Outcome after rehabilitation for total joint replacement at IRF and SNF: a case-controlled comparison.
OBJECTIVE
The objective of this study was to determine whether outcomes differed between patients with single knee or hip joint replacement surgery undergoing rehabilitation in an inpatient rehabilitation facility (IRF) vs. skilled nursing facilities (SNFs).


METHODS
A retrospective chart review was performed on 87 pairs of patients treated in either an IRF or a SNF matched for age, gender, type of surgery, and Functional Independent Measure (FIM) motor score at admission. All patients discharged from the IRF for rehabilitation following single hip or knee replacement surgery in 2004 were eligible for comparison with index cases discharged from SNFs with the same diagnosis in 2004. At discharge, FIM motor scores, device used for ambulation, ambulation distance, disposition, and length of stay (LOS) were recorded.


RESULTS
The mean LOS of IRF-treated patients was 10.3 +/- 3.3 days, compared with 20.0 +/- 10.8 days for SNF-treated patients (P < 0.005). A significantly higher percentage of IRF-treated patients were discharged directly home (IRF: 89.5%; SNF: 79.1%; P < 0.029). The mean discharge locomotion FIM score for IRF-treated patients was 5.71 +/- 0.91 compared with 4.90 +/- 1.92 for the SNF-treated patients (P < 0.004). At discharge, the mean ambulation distance of patients treated at the IRF was of 380 +/- 168 feet compared with 289 +/- 212 feet for patients treated at SNFs (P < 0.005). Significantly more of the SNF-treated patients required a walker (80.2%) for ambulation at discharge compared with patients treated at the IRF (38.3%, P < 0.001). Of the patients who were discharged home, 75% of the SNF-treated patients required homecare services compared with 41.2% of the IRF-treated patients (P < 0.001).


CONCLUSIONS
When patients were matched for age, gender, operative diagnosis, and admission ambulation FIM, those who received rehabilitation in the IRF had, on average, a shorter length of stay and superior functional outcomes than those treated in SNFs.
Walsh
Mary Beth
MB
Burke Rehabilitation Hospital, White Plains, NY 10605, USA.
Herbold
Janet
J
D000368:Aged; D019643:Arthroplasty, Replacement / Q000534:rehabilitation*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009518:New York; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D016138:Walking / Q000706:statistics & numerical data