michigan State University, College of Osteopathic MedicineDetroitMichiganUSA
- Surgical Outcomes Research Institute, John D. Dingell VA Medical CenterDetroitMichiganUSA
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De Rosis S, Pennucci F, Lungu DA, Manca M, Nuti S. A continuous PREMs and PROMs Observatory for elective hip and knee arthroplasty: study protocol. BMJ Open 2021; 11:e049826. [PMID: 34548358 PMCID: PMC8458328 DOI: 10.1136/bmjopen-2021-049826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Scholars, healthcare practitioners and policymakers have increasingly focused their attention on patient-centredness. Patient-reported metrics support patient-driven improvement actions in healthcare systems. Despite the great interest, patient-reported outcome measures (PROMs) are still not extensively collected in many countries and not integrated with the collection of patient-reported experience measures (PREMs). This protocol describes the methodology behind an innovative observatory implemented in Tuscany, Italy, aiming at continuously and longitudinally collecting PROMs and PREMs for elective hip and knee total replacement. METHODS AND ANALYSIS The Observatory is digital. Enrolled patients are invited via SMS or email to online questionnaires, which include the Oxford Hip Score or the Oxford Knee Score. Data are real-time reported to healthcare professionals and managers in a raw format, anonymised and aggregated on a web platform. The data will be used to investigate the relationship between the PROMs trend and patients' characteristics, surgical procedure, hospital characteristics, and PREMs. Indicators using patient data will be computed, and they will integrate the healthcare performance evaluation system adopted in Tuscany. ETHICS AND DISSEMINATION The data protection officers of local healthcare organisations and the regional privacy office framed the initiative referring to the national and regional guidelines that regulate patient surveys. The findings will be reported both in real time and for publication in peer-reviewed journals.
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Affiliation(s)
- Sabina De Rosis
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel Adrian Lungu
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mario Manca
- Department of Orthopaedic Surgery, Versilia Hospital, Lido di Camaiore, Italy
| | - Sabina Nuti
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
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Neginhal V, Kurtz W, Schroeder L. Patient Satisfaction, Functional Outcomes, and Survivorship in Patients with a Customized Posterior-Stabilized Total Knee Replacement. JBJS Rev 2021; 8:e1900104. [PMID: 32678537 DOI: 10.2106/jbjs.rvw.19.00104] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND In this study, we assessed implant survivorship, patient satisfaction, and patient-reported functional outcomes at approximately 2 years for patients who had received a customized posterior-stabilized (PS) knee replacement system. We hypothesized that the customized PS implant would have high overall patient-reported outcomes because of its patient-specific design. METHODS Ninety-three patients (100 knees) who had received the customized total knee replacement system were enrolled at 2 centers. The patients' length of hospitalization and preoperative pain intensity were assessed. At a single follow-up time-point, we assessed patient-reported outcomes utilizing the Knee injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), satisfaction rates, implant survivorship, and patients' perception of their knee. RESULTS At an average follow-up time of 1.9 years (range, 1.5 to 2.4 years), implant survivorship was found to be 100%. From an average preoperative baseline pain rating of 6.5 (range, 3 to 10) until the time of follow-up, we observed an average decrease of 5.2 on the numeric pain rating scale to an average of 1.3 (range, 0 to 8), indicating satisfactory pain relief after the procedure. The satisfaction rate was found to be high, with 90% of patients being satisfied or very satisfied and 88% of patients reporting a "natural" perception of their knee either some or all of the time. The evaluation of the patient-reported outcome measure showed satisfactory results with a high KOOS JR average score of 90 (range, 34 to 100) at the time of follow-up. CONCLUSIONS Based on our results, we believe that the customized PS implant provides patients with excellent postoperative outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Vivekanand Neginhal
- 1Scott Orthopaedics, Huntington, West Virginia 2Tennessee Orthopaedic Alliance, Nashville, Tennessee 3Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Julius-Maximilians University Wuerzburg, Wuerzburg, Germany
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A D, A T, T J, O R, LE D, M E. The role of pain and walking difficulties in shaping willingness to undergo joint surgery for osteoarthritis: Data from the Swedish BOA register. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100157. [PMID: 36474994 PMCID: PMC9718157 DOI: 10.1016/j.ocarto.2021.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To investigate whether the association between pain intensity and willingness to undergo surgery is explained by walking difficulties, in patients with knee or hip osteoarthritis (OA). Methods This is an observational study using data from the Better management of patients with Osteoarthritis (BOA) register, which collects data from a publicly financed self-management programme for people with OA in Sweden. We included all patients with knee or hip OA who attended the baseline visit between 2008 and 2016. We conducted separate mediation analyses within a counterfactual framework to estimate the mediation effect of walking difficulties (yes/no) on willingness to undergo surgery (yes/no) for each one-point increase in pain (0-10 on a numeric rating scale), adjusted for relevant confounders. Results We included 72,131 patients (69% women, mean age 66, mean pain 5.4, 81% had walking difficulties, 27% was willing to undergo surgery). A one-point increase in pain intensity was associated with 1.53 (95% CI: 1.51; 1.55) higher odds of being willing to undergo surgery. Walking difficulties mediated 10%-25% of the effect of one-point increase in pain when pain was <8/10, while at pain ≥8/10 this percentage decreased to 3%. Conclusions More than 80% of the BOA patients have mild to moderate pain (<8/10) and walking difficulties can mediate up to a quarter of the total effect of pain on the willingness to undergo surgery in these patients. Trials to evaluate the potential to lower surgery demand by reducing walking difficulties in people with these characteristics are needed.
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Affiliation(s)
- Dell’Isola A
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Turkiewicz A
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jönsson T
- Department of Health Sciences, Division of Physiotherapy, Sport Sciences, Lund University, Sweden
| | - Rolfson O
- Department of Orthopedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Dahlberg LE
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Englund M
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Dell’Isola A, Jönsson T, Rolfson O, Cronström A, Englund M, Dahlberg L. Willingness to Undergo Joint Surgery Following a First-Line Intervention for Osteoarthritis: Data From the Better Management of People With Osteoarthritis Register. Arthritis Care Res (Hoboken) 2021; 73:818-827. [PMID: 33053273 PMCID: PMC8251860 DOI: 10.1002/acr.24486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/08/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the proportion of participants reconsidering their willingness to undergo surgery after 3 and 12 months. Secondary aims were to analyze and compare the characteristics of individuals willing and unwilling to undergo joint surgery for osteoarthritis (OA) before a first-line intervention, and to study the association between pain intensity, walking difficulties, self-efficacy, and fear of movement with the willingness to undergo surgery. METHODS This was an observational study based on Swedish register data. We included 30,578 individuals with knee or hip OA who participated in a first-line intervention including education and exercise. RESULTS Individuals willing to undergo surgery at baseline showed a higher proportion of men (40% versus 27%) and more severe symptoms and disability. Respectively, 45% and 30% of the individuals with knee and hip OA who were willing to undergo surgery at baseline became unwilling after the intervention. At the end of the study period (12 months), 35% and 19% of those with knee and hip OA, respectively, who were willing to undergo surgery at baseline became unwilling. High pain intensity, walking difficulties, and fear of movement were associated with higher odds of being willing to undergo surgery at both follow-ups, while increased self-efficacy showed the opposite association. CONCLUSION A first-line intervention for OA is associated with reduced willingness to undergo surgery, with a greater proportion among patients with knee OA than hip OA. Due to its temporal variability, willingness to undergo surgery should be used with care to deem surgery eligibility.
