The impact of rheumatoid arthritis on rehabilitation outcomes after lower extremity arthroplasty.
BACKGROUND
Medical rehabilitation after lower extremity arthroplasty is an integral part of recovery and a critical step in returning to independent mobility. We hypothesized that rehabilitation may take longer for patients with rheumatoid arthritis (RA) versus osteoarthritis (OA) because joint pain, swelling, and deformities are generally worse among persons with RA.


OBJECTIVE
To determine the impact of RA on length of rehabilitation stay and rehabilitation functional status gain after arthroplasty.


METHODS
We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients admitted after a lower extremity arthroplasty between 1994 and 2001. Sample included 1361 patients with RA and 26,096 patients with OA. The main outcome measure was functional status gain as assessed by the functional independence measure (FIM). Our primary analytic method was linear regression. Covariates were age, gender, race/ethnicity, other comorbidity, admission FIM, and site of arthroplasty.


RESULTS
Mean length of stay for patients with RA was 11.3 +/- 7.1 days (mean +/- standard deviation) versus 10.3 +/- 6.5 days for those with OA. Mean weekly gain was 18.6 +/- 12.1 for patients with RA versus 20.6 +/- 12.0 for those with OA. After adjusting for covariates, RA was associated with longer stay (0.7 day) and lower FIM gain (2.6).


CONCLUSIONS
RA was associated with longer length of rehabilitation stay and lower FIM gain in patients with lower extremity arthroplasty. Such patients may require additional monitoring to ensure sufficient rehabilitation.
Nguyen-Oghalai
Tracy U
TU
Division of Rheumatology, Department of Medicine, University of Texas Medical Branch (UTMB), 301 University Boulevard, Galveston, TX 77555, USA. tranguye@utmb.edu
Ottenbacher
Kenneth J
KJ
Caban
Mabel
M
Granger
Carl V
CV
Grecula
Michael
M
Goodwin
James S
JS
D000203:Activities of Daily Living; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies