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. 2018 Oct 17;100(20):1728-1734.
doi: 10.2106/JBJS.17.01667.

Home-Health-Care Physical Therapy Improves Early Functional Recovery of Medicare Beneficiaries After Total Knee Arthroplasty

Jason R Falvey  1   2 , Michael J Bade  1 , Jeri E Forster  1   2 , Robert E Burke  2 , Jason M Jennings  3   4 , Eugene Nuccio  5 , Jennifer E Stevens-Lapsley  1   6
Affiliations

Home-Health-Care Physical Therapy Improves Early Functional Recovery of Medicare Beneficiaries After Total Knee Arthroplasty

Jason R Falvey et al. J Bone Joint Surg Am. .

Abstract

Background: Home-health-care utilization after total knee arthroplasty (TKA) is increasing. Recent publications have suggested that supervised rehabilitation is not needed to optimize functional recovery after TKA; however, few studies have evaluated patients in home-health-care settings. The objectives of this study were to (1) determine whether physical therapy (PT) utilization is associated with functional improvements for patients in home-health-care settings after TKA and (2) determine which factors are related to utilization of PT.

Methods: This study was an analysis of Medicare home-health-care claims data for patients treated with a TKA in 2012 who received home-health-care services for postoperative rehabilitation. Multivariable linear regression models were used to evaluate relationships between PT utilization and recovery in activities of daily living (ADLs). Negative binomial regression models were used to determine factors associated with PT utilization.

Results: Records from 5,967 Medicare beneficiaries were evaluated. Low home-health-care PT utilization (≤5 visits) was associated with less improvement in ADLs compared with 6 to 9 visits, 10 to 13 visits, or ≥14 visits. Compared with low home-health-care utilization, utilization of 6 to 9 visits was associated with a 25% greater improvement in ADLs over the home-health-care episode (p < 0.0001); 10 to 13 visits, with a 40% greater improvement (p < 0.0001); and ≥14 visits, with a 50% greater improvement (p < 0.0001). The findings remained robust following adjustments for medical complexity, baseline functional status, and home-health-care episode duration. After adjustment, lower PT utilization was observed for patients receiving home health care from rural agencies (10.7% fewer visits, 95% confidence interval [CI] = 7.9% to 13.7%), those with depressive symptoms (4.8% fewer visits, 95% CI = 1.3% to 8.3%), and those with any baseline dyspnea (5.3% fewer visits, 95% CI = 3.1% to 7.5%).

Conclusions: Low home-health-care PT utilization was significantly associated with worse recovery in ADLs after TKA for Medicare beneficiaries, after controlling for medical complexity, baseline function, and home-health-care episode duration. Patients who are served by rural agencies or who have higher medical complexity receive fewer PT visits after TKA and may need closer monitoring to ensure optimal functional recovery.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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References

    1. Agency for Healthcare Research and Quality. Most frequent operating room procedures performed in US hospitals, 2003-2012. 2014. December https://www.hcup-us.ahrq.gov/reports/statbriefs/sb186-Operating-Room-Pro.... Accessed 2016 Jul 8. - PubMed
    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007. April;89(4):780-5. - PubMed
    1. Siddiqi A, White PB, Mistry JB, Gwam CU, Nace J, Mont MA, Delanois RE. Effect of bundled payments and health care reform as alternative payment models in total joint arthroplasty: a clinical review. J Arthroplasty. 2017. August;32(8):2590-7. Epub 2017 Mar 20. - PubMed
    1. Cram P, Ravi B, Vaughan-Sarrazin MS, Lu X, Li Y, Hawker G. What drives variation in episode-of-care payments for primary TKA? An analysis of Medicare administrative data. Clin Orthop Relat Res. 2015. November;473(11):3337-47. Epub 2015 Aug 4. - PMC - PubMed
    1. Slover JD, Mullaly KA, Payne A, Iorio R, Bosco J. What is the best strategy to minimize after-care costs for total joint arthroplasty in a bundled payment environment? J Arthroplasty. 2016. December;31(12):2710-3. Epub 2016 May 20. - PubMed