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Affiliation(s)
| | | | - Ola Rolfson
- The Swedish Hip Arthroplasty RegisterCentre of Registers Västra Götaland, and Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Hsieh CJ, DeJong G, Vita M, Zeymo A, Desale S. Effect of Outpatient Rehabilitation on Functional Mobility After Single Total Knee Arthroplasty: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2016571. [PMID: 32940679 PMCID: PMC7499127 DOI: 10.1001/jamanetworkopen.2020.16571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/26/2020] [Indexed: 11/16/2022] Open
Abstract
Importance Even without evidence, rehabilitation practitioners continue to introduce new interventions to enhance the mobility outcomes for the increasing population with a recent total knee arthroplasty (TKA). Objective To compare post-TKA functional mobility outcomes among 3 newly developed physical therapy protocols with a standard-of-care post-TKA rehabilitation protocol. Design, Setting, and Participants This randomized clinical trial included 4 study arms implemented in 15 outpatient clinics within a single health system in the Baltimore, Maryland, and Washington, District of Columbia, region from October 2013 to April 2017. Participants included patients who underwent elective unilateral TKA, were aged 40 years and older, and began outpatient physical therapy within 24 days after TKA. A total of 505 patients were screened and 386 participants were enrolled. Patients provided informed consent and were randomly assigned to 1 of 4 groups. Blinding patients and treating therapists was not feasible owing to the nature of the intervention. Analysis was conducted under the modified intent-to-treat principle from October 2017 to May 2019. Interventions The control group used a standard recumbent bike for 15 to 20 minutes each session. Interventions used 1 of 3 modalities for 15 to 20 minutes each session: (1) a body weight-adjustable treadmill, (2) a patterned electrical neuromuscular stimulation device, or (3) a combination of the treadmill and electrical neuromuscular stimulation. Main Outcomes and Measures Outcomes included the Activity Measure for Post-acute Care basic mobility score, a patient-reported outcome measure, and the 6-minute walk test. Outcomes were measured at baseline, monthly, and on discharge from outpatient therapy. Results Data from 363 patients (mean [SD] age, 63.4 [7.9] years; 222 [61.2%] women) were included in the final analysis, including 92 participants randomized to the control group, 91 participants randomized to the treadmill group, 90 participants randomized to the neuromuscular stimulation device group, and 90 participants randomized to the combination intervention group. Activity Measure for Post-acute Care scores at discharge were similar across groups, ranging from 61.1 to 61.3 (P = .99) with at least 9.0 points improvement (P = .80) since baseline. The distances as measured by the 6-minute walking test were not statistically different across groups (range, 382.9-404.5 m; P = .60). Conclusions and Relevance This randomized clinical trial found no statistically or clinically significant differences in outcomes across the 4 arms. Because outcomes were similar among arms, clinicians should instead consider relative cost in tailoring TKA rehabilitation. Trial Registration ClinicalTrials.gov Identifier: NCT02426190.
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Affiliation(s)
- Chinghui Jean Hsieh
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Maryland
| | - Gerben DeJong
- MedStar National Rehabilitation Hospital, Washington, District of Columbia
- Department of Rehabilitation Medicine, Georgetown University School of Medicine, Washington, District of Columbia
| | - Michele Vita
- MedStar National Rehabilitation Network, Washington, District of Columbia
| | | | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, Maryland
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Maharaj Z, Pietrzak JRT, Sikhauli N, van de Jagt D, Mokete L. The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa. SICOT J 2020; 6:3. [PMID: 31967541 PMCID: PMC6975206 DOI: 10.1051/sicotj/2019042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/20/2019] [Indexed: 01/08/2023] Open
Abstract
Aim: The aim was to assess the seroprevalence of Human Immunodeficiency Virus (HIV) in non-haemophilic patients undergoing primary Total Joint Arthroplasty (TJA) at an academic hospital in South Africa. Methods: A retrospective review of all Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) patients from January 2017 to December 2018 was conducted. All patients awaiting TJA were offered HIV screening and their demographic data were recorded. Consenting patients were tested or the refusal of testing was documented. The CD4+ T-cell count (CD4+) and viral load (VL) was measured for all HIV-positive patients and newly diagnosed patients were initiated on Highly Active Antiretroviral Treatment (HAART). Results: We included 1007 patients in the study. The TJA population HIV seroprevalence was 10.7% (n = 108). The seroprevalence for THA was 14.9% (n = 78) and that for TKA was 6.2% (n = 30). There were 93 patients (9.2%) who refused screening. There were 12 (15.4%) and 3 patients (10%) that were newly diagnosed in the THA and TKA seropositive populations, respectively. The average CD4+ for THA and TKA was 569 cells/mm3 (105–1320) and 691 cells/mm3 (98–1406), respectively. The VL was undetectable in 75.9% (n = 82) of HIV-positive patients. Overall 12 HIV-positive patients (11.12%) had CD4+ <200 cells/mm3, 8 of these patients (66%) were newly diagnosed. The average age of the seropositive population was 58 ± 6.5 years and 66 ± 8.5 years for THA and TKA, respectively (p = 0.03). Femoral head osteonecrosis was the underlying pathology for 65.38% (n = 51) of seropositive patients for THA. Conclusion: The seroprevalence of HIV in patients undergoing THA in our South African institution is greater than the seroprevalence in the general population. The seroprevalence of HIV in THA is significantly greater than that in TKA. This may reflect the association between HIV, HAART and hip joint degeneration. Our findings draw attention to the significant burden HIV has on TJA.
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Affiliation(s)
- Zia Maharaj
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
| | - Jurek Rafal Tomasz Pietrzak
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
| | - Nkhodiseni Sikhauli
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
| | - Dick van de Jagt
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
| | - Lipalo Mokete
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
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Mc Colgan R, Dalton DM, O’Sullivan HP, Sproule JA. The prescription of lidocaine patches in osteoarthritis—a complete audit cycle. Ir J Med Sci 2018; 188:525-530. [DOI: 10.1007/s11845-018-1878-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/23/2018] [Indexed: 12/31/2022]
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Godziuk K, Prado CM, Woodhouse LJ, Forhan M. The impact of sarcopenic obesity on knee and hip osteoarthritis: a scoping review. BMC Musculoskelet Disord 2018; 19:271. [PMID: 30055599 PMCID: PMC6064616 DOI: 10.1186/s12891-018-2175-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/10/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The progressive, debilitating nature of knee and hip osteoarthritis can result in severe, persistent pain and disability, potentially leading to a need for total joint arthroplasty (TJA) in end-stage osteoarthritis. TJA in adults with obesity is associated with increased surgical risk and prolonged recovery, yet classifying obesity only using body mass index (BMI) precludes distinction of obesity phenotypes and their impact on surgical risk and recovery. The sarcopenic obesity phenotype, characterized by high adiposity and low skeletal muscle mass, is associated with higher infection rates, poorer function, and slower recovery after surgery in other clinical populations, but not thoroughly investigated in osteoarthritis. The rising prevalence and impact of this phenotype demands further attention in osteoarthritis treatment models of care, particularly as osteoarthritis-related pain, disability, and current treatment practices may inadvertently be influencing its development. METHODS A scoping review was used to examine the extent of evidence of sarcopenic obesity in adults with hip or knee osteoarthritis. Medline, CINAHL, Web of Science and EMBASE were systematically searched from inception to December 2017 with keywords and subject headings related to obesity, sarcopenia and osteoarthritis. RESULTS Eleven studies met inclusion criteria, with indications that muscle weakness, low skeletal muscle mass or sarcopenia are present alongside obesity in this population, potentially impacting therapeutic outcomes, and TJA surgical risk and recovery. CONCLUSIONS Consideration of sarcopenic obesity should be included in osteoarthritis patient assessments.
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Affiliation(s)
- Kristine Godziuk
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 – 114 Street, 2-64 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Carla M. Prado
- Division of Human Nutrition, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB Canada
| | - Linda J. Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada
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Effect of Physical Therapy Interventions in the Acute Care Setting on Function, Activity, and Participation After Total Knee Arthroplasty: A Systematic Review. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Westby MD, Marshall DA, Jones CA. Development of quality indicators for hip and knee arthroplasty rehabilitation. Osteoarthritis Cartilage 2018; 26:370-382. [PMID: 29292095 DOI: 10.1016/j.joca.2017.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop quality indicators (QIs) reflecting the minimum acceptable standard of rehabilitation care before and after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis (OA). METHODS Informed by high quality evidence and using a modified RAND-UCLA Delphi approach, an 18-member Canadian panel of clinicians, researchers and patients considered 81 proposed QIs (40 for THA, 42 for TKA) addressing rehabilitation before and after elective THA and TKA. Panelists rated QIs for their importance and validity on a 9-point Likert scale through two rounds of online rating interspersed with a moderated and anonymous online discussion forum. Those QIs with median ratings of ≥7 for importance and validity with no disagreement based on the inter-percentile range adjusted for symmetry were included in the final sets. RESULTS Fifteen panelists from seven provinces and varied practice settings completed the Delphi process. Of the 81 plus one additional QIs (total of 82), 67 (82%) were rated as both important and valid (31 for THA, 36 for TKA). For THA, 14 pre-op, six acute and eight post-acute QIs were accepted. For TKA, 16 pre-op, 10 acute and eight post-acute indicators were accepted. Two of three 'across-continuum' QIs were rated appropriate for both procedures. CONCLUSION This work represents the first QIs with which to measure, report and benchmark quality of care in patients receiving rehabilitation before and after THA/TKA surgery. The QIs will be further tested for reliability and feasibility before being widely disseminated in clinical settings and used to assess care gaps.
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Affiliation(s)
- M D Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
| | - D A Marshall
- Department of Community Health Sciences, Arthur JE Child Chair in Rheumatology Research, University of Calgary, Calgary, Alberta, Canada
| | - C A Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Vina ER, Kallan MJ, Collier A, Nelson CL, Ibrahim SA. Race and Rehabilitation Destination After Elective Total Hip Arthroplasty: Analysis of a Large Regional Data Set. Geriatr Orthop Surg Rehabil 2018; 8:192-201. [PMID: 29318080 PMCID: PMC5755837 DOI: 10.1177/2151458517726409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/22/2017] [Accepted: 07/22/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Three-quarters of patients who undergo total hip replacement (THR) receive postsurgical rehabilitation care in an inpatient rehabilitation facility (IRF), a skilled nursing facility (SNF), or through a home health agency. The objectives of this study are to examine racial differences where THR recipients receive postsurgical rehabilitation care and determine whether discharge destination is associated with hospital readmission. Methods: Using the Pennsylvania Health Care Cost Containment Council database, we selected African American (AA) or white adults who underwent THR surgery (n = 68,016). We used multinomial logistic regression models to assess the relationship between race and postsurgical discharge destination. We calculated 90-day hospital readmission as function of discharge destination. Results: Among patients <65 years, compared to whites, AAs had a higher risk of discharge to an IRF (adjusted relative risk ratio [aRRR]: 2.56, 95% confidence interval [CI]: 1.77-3.71) and a SNF (aRRR 3.37, 95% CI: 2.07-5.49). Among those ≥65 years, AA patients also had a higher risk of discharge to an IRF (aRRR: 1.96, 95% CI: 1.39-2.76) and a SNF (aRRR: 3.66, 95% CI: 2.29-5.84). Discharge to either IRF or SNF, instead of home with self-care, was significantly associated with higher odds of 90-day hospital readmission (<65 years: adjusted odds ratio [aOR]: 4.06, 95% CI: 3.49-4.74; aOR: 2.05, 95% CI: 1.70-2.46, respectively; ≥65 years: aOR: 4.32, 95% CI: 3.67-5.09, respectively; aOR: 1.74, 95% CI: 1.46-2.07, respectively). Conclusions: Compared to whites, AAs who underwent THR were more likely to be discharged to an IRF or SNF. Discharge to either facility was associated with a higher risk of hospital readmission.
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Affiliation(s)
- Ernest R Vina
- University of Arizona Arthritis Center, University of Arizona School of Medicine, Tucson, AZ, USA
| | - Michael J Kallan
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Aliya Collier
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Charles L Nelson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Said A Ibrahim
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA
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Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss - a pilot study of 34 patients. BMC Musculoskelet Disord 2017; 18:383. [PMID: 28865425 PMCID: PMC5581473 DOI: 10.1186/s12891-017-1742-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/28/2017] [Indexed: 02/02/2023] Open
Abstract
Background Hip and knee replacements in patients with bone defects after infection correlates with high rates of reinfection. In this vulnerable patient population, the prevention of reinfection is to be considered superordinate to the functionality and defect bridging. The use of silver coating of aseptic implants as an infection prophylaxis is already proven; however, the significance of these coatings in septic reimplantation of large implants is still not sufficiently investigated. Methods In a retrospective analysis, 34 patients who have been treated with a modular mega-endoprosthesis after a cured bone infection of the lower limb (femur or tibia) have been evaluated. One group with 14 patients (NSCG: non silver- coated group) was supplied with the non silver- coated implants: MML München- Lübeck™ modular endoprosthesis system (AQ Implants, Ahrensburg, Germany) or MUTARS® Modular Universal Tumor And Revision System (Implantcast GmbH, Buxtehude, Germany). The other group with 20 patients (SCG: silver- coated group) was supplied with the silver- coated system of MUTARS®. In addition to the clinical findings and the patients’ histories, specifically the reinfection rates, the patients’ mobility was assessed using the New Mobility Score (NMS, by Parker and Palmer). Results The median follow-up period was 72 months, ranging from 6 to 267 months. The dropout rate was 5.8%. The reinfection rate after healed reinfection in SCG was 40% (8/20), in NSCG 57% (8/14), p = 0.34; α =0.05. The time for reinfection was, on average, 14 months (1–72 months) in SCG and 8 months (1–48 months) in the NSCG (p = 0.61; α =0.05). The two groups showed no differences in the NMS. Conclusion With this retrospective analysis, it can be determined that the rate of reinfection of modular mega-endoprostheses on the hip and knee joint after healed periprosthetic joint infection (PJI) can be reduced by the use of silver coated implants. The time until reinfection can also be delayed by utilizing silver coated implants. Due to the low number of cases of this highly specific patient population, no statistical significance could be determined. A positive effect, however, can be assumed through the use of silver coatings in mega-endoprostheses after an infectious situation.
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Buhagiar MA, Naylor JM, Simpson G, Harris IA, Kohler F. Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector. BMC Health Serv Res 2017. [PMID: 28629423 PMCID: PMC5477339 DOI: 10.1186/s12913-017-2379-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background To understand private consumer and clinician preferences towards different rehabilitation modes following knee or hip arthroplasty, and identify factors which influence the chosen rehabilitation pathway. Methods Mixed 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. Results Pre-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. Conclusions No 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 material The 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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Affiliation(s)
- Mark A Buhagiar
- South West Sydney Clinical School, University of New South Wales, Elizabeth Drive, Liverpool Hospital, Liverpool, NSW, 2170, Australia. .,, Level 2, 12 Victoria Rd, Parramatta, NSW, 2150, Australia.
| | - Justine M Naylor
- South West Sydney Clinical School, University of New South Wales, Elizabeth Drive, Liverpool Hospital, Liverpool, NSW, 2170, Australia.,South West Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, 2170, Australia.,Whitlam Orthopaedic Research Centre, P.O Box 906, Caringbah, NSW, 2229, Australia.,Ingham Institute of Applied Medical Research, PO Box 3151 Westfields Liverpool, Liverpool, NSW, 2170, Australia
| | - Grahame Simpson
- South West Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, 2170, Australia.,Ingham Institute of Applied Medical Research, PO Box 3151 Westfields Liverpool, Liverpool, NSW, 2170, Australia
| | - Ian A Harris
- South West Sydney Clinical School, University of New South Wales, Elizabeth Drive, Liverpool Hospital, Liverpool, NSW, 2170, Australia.,South West Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, 2170, Australia.,Whitlam Orthopaedic Research Centre, P.O Box 906, Caringbah, NSW, 2229, Australia.,Ingham Institute of Applied Medical Research, PO Box 3151 Westfields Liverpool, Liverpool, NSW, 2170, Australia
| | - Friedbert Kohler
- South West Sydney Clinical School, University of New South Wales, Elizabeth Drive, Liverpool Hospital, Liverpool, NSW, 2170, Australia.,South West Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, 2170, Australia.,HammondCare, 2/447 Kent St, Sydney, NSW, 2000, Australia
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Niccoli G, Mercurio D, Cortese F. Bone scan in painful knee arthroplasty: obsolete or actual examination? ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:68-77. [PMID: 28657567 DOI: 10.23750/abm.v88i2 -s.6516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
ptic loosening, instability and infection are the major causes of TKA failure. For many years, nuclear medicine (NM) imaging was helpful to frame a painful total joint arthroplasty. The differentiation of septic from aseptic prosthetic loosening is critical. The latest AAOS guidelines to detect periprosthetic joint infection (PJI) restrict the role of NM scintigraphy. On the other hand, several studies suggest that NM imaging plays an important role in the evaluation of patients with painful prosthesis, but its specificity in differentiating aseptic loosening from infection is low. Moreover, scintigraphic exams showed different diagnostic accuracy in TKA compared to total hip arthroplasty (THA). PURPOSE To assess and discuss current knowledges about the diagnostic value of the various scans in TKA failure alone. METHODS We perform a pubmed/medline search to identify all papers published in the literature matching the following key words: "total knee arthroplasty", "bone", "scintigraphy", "imaging", "three-phase", "triple-phase", "99mTc-HDP", "99mTc-MDP", "99mTc-hydroxymethane diphosphonate", and "99m Tc-methylenediphosphonate", "leukocyte scanning", "labeled leukocyte scintigraphy", "antigranulocyte", "nuclear medicine", "septic loosening", "aseptic loosening" and "infection". RESULTS Three phases bone scintigraphy results an early diagnostic screening test or part of the preoperative tests for painful TKA and when PJI is suspected. Instead, leukocyte/bone marrow scintigraphy is superior to other scintigraphic tools in diagnosis of TKA infections. Granulocyte scintigraphy, seems to be an excellent choice when the diagnosis is unclear. Moreover, nuclear diagnostic tests showed different diagnostic accuracy between TKA and THA. CONCLUSIONS Although nuclear diagnostic tests for THA failure are superior in diagnostic accuracy compared to TKA, NM scintigraphy is still an effective tool in the identification of chronic, low grade PJI. To date, scintigraphic exams have an higher levels of sensitivity, specificity and accuracy. Currently, leukocyte/bone marrow scintigraphy is considered the gold standard for this aim. Nevertheless, further studies are needed to assess and improve the accuracy of the scintigraphic exams in order to discriminate the causes of failure for painful TKA.
