To explore the association between therapy minutes per LOS day (TMLD), functional outcomes, and rate of functional recovery among older adults following elective hip or knee replacement surgery across post-acute (PAC) settings.
Secondary analysis of data collected for an observational cohort study from 2005-2010 SETTING: Four inpatient rehabilitation facilities (IRF) and seven skilled nursing facilities (SNF).
Adults aged >65 with Medicare fee-for-service insurance and primary diagnosis of elective hip or knee replacement (N=162).
N/A MAIN OUTCOME MEASURES: Functional Independence Measure (FIM) mobility and self-care measures at discharge.
TMLD were divided into high, medium, and low categories. Participants were grouped into low, medium, and high gain rate groups based on average change in mobility and self-care FIM measures per LOS day. Gain rate and TMLD groups were cross-mapped to create nine gain/TMLD groups separately for mobility and self-care. There were no significant differences in admission mobility or self-care measures by gain rate/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.
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. Post-surgical pain management remains a significant challenge in older adults.

Copyright © 2020. Published by Elsevier Inc.