Abstract
Objectives
To explore the association between therapy minutes per length of stay (LOS) day (TMLD),
functional outcomes, and rate of functional recovery among older adults after elective
hip or knee replacement surgery across postacute (PAC) settings.
Design
Secondary analysis of data collected for an observational cohort study from 2005 to 2010.
Setting
Four inpatient rehabilitation facilities (IRF) and 7 skilled nursing facilities (SNF).
Participants
Adults aged 65 years or older (N=162) with Medicare fee-for-service insurance and
a primary diagnosis of elective hip or knee replacement.
Interventions
Not applicable.
Main Outcome Measures
FIM mobility and self-care measures at discharge.
Results
The TMLD was divided into high, medium, and low categories. Participants were grouped
into low, medium, and high gain rate groups based on their average change in mobility
and self-care FIM measures per LOS day. Gain rate and TMLD groups were crossmapped
to create 9 gain-TMLD groups separately for mobility and self-care. There were no
significant differences in admission mobility or self-care measures by gain rate and
TMLD trajectory or by facility type (IRF or SNF). TMLD was not significantly associated
with discharge mobility measures. Participants in high gain trajectories attained
independence with mobility and self-care tasks at discharge regardless of TMLD. Those
in low gain trajectories needed supervision or assistance on all mobility tasks. Older
age and greater pain at discharge were significantly associated with lower odds of
being in the medium or high gain rate groups.
Conclusions
For clinicians and facility managers who must care for patients with constrained resources,
the shift to value-based reimbursement for rehabilitation services in PAC settings
has reinvigorated the question of whether the duration of therapy provided influences
patient outcomes. Three hours of daily therapy after joint replacement surgery may
exceed what is necessary for recovery. Postsurgical pain management remains a significant
challenge in older adults.
Keywords
List of abbreviations:
IQR (interquartile range), IRF (inpatient rehabilitation facility), LOS (length of stay), PAC (postacute care), SNF (skilled nursing facility), TMLD (therapy minutes per length of stay day)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 16, 2020
Footnotes
The original study that enabled the collection of the data for the submitted work was funded by the Department of Education, National Institute on Disability, and Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (award H133B040032) to Allen Heinemann, PhD, at the Rehabilitation Institute of Chicago (now the Shirley Ryan Ability Lab). Dr Mallinson was a coinvestigator on that original funding. No additional funding supported the current analyses. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government.
Disclosures: Dr Cogan is supported by a Polytrauma/TBI Advanced Fellowship from the VA Office of Academic Affiliations. The other authors have nothing to disclose.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