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Haghverdian BA, Wright DJ, Schwarzkopf R. Length of Stay in Skilled Nursing Facilities Following Total Joint Arthroplasty. J Arthroplasty 2017; 32:367-374. [PMID: 27600304 DOI: 10.1016/j.arth.2016.07.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The most commonly used postacute care facility after total joint arthroplasty is a skilled nursing facility (SNF). However, little is known regarding the role of physical therapy achievements and insurance status on the decision to discharge from an SNF. In this study, we aim to compare functional outcomes and length of stay (LOS) at an SNF among patients with Medicare vs private health coverage. METHODS We retrospectively collected physical therapy data for 114 patients who attended an SNF following acute hospitalization for total joint arthroplasty. Medicare beneficiaries were compared with patients covered by Managed Care (MC) policies (health maintenance organization [HMO] and preferred provider organization [PPO]) using several SNF discharge outcomes, including LOS, distance ambulated, and functional independence in gait, transfers, and bed mobility. RESULTS LOS at the SNF was significantly longer for Medicare patients (Medicare: 24 ± 22 days, MC: 12 ± 7 days, P = .007). After adjusting for LOS and covariates, MC patients had significantly greater achievements in all functional outcomes measured. In a study subanalysis, Medicare patients were found to achieve similar functional outcomes by SNF day 14 as MC patients achieved by their day of discharge on approximately day 12. Yet, the Medicare group was not discharged until several days later. CONCLUSION Medicare status is associated with poor functional outcomes, long LOS, and slow progress in the SNF. Our results suggest that insurance reimbursement may be a primary factor in the decision to discharge, rather than the achievement of functional milestones.
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Affiliation(s)
- Brandon A Haghverdian
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, California
| | - David J Wright
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, California
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU Langon Medical Center, New York, New York
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Jiang S, Xiang J, Gao X, Guo K, Liu B. The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. J Telemed Telecare 2016; 24:257-262. [PMID: 28027679 DOI: 10.1177/1357633x16686748] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The objective of this study was to assess the efficacy of telerehabilitation for patients after total knee arthroplasty (TKA) compared with face-to-face rehabilitation. Methods Medline, SCOPUS, Google Scholar, EMBASE, Springer, Science Direct, and Cochrane databases were searched electronically. Relevant journals and references of studies included were hand-searched for randomized controlled trials (RCTs) regarding the efficacy of telerehabilitation on functional recovery in patients after TKA. Two reviewers independently performed data extraction and quality assessment. Data were analysed using RevMan 5.3 software and Stata 12.0 software. Results Four RCTs involving 442 patients were included in the meta-analysis. Overall, compared with face-to-face rehabilitation, telerehabilitation could achieve comparable pain relief (mean difference = 0.52; 95% confidence interval (CI) = −0.20 to 1.24; p = 0.16) and better Western Ontario and McMaster Universities Osteoarthritis Index improvement (mean difference = 1.13; 95% CI = 0.23 to 2.02; p = 0.014). In addition, telerehabilitation treatment resulted in a significantly higher extension range ( p < 0.00001) and quadriceps strength ( p = 0.0002) than face-to-face rehabilitation. Discussion Telerehabilitation should be recommended for patients after TKA because of its comparable pain control and better improvement of functional recovery as compared to face-to-face rehabilitation.
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Affiliation(s)
- Shuihua Jiang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Xuzhou Medical University, Jiangshu, China
| | - Jie Xiang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Xuzhou Medical University, Jiangshu, China
| | - Xiuming Gao
- Department of Rehabilitation Medicine, The Affiliated Hospital of Xuzhou Medical University, Jiangshu, China
| | - Kaijin Guo
- Department of Rehabilitation Medicine, The Affiliated Hospital of Xuzhou Medical University, Jiangshu, China
| | - Baohua Liu
- Department of Rehabilitation Medicine, The 2nd Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
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Jones CA, Martin RS, Westby MD, Beaupre LA. Total joint arthroplasty: practice variation of physiotherapy across the continuum of care in Alberta. BMC Health Serv Res 2016; 16:627. [PMID: 27809849 PMCID: PMC5095989 DOI: 10.1186/s12913-016-1873-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/21/2016] [Indexed: 12/27/2022] Open
Abstract
Background Comprehensive and timely rehabilitation for total joint arthroplasty (TJA) is needed to maximize recovery from this elective surgical procedure for hip and knee arthritis. Administrative data do not capture the variation of treatment for rehabilitation across the continuum of care for TJA, so we conducted a survey for physiotherapists to report practice for TJA across the continuum of care. The primary objective was to describe the reported practice of physiotherapy for TJA across the continuum of care within the context of a provincial TJA clinical pathway and highlight possible gaps in care. Method A cross-sectional on-line survey was accessible to licensed physiotherapists in Alberta, Canada for 11 weeks. Physiotherapists who treated at least five patients with TJA annually were asked to complete the survey. The survey consisted of 58 questions grouped into pre-operative, acute care and post-acute rehabilitation. Variation of practice was described in terms of number, duration and type of visits along with goals of care and program delivery methods. Results Of the 80 respondents, 26 (33 %) stated they worked in small centres or rural settings in Alberta with the remaining respondents working in two large urban sites. The primary treatment goal differed for each phase across the continuum of care in that pre-operative phase was directed at improving muscle strength, functional activities were commonly reported for acute care, and post-acute phase was directed at improving joint range-of-motion. Proportionally, more physiotherapists from rural areas treated patients in out-patient hospital departments (59 %), whereas a higher proportion in urban physiotherapists saw patients in private clinics (48 %). Across the continuum of care, treatment was primarily delivered on an individual basis rather than in a group format. Conclusions Variation of practice reported with pre-and post-operative care in the community will stimulate dialogue within the profession as to what is the minimal standard of care to provide patients undergoing TJA. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1873-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada.
| | - Ruben San Martin
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada
| | - Marie D Westby
- School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada
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Haghverdian B, Wright D, Doan LT, Tran D, Schwarzkopf R. Gait Training in Patients Discharged to a Skilled Nursing Facility Following Total Joint Arthroplasty. Geriatr Orthop Surg Rehabil 2016; 7:33-8. [PMID: 26929855 PMCID: PMC4748164 DOI: 10.1177/2151458515627310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
| | - David Wright
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Linda T Doan
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Dennis Tran
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA
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Cary MP, Baernholdt M, Merwin EI. Changes in Payment Regulation and Acute Care Use for Total Hip Replacement: Trends in Length of Stay, Costs, and Discharge, 1997-2012. Rehabil Nurs 2016; 41:67-77. [PMID: 25820992 PMCID: PMC4584198 DOI: 10.1002/rnj.210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE To describe trends in the length of stay (LOS), costs, mortality, and discharge destination among a national sample of total hip replacement (THR) patients between 1997 and 2012. DESIGN Longitudinal retrospective design METHODS Descriptive analysis of the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample data. FINDINGS A total of 3,516,636 procedures were performed over the study period. Most THR patients were women, and the proportion aged 44-65 years increased. LOS decreased from 5 to 3 days. Charges more than doubled, from $22,184 to $53,901. Deaths decreased from 43 to 12 deaths per 10,000 patients. THR patients discharged to an institutional setting declined, while those discharged to the community increased. CONCLUSION We found an increase in THR patients, who were younger, women, had private insurance, and among those discharged to community-based settings. CLINICAL RELEVANCE Findings have implications for patient profiles, workplace environments, quality improvement, and educational preparation of nurses in acute and postacute settings.
