Characterizing Rehabilitation Services for Patients With Knee and Hip Replacement in Skilled Nursing Facilities and Inpatient Rehabilitation Facilities

Abstract 

DeJong G, Hsieh C-H, 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.

Objective

To characterize rehabilitation services for patients with knee and hip replacement in 3 types of postacute facilities in the U.S.

Design

Multi-site prospective observational cohort study.

Setting

Eight freestanding skilled nursing facilities (SNFs), 1 hospital-based SNF, and 11 inpatient rehabilitation facilities (IRFs).

Participants

Patients (N=2158) with knee or hip replacement.

Interventions

No new interventions.

Main Outcome Measures

Length of stay (LOS), amount and intensity of physical therapy (PT) and occupational therapy (OT), types of therapy activities.

Results

Average LOS was about 15 days for freestanding SNF patients, and 9 to 10 days for hospital-based SNF and IRF patients. Freestanding SNFs and IRFs provide about the same number of hours of PT and OT; the hospital-based SNF provided 27% fewer hours. Freestanding SNFs and the hospital-based SNF provided fewer hours a day than did IRFs. Joint replacement patients across all 3 types of facilities spent, on average, 70% to 75% of their PT time in just 2 activities—exercise and gait and spent 56% to 66% of their OT time in 3 activities—exercise, functional mobility, and dressing lower body.

Conclusions

Both freestanding SNFs and IRFs provided similar amounts of PT with a similar emphasis on exercise and gait activities. IRFs, however, provided more OT than freestanding SNFs. IRFs had shorter LOSs and more intensive therapy services than freestanding SNFs. Study freestanding SNFs exhibited greater variation in LOS and intensity of therapy than IRFs.

Key Words: Arthroplasty, replacement, hip, Arthroplasty, replacement, knee, Occupational therapy, Physical therapy (specialty), Rehabilitation, Rehabilitation centers, Skilled nursing facilities

List of Abbreviations: BMI, body mass index, CMG, case-mix group, CMS, Centers for Medicare and Medicaid Services, CSI, Comprehensive Severity Index, DME, durable medical equipment, IRF, inpatient rehabilitation facility, JOINTS, Joint Replacement Outcomes in Inpatient Rehabilitation Facilities and Nursing Treatment Sites, LOS, length of stay, MDS, minimum data set, OT, occupational therapy, POC, point-of-care, PT, physical therapy, SNF, skilled nursing facility