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Affiliation(s)
- Michael P. Cary
- Duke University, School of Nursing, Assistant Professor, DUMC 3322,
307 Trent Drive, Durham, NC 27710, ,
1-919-613-6031
| | - Marianne Baernholdt
- Virginia Commonwealth University, School of Nursing, Professor,
1100 East Leigh Street, P.O. Box 980567, Richmond, VA 23298-0567,
, ,
1-757-870-4978
| | - Elizabeth I. Merwin
- Duke University, School of Nursing, Professor, DUMC 3322, 307 Trent
Drive, Durham, NC 27710, ,
1-919-681-0886
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Westby MD, Klemm A, Li LC, Jones CA. Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery. Phys Ther 2016; 96:90-100. [PMID: 26089040 PMCID: PMC4706598 DOI: 10.2522/ptj.20150106] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/08/2015] [Indexed: 12/27/2022]
Abstract
Quality-based care is a hallmark of physical therapy. Treatment effectiveness must be evident to patients, managers, employers, and funders. Quality indicators (QIs) are tools that specify the minimum acceptable standard of practice. They are used to measure health care processes, organizational structures, and outcomes that relate to aspects of high-quality care of patients. Physical therapists can use QIs to guide clinical decision making, implement guideline recommendations, and evaluate and report treatment effectiveness to key stakeholders, including third-party payers and patients. Rehabilitation managers and senior decision makers can use QIs to assess care gaps and achievement of benchmarks as well as to guide quality improvement initiatives and strategic planning. This article introduces the value and use of QIs to guide clinical practice and health service delivery specific to physical therapy. A framework to develop, select, report, and implement QIs is outlined, with total joint arthroplasty rehabilitation as an example. Current initiatives of Canadian and American physical therapy associations to develop tools to help clinicians report and access point-of-care data on patient progress, treatment effectiveness, and practice strengths for the purpose of demonstrating the value of physical therapy to patients, decision makers, and payers are discussed. Suggestions on how physical therapists can participate in QI initiatives and integrate a quality-of-care approach in clinical practice are made.
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Affiliation(s)
- Marie D Westby
- M.D. Westby, PT, PhD, School of Public Health, University of Alberta, c/o Arthritis Research Canada, 5591 No. 3 Rd, Richmond, British Columbia, Canada V6X 2C7.
| | - Alexandria Klemm
- A. Klemm, BKin, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- L.C. Li, PT, PhD, Department of Physical Therapy, University of British Columbia
| | - C Allyson Jones
- C.A. Jones, PT, PhD, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
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Piva SR, Moore CG, Schneider M, Gil AB, Almeida GJ, Irrgang JJ. A randomized trial to compare exercise treatment methods for patients after total knee replacement: protocol paper. BMC Musculoskelet Disord 2015; 16:303. [PMID: 26474988 PMCID: PMC4609104 DOI: 10.1186/s12891-015-0761-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/07/2015] [Indexed: 12/27/2022] Open
Abstract
Background Although the outcome of total knee replacement (TKR) is favorable, surgery alone fails to resolve the functional limitations and physical inactivity that existed prior to surgery. Exercise is likely the only intervention capable of improving these persistent limitations, but exercises have to be performed with intensity sufficient to promote significant changes, at levels that cannot be tolerated until later stages post TKR. The current evidence is limited regarding the effectiveness of exercise at a later stage post TKR. To that end, this study aims to compare the outcomes of physical function and physical activity between 3 treatment groups: clinic-based individual outpatient rehabilitative exercise during 12 weeks, community-based group exercise classes during 12 weeks, and usual medical care (wait-listed control group). The secondary aim is to identify baseline predictors of functional recovery for the exercise groups. Methods/Design This protocol paper describes a comparative effectiveness study, designed as a 3-group single-blind randomized clinical trial. Two hundred and forty older adults who underwent TKR at least 2 months prior will be randomized into one of the three treatment approaches. Data will be collected at baseline, 3 months, and 6 months. The wait-listed control group will be randomized to one of the 2 exercise groups after 6 months of study participation, and will complete a 9-month follow-up. Primary outcome is physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index Physical Function Subscale (WOMAC-PF). Physical function is also measured by performance-based tests. Secondary outcomes include performance-based tests and physical activity assessed by a patient-reported survey and accelerometry-based physical activity monitors. Exploratory outcomes include adherence, co-interventions, attrition, and adverse events including number of falls. Linear mixed models will be fitted to compare the changes in outcome across groups. Logistic regression will identify patient characteristics that predict functional recovery in the exercise groups. Instrumental variable methods will be used to estimate the efficacy of the interventions in the presence of non-compliance. Discussion Results will inform recommendations on exercise programs to improve physical function and activity for patients at the later stage post TKR and help tailor interventions according with patients’ characteristics. Trial registration ClinicalTrials.gov Identifier NCT02237911.
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Affiliation(s)
- Sara R Piva
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219-3130, USA.
| | - Charity G Moore
- Research in Biostatistics, Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, North Carolina, USA.
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219-3130, USA.
| | - Alexandra B Gil
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219-3130, USA.
| | - Gustavo J Almeida
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219-3130, USA.
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Schwarzkopf R, Ho J, Snir N, Mukamel DD. Factors Influencing Discharge Destination After Total Hip Arthroplasty: A California State Database Analysis. Geriatr Orthop Surg Rehabil 2015; 6:215-9. [PMID: 26328239 PMCID: PMC4536515 DOI: 10.1177/2151458515593778] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION With this growing demand, the length of stay for total hip arthroplasty (THA) procedures has decreased, and as a trade-off, we have seen a higher utilization of extended care facilities (ECFs). Both trends have significant economic implications on the health care system, and predicting the discharge destinations of THA patients would help policy makers plan for future health expenditures. We performed a retrospective data analysis of a large patient database to determine which variables are significant in predicting discharge destinations of THA patients. METHODS We used the California Hospital Discharge data set of the year 2010, collected and provided by the Office of Statewide Health Planning and Development. The data set includes information about patient demographics, insurance type, diagnoses and procedures, and patient disposition. The study cohort included 14 326 patients. Discharge to home was the reference category. Discharge to ECF and discharge to home with home care were the 2 additional alternatives. RESULTS In all, 46.9% of patients were discharged home with home health care, followed by 29.6% to ECF, and 23.5% to home without care. Discharge to ECF was more likely for patients with more comorbidities and a higher age. The strongest predictors were Medicaid and black or Asian race. Medicare relative to private payer was a strong predictor of ECF discharge. Male gender was the only factor that lowered the risk of discharge to ECF. The strongest predictor for discharge to home with home care was black race relative to whites. Medicaid lowered the risk of home care, and gender did not matter. CONCLUSION This study serves to provide insight on which patient characteristics influence discharge destination after THA. Race, insurance, and morbidity were highly significant factors on patient discharge destination to a subacute nursing facility.
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Affiliation(s)
- Ran Schwarzkopf
- Department of Orthopaedics Surgery, University of California Irvine, Orange, CA, USA
| | - Jenny Ho
- Health Policy Research Institute, University of California Irvine, Irvine, CA, USA
| | - Nimrod Snir
- Orthopaedic Division, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana D Mukamel
- Health Policy Research Institute, University of California Irvine, Irvine, CA, USA
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Ong KL, Lotke PA, Lau E, Manley MT, Kurtz SM. Prevalence and Costs of Rehabilitation and Physical Therapy After Primary TJA. J Arthroplasty 2015; 30:1121-6. [PMID: 25765130 DOI: 10.1016/j.arth.2015.02.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/12/2015] [Accepted: 02/21/2015] [Indexed: 02/01/2023] Open
Abstract
This study evaluated the trends in discharge patterns and the prevalence and cost of post-discharge PT. The 5% Medicare database (1997-2010) was used to identify 50,886 primary THA and 107,675 TKA patients. More than 50% of patients were discharged from hospital to an inpatient facility. There were an increase in discharges to skilled nursing units and a reduced rate to rehabilitation facilities. In contrast to hospital, surgeon reimbursement, and implant costs, the average annual PT cost per patient rose through the study period. Approximately 25% of PT costs were used on less common modalities. PT costs more than $648 million a year. With the increased pressure to control costs for primary TJA, these patterns may change unless PT effectiveness can be demonstrated.
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Affiliation(s)
| | - Paul A Lotke
- University of Pennsylvania, Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania
| | | | - Michael T Manley
- Homer Stryker Center for Orthopaedic Education and Research, Mahwah, New Jersey
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Zajonz D, Wuthe L, Tiepolt S, Brandmeier P, Prietzel T, von Salis-Soglio GF, Roth A, Josten C, Heyde CE, Ghanem M. Diagnostic work-up strategy for periprosthetic joint infections after total hip and knee arthroplasty: a 12-year experience on 320 consecutive cases. Patient Saf Surg 2015; 9:20. [PMID: 25987902 PMCID: PMC4435661 DOI: 10.1186/s13037-015-0071-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/29/2015] [Indexed: 12/16/2022] Open
Abstract
Background Elective knee and hip arthroplasty is followed by infections in currently about 0.5–2.0 % of cases – a figure which is on the increase due to the rise in primary implants. Correct diagnosis early on is essential so that appropriate therapy can be administered. This work presents a retrospective analysis of the diagnoses of patients suffering infections after total hip or knee arthroplasty. Methods 320 patients with prosthetic joint infection (PJI) following knee or hip arthroplasty were identified. They comprised a) 172 patients with an infection after total hip arthroplasty (THA): 56 % females (n = 96) and 44 % males (n = 76) with a mean age of 70.9 (39–92) years; and 148 patients with an infection after total knee arthroplasty (TKA): 55 % females (n = 82) and 45 % males (n = 66) with a mean age of 70.7 (15–87) years. Results Although significantly more TKA than THA patients reported pain, erythema, a burning sensation and swelling, no differences between the two groups were observed with respect to dysfunction, fever or fatigue. However, significant differences were noted in the diagnosis of loosening (THA 55 %, TKA 31 %, p < 0.001) and suspected infection using conventional X-rays (THA 61 %, TKA 29 %, p < 0.001). FDG-PET-CT produced very good results in nearly 95 % of cases. There were no differences between THA and TKA patients regarding levels of inflammation markers. Histological evaluation proved to be significantly better than microbiological analysis. Summary The clinical picture may be non-specific and not show typical inflammatory symptoms for a long time, particularly in PJI of the hip. As imaging only provides reliable conclusions after the symptoms have persisted for a long time, morphological imaging is not suitable for the detection of early infections. FDG-PT-CT proved to be the most successful technique and is likely to be used more frequently in future. Nevertheless, there are currently no laboratory parameters which are suitable for the reliable primary diagnosis of PJI. Diagnosis requires arthrocentesis, and the fluid obtained should always be examined both microbiologically and histologically.
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Affiliation(s)
- Dirk Zajonz
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Lena Wuthe
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Solveig Tiepolt
- Department of Nuclear medicine, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Philipp Brandmeier
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Torsten Prietzel
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Georg Freiherr von Salis-Soglio
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Christoph-E Heyde
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Mohamed Ghanem
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
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Abstract
AIM A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession's philosophical basis and espoused commitment to client-centred practice. FINDINGS The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession's espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine's expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession's core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. CONCLUSION Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.
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Affiliation(s)
- Jyothi Gupta
- DPT & Occupational Science & Occupational Therapy, St Catherine University , Minneapolis, MN , USA
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Correlation between physician specific discharge costs, LOS, and 30-day readmission rates: an analysis of 1,831 cases. J Arthroplasty 2014; 29:1717-22. [PMID: 24814806 DOI: 10.1016/j.arth.2014.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/04/2014] [Accepted: 04/02/2014] [Indexed: 02/01/2023] Open
Abstract
There is currently wide variation in the use and cost of post acute care following total joint arthroplasty. Additionally the optimum setting to which patients should be discharged after surgery is controversial. Discharge patterns following joint replacement vary widely between physicians at our institution, however, only weak correlations were found between the cost of discharge and length of stay or readmission rates. The inter-physician variance in discharge cost did not correlate to a difference in quality, as measured by length of stay and readmission rates, but does imply there is significant opportunity to modify physician discharge practices without impacting patient outcomes and the quality of care.
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Admetlla Falgueras M, Fusté Sugrañes J. Cuidados postagudos. Med Clin (Barc) 2014; 143:29-33. [DOI: 10.1016/j.medcli.2013.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/17/2013] [Accepted: 05/23/2013] [Indexed: 11/15/2022]
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Oatis CA, Li W, DiRusso JM, Hoover MJ, Johnston KK, Butz MK, Phillips AL, Nanovic KM, Cummings EC, Rosal MC, Ayers DC, Franklin PD. Variations in Delivery and Exercise Content of Physical Therapy Rehabilitation Following Total Knee Replacement Surgery: A Cross-Sectional Observation Study. ACTA ACUST UNITED AC 2014; Suppl 5. [PMID: 26594649 PMCID: PMC4651458 DOI: 10.4172/2329-9096.s5-002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Prevalence of total knee replacement (TKR) is large and growing but functional outcomes are variable. Physical therapy (PT) is integral to functional recovery following TKR but little is known about the quantity or content of PT delivered. Purposes of this study were to describe the amount and exercise content of PT provided in the terminal episode of PT care following TKR and to examine factors associated with utilization and content. Methods Subjects included participants in a clinical trial of behavioral interventions for patients undergoing primary unilateral TKR who had completed the 6-month study evaluation. PT records were requested from 142 consecutive participants who had completed their post-TKR rehabilitation, 102 in/out patient care, and 40 in homecare. Information on utilization and exercises was extracted from a retrospective review of the PT records. Results We received 90 (88%) outpatient and 27 (68%) homecare PT records. Records showed variability in timing, amount and content of PT. Patients receiving outpatient PT had more visits and remained in PT longer (p<0.001). Exercises known in the TKR literature were utilized more frequently in the outpatient setting (p=0.001) than in home care. Records from both settings had limited documentation of strengthening progression. Conclusions The study reveals considerable variability in timing, utilization and exercise content of PT following TKR and suggests sub-optimal exercise for strengthening. While methods we employed document variability, improved systematic PT documentation and in-depth research are needed to identify optimal timing, utilization and content of PT following TKR.
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Affiliation(s)
- Carol A Oatis
- Department of Physical Therapy, Arcadia University, 450 S. Easton Road, Glenside, PA 19038, USA
| | - Wenjun Li
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA ; Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jessica M DiRusso
- The Queens Medical Center, 1301 Punchbowl St, Honolulu, HI 96813, USA
| | - Mindy J Hoover
- The Physical Therapy Associates of Myerstown, 11 E Lincoln Ave, Myerstown, PA 17067, USA
| | - Katherine K Johnston
- Sports and More Physical Therapy, Inc., 8300 Health Park, Suite 127, Raleigh, NC 27615, USA
| | - Monika K Butz
- Drayer PT Institute, 998 Hospitality Way, Aberdeen, MD 21001, USA
| | - Amy L Phillips
- UPMC Shadyside, 5230 Centre Ave, Pittsburgh, PA 15232, USA
| | - Kimberly M Nanovic
- St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Elizabeth C Cummings
- HealthEast Optimum Rehabilitation, Midway Clinic, 1390 University Avenue West Saint Paul, Minnesota 55104, USA
| | - Milagros C Rosal
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Patricia D Franklin
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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Ramos NL, Karia RJ, Hutzler LH, Brandt AM, Slover JD, Bosco JA. The effect of discharge disposition on 30-day readmission rates after total joint arthroplasty. J Arthroplasty 2014; 29:674-7. [PMID: 24183369 DOI: 10.1016/j.arth.2013.09.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/10/2013] [Accepted: 09/11/2013] [Indexed: 02/01/2023] Open
Abstract
Previous studies have demonstrated no significant difference in overall functional outcomes of patients discharged to a sub acute setting versus home with health services after total joint arthroplasty. These findings coupled with pressure to reduce health care costs and the implementation of a prospective payment system under Medicare have supported the use of home rehabilitation services and the trend towards earlier discharge after hospitalization. While the overall functional outcome of patients discharged to various settings has been studied, there is a relative dearth of investigation comparing postoperative complications and readmission rates between various discharge dispositions. Our study demonstrated patients discharged home with health services had a significantly lower 30 day readmission rate compared to those discharged to inpatient rehab facilities. Patients discharged to rehab facilities have a higher incidence of comorbidity and this association could be responsible for their higher rate of readmission.
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Affiliation(s)
| | - Raj J Karia
- NYU Hospital for Joint Diseases, New York, New York
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Westby MD, Brittain A, Backman CL. Expert Consensus on Best Practices for Post-Acute Rehabilitation After Total Hip and Knee Arthroplasty: A Canada and United States Delphi Study. Arthritis Care Res (Hoboken) 2014; 66:411-23. [DOI: 10.1002/acr.22164] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 09/03/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Marie D. Westby
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada; Richmond, British Columbia Canada
| | - Asuko Brittain
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada; Richmond, British Columbia Canada
| | - Catherine L. Backman
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada; Richmond, British Columbia Canada
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Reistetter TA, Karmarkar AM, Graham JE, Eschbach K, Kuo YF, Granger CV, Freeman J, Ottenbacher KJ. Regional variation in stroke rehabilitation outcomes. Arch Phys Med Rehabil 2014; 95:29-38. [PMID: 23921200 PMCID: PMC4006274 DOI: 10.1016/j.apmr.2013.07.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/18/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation. DESIGN Retrospective cohort design. SETTING Inpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation from the United States. PARTICIPANTS Patients (N=143,036) with stroke discharged from inpatient rehabilitation during 2006 and 2007. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Community discharge, length of stay (LOS), and discharge functional status ratings (motor, cognitive) across 10 geographic service regions defined by the Centers for Medicare and Medicaid Services (CMS). RESULTS Approximately 71% of the sample was discharged to the community. After adjusting for covariates, the percentage discharged to the community varied from 79.1% in the Southwest (CMS region 9) to 59.4% in the Northeast (CMS region 2). Adjusted LOS varied by 2.1 days, with CMS region 1 having the longest LOS at 18.3 days and CMS regions 5 and 9 having the shortest at 16.2 days. CONCLUSIONS Rehabilitation outcomes for persons with stroke varied across CMS regions. Substantial variation in discharge destination and LOS remained after adjusting for demographic and clinical characteristics.
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Affiliation(s)
- Timothy A Reistetter
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX.
| | - Amol M Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Karl Eschbach
- Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Carl V Granger
- Uniform Data System for Medical Rehabilitation, Buffalo, NY
| | - Jean Freeman
- Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
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Issa K, Naziri Q, Johnson AJ, Memon T, Dattilo J, Harwin SF, Mont MA. Evaluation of patient satisfaction with physical therapy following primary THA. Orthopedics 2013; 36:e538-42. [PMID: 23672902 DOI: 10.3928/01477447-20130426-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Physical therapy following total hip arthroplasty (THA) is intended to maximize a patient's range of motion and function and improve the quality of life. No universally accepted standard of care exists for physical therapy among physicians or therapists. However, it may be crucial to enhance efforts to more fully elucidate contributing parameters that affect patient experiences. The purpose of this study was to evaluate various factors contributing to patient satisfaction with postoperative physical therapy. One hundred consecutive patients (110 hips) who underwent THA were prospectively surveyed for satisfaction with postoperative physical therapy. All surveys were filled out anonymously by the patients, and investigators were blinded to clinical outcomes and who was surveyed. Seventy-six percent of patients reported being satisfied with their rehabilitation experiences. Factors, including patient age and sex, duration of therapy, number of patients per session, continuity of care with the same therapist, amount of hands-on time spent with the therapist, number of patients per session, and total number of sessions completed, were significantly correlated with patient satisfaction. Co-pay amount did not significantly affect patient satisfaction. These factors may be underappreciated by physicians and physical therapists. To maximize patient satisfaction with physical therapy, physicians should identify institutions whose therapists are willing to spend adequate hands-on time during one-on-one or small-group sessions while maintaining the greatest possible continuity of care with a single provider.
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Affiliation(s)
- Kimona Issa
- Center for Joint Preservation and Reconstruction, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD 21215, USA
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Mota REM, Tarricone R, Ciani O, Bridges JFP, Drummond M. Determinants of demand for total hip and knee arthroplasty: a systematic literature review. BMC Health Serv Res 2012; 12:225. [PMID: 22846144 PMCID: PMC3483199 DOI: 10.1186/1472-6963-12-225] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Documented age, gender, race and socio-economic disparities in total joint arthroplasty (TJA), suggest that those who need the surgery may not receive it, and present a challenge to explain the causes of unmet need. It is not clear whether doctors limit treatment opportunities to patients, nor is it known the effect that patient beliefs and expectations about the operation, including their paid work status and retirement plans, have on the decision to undergo TJA. Identifying socio-economic and other determinants of demand would inform the design of effective and efficient health policy. This review was conducted to identify the factors that lead patients in need to undergo TJA. METHODS An electronic search of the Embase and Medline (Ovid) bibliographic databases conducted in September 2011 identified studies in the English language that reported on factors driving patients in need of hip or knee replacement to undergo surgery. The review included reports of elective surgery rates in eligible patients or, controlling for disease severity, in general subjects, and stated clinical experts' and patients' opinions on suitability for or willingness to undergo TJA. Quantitative and qualitative studies were reviewed, but quantitative studies involving fewer than 20 subjects were excluded. The quality of individual studies was assessed on the basis of study design (i.e., prospective versus retrospective), reporting of attrition, adjustment for and report of confounding effects, and reported measures of need (self-reported versus doctor-assessed). Reported estimates of effect on the probability of surgery from analyses adjusting for confounders were summarised in narrative form and synthesised in odds ratio (OR) forest plots for individual determinants. RESULTS The review included 26 quantitative studies-23 on individuals' decisions or views on having the operation and three about health professionals' opinions-and 10 qualitative studies. Ethnic and racial disparities in TJA use are associated with socio-economic access factors and expectations about the process and outcomes of surgery. In the United States, health insurance coverage affects demand, including that from the Medicare population, for whom having supplemental Medicaid coverage increases the likelihood of undergoing TJA. Patients with post-secondary education are more likely to demand hip or knee surgery than those without it (range of OR 0.87-2.38). Women are as willing to undergo surgery as men, but they are less likely to be offered surgery by specialists than men with the same need. There is considerable variation in patient demand with age, with distinct patterns for hip and knee. Paid employment appears to increase the chances of undergoing surgery, but no study was found that investigated the relationship between retirement plans and demand for TJA. There is evidence of substantial geographical variation in access to joint replacement within the territory covered by a public national health system, which is unlikely to be explained by differences in preference or unmeasured need alone. The literature tends to focus on associations, rather than testing of causal relationships, and is insufficient to assess the relative importance of determinants. CONCLUSIONS Patients' use of hip and knee replacement is a function of their socio-economic circumstances, which reinforce disparities by gender and race originating in the doctor-patient interaction. Willingness to undergo surgery declines steeply after the age of retirement, at the time some eligible patients may lower their expectations of health status achievement. There is some evidence that paid employment independently increases the likelihood of operation. The relative contribution of variations in surgical decision making to differential access across regions within countries deserves further research that controls for clinical need and patient lifestyle preferences, including retirement decisions. Evidence on this question will become increasingly relevant for service planning and policy design in societies with ageing populations.
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Affiliation(s)
- Rubén E Mújica Mota
- Institute for Health Services Research, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK.
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Villanueva-Martınez M, Hernandez-Barrera V, Chana-Rodríguez F, Rojo-Manaute J, Rıos-Luna A, San Roman Montero J, Gil-de-Miguel A, Jimenez-Garcia R. Trends in incidence and outcomes of revision total hip arthroplasty in Spain: a population based study. BMC Musculoskelet Disord 2012; 13:37. [PMID: 22429798 PMCID: PMC3349558 DOI: 10.1186/1471-2474-13-37] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 03/19/2012] [Indexed: 12/02/2022] Open
Abstract
Background To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain. Methods We selected all surgical admissions in individuals aged ≥ 40 years who underwent RTHA (ICD-9-CM procedure code 81.53) between 2001 and 2008 from the Spanish National Hospital Discharge Database. Age- and sex-specific incidence rates, Charlson co-morbidity index, length of stay (LOS), costs and in-hospital mortality (IHM) were estimated for each year. Multivariate analyses were conducted to asses time trends. Results 32, 280 discharges of patients (13, 391 men/18, 889 women) having undergone RTHA were identified. Overall crude incidence showed a small but significant increase from 20.2 to 21.8 RTHA per 100, 000 inhabitants from 2001 to 2008 (p < 0.01). The incidence increased for men (17.7 to 19.8 in 2008) but did not vary for women (22.3 in 2001 and 22.2 in 2008). Greater increments were observed in patients older than 84 years and in the age group 75-84. In 2001, 19% of RTHA patients had a Charlson Index ≥ 1 and this proportion rose to 24.6% in 2008 (p < 0.001). The ratio RTHA/THA remained stable and around 20% in Spain along the entire period The crude overall in-hospital mortality (IHM) increased from 1.16% in 2001 to 1.77% (p = 0.025) in 2008. For both sexes the risk of death was higher with age, with the highest mortality rates found among those aged 85 or over. After multivariate analysis no change was observed in IHM over time. The mean inflation adjusted cost per patient increased by 78.3%, from 9, 375 to 16, 715 Euros from 2001 to 2008. After controlling for possible confounders using Poisson regression models, we observed that the incidence of RTHA hospitalizations significantly increased for men and women over the period 2001 to 2008 (IRR 1.10, 95% CI 1.03-1.18 and 1.08, 95% CI 1.02-1.14 respectively). Conclusions The crude incidence of RTHA in Spain showed a small but significant increase from 2001 to 2008 with concomitant reductions in LOS, significant increase in co-morbidities and cost per patient.
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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. Arch Phys Med Rehabil 2011; 92:712-20. [PMID: 21530718 DOI: 10.1016/j.apmr.2010.12.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/15/2010] [Accepted: 12/04/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine differences in outcomes of patients after lower-extremity joint replacement across 3 post-acute 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.
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Tian W, DeJong G, Horn SD, Putman K, Hsieh CH, DaVanzo JE. Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility? Med Decis Making 2011; 32:176-87. [PMID: 21487103 DOI: 10.1177/0272989x11403488] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). METHODS This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. RESULTS IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. CONCLUSIONS The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.
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Affiliation(s)
- Wenqiang Tian
- National Rehabilitation Hospital, Washington, DC (WT, GD, C-HH)
| | - Gerben DeJong
- National Rehabilitation Hospital, Washington, DC (WT, GD, C-HH)
| | - Susan D Horn
- Institute for Clinical Outcome Research, Salt Lake City, Utah (SDH)
| | | | - Ching-Hui Hsieh
- National Rehabilitation Hospital, Washington, DC (WT, GD, C-HH)
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Tian W, DeJong G, Munin MC, Smout R. Patterns of rehabilitation after hip arthroplasty and the association with outcomes: an episode of care view. Am J Phys Med Rehabil 2010; 89:905-18. [PMID: 20962601 DOI: 10.1097/phm.0b013e3181f1c6d8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the patterns of rehabilitation after elective and nonelective hip arthroplasty and its association with outcomes over an episode of postacute care. DESIGN Data were obtained from a multisite prospective observational cohort study and its companion follow-up study. Patterns of care were measured by the combination of settings of care where hip arthroplasty patients received rehabilitation therapy. Main outcome measure was motor portion of the functional independence measure. RESULTS Approximately 90% of hip arthroplasty patients received rehabilitation care from more than one setting. Eight patterns of care were identified in the follow-up period. Patterns of subsequent care were driven more by initial setting than by etiology. Nonelective hip arthroplasty patients had lower motor functional independence measure scores and used more rehabilitation services than did elective hip arthroplasty patients. Patterns of care were modest factors (accounted for only 7% of variance) in predicting patient motor functional independence measure over an episode of postacute care. CONCLUSIONS Etiology of hip arthroplasty is associated with amounts of rehabilitation care used and outcomes. After the initial postacute rehabilitation setting, patients continued to receive considerable amounts of therapy in various settings. It is important to look beyond a single setting of care to an entire episode of care when examining clinical outcomes.
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Affiliation(s)
- Wenqiang Tian
- Center for Post-acute Studies, National Rehabilitation Hospital, Washington, DC 20010, USA
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Yeung SMT, Davis AM, Soric R. Factors influencing inpatient rehabilitation length of stay following revision hip replacements: a retrospective study. BMC Musculoskelet Disord 2010; 11:252. [PMID: 20979662 PMCID: PMC2987976 DOI: 10.1186/1471-2474-11-252] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 10/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The annual incidence of revision hip replacements has increased in both Canada and United States, particularly in younger adults. Patients following revision hip replacements often require longer hospital length of stay (LOS) but little is known about predictors of inpatient rehabilitation LOS in this group of patients. The purpose of this study was to evaluate the socio-demographic, pre-surgery, surgery and post-surgery related factors that might influence rehabilitation LOS of inpatients following revision hip replacements. METHODS This study included inpatients discharged from a musculoskeletal ward between 2002 and 2006 following rehabilitation revision hip replacement. Data sources included the National Reporting System, a standardized, provincial administrative database and augmented by chart abstraction. The collected elements included the outcome LOS and the following independent variables: age, sex, support at home, environmental barriers, language barrier, number of revision surgeries on the affected hip, comorbidity, previous orthopaedic surgeries in the lower extremities (L/ES), the hip component(s) revised, weight-bearing status, hemoglobin level, complications, days lapsed from surgery to rehabilitation admission and admission scores on the Functional Independence Measure (FIM). Simple linear regression was used to take forward any predictors significant at p < .10 level. Variables that satisfied the significance level were grouped in blocks and entered for regression analyses. RESULTS The 275 patients in this sample had a mean age of 69 years; 62% were female and the mean LOS was 29.6 days. Statistically significant predictors of longer LOS were low admission FIM score, female sex, revision of only the femoral component, 2 or more prior surgeries in the L/Es and 2 or more hip revisions (redo revision). The final model explained 28% of variance in inpatient LOS. CONCLUSIONS A score of 9-14 points lower in admission FIM, female sex, revision of only the femoral component, prior surgeries in the L/Es and redo hip revision are all independent factors associated with 4-6 days longer LOS. These results may facilitate an understanding of bed flow. Additionally, patients with one or a combination of the above characteristics may benefit from enhanced care plans that facilitate achievement of rehabilitation goals for discharge home.
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Affiliation(s)
- So-Mei Teresa Yeung
- Musculoskeletal Service, West Park Healthcare Centre, 82 Buttonwood Ave, Toronto, ON, M6M 2J5, Canada.
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Stineman MG, Chan L. Commentary on the comparative effectiveness of alternative settings for joint replacement rehabilitation. Arch Phys Med Rehabil 2009; 90:1257-9. [PMID: 19651259 DOI: 10.1016/j.apmr.2009.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 05/22/2009] [Accepted: 05/24/2009] [Indexed: 11/15/2022]
Abstract
The comprehensive Joint Replacement Outcomes in Inpatient Rehabilitation Facilities and Nursing Treatment Sites 1 and 2 studies presented in this issue of the Archives by DeJong and colleagues focus on an important issue facing U.S. rehabilitation today: the comparative effectiveness of alternative rehabilitation settings for the management of conditions such as joint replacement. Although there are hints in the data that patients receiving care in inpatient rehabilitation facilities compared with those treated in skilled nursing facilities may have slightly better recoveries of physical function, the evidence is weaker than for a number of other conditions. It is important to look beyond the question of which setting is best, toward gaining a deeper understanding of the elements within these settings that most enhance outcomes.
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Affiliation(s)
- Margaret G Stineman
- Department of Rehabilitation Medicine, the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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DeJong G, Hsieh CH, Gassaway J, Horn SD, Smout RJ, Putman K, James R, Brown M, Newman EM, Foley MP. Characterizing Rehabilitation Services for Patients With Knee and Hip Replacement in Skilled Nursing Facilities and Inpatient Rehabilitation Facilities. Arch Phys Med Rehabil 2009; 90:1269-83. [DOI: 10.1016/j.apmr.2008.11.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 10/28/2008] [Accepted: 11/24/2008] [Indexed: 11/28/2022]
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Joint Replacement Rehabilitation Outcomes on Discharge From Skilled Nursing Facilities and Inpatient Rehabilitation Facilities. Arch Phys Med Rehabil 2009; 90:1284-96. [DOI: 10.1016/j.apmr.2009.02.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 01/15/2009] [Accepted: 02/15/2009] [Indexed: 11/17/2022]
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