title: Joint replacement rehabilitation outcomes on discharge from skilled nursing facilities and inpatient rehabilitation facilities.
abstract: OBJECTIVE
  To compare functional outcomes at discharge across postacute settings.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Eleven inpatient rehabilitation facilities (IRFs), 8 freestanding skilled nursing facilities (SNFs), and 1 hospital-based SNF from across the United States.
  
  
  METHODS
  Consecutively enrolled patients (N=2152): patients with knee replacement (n=1401) and patients with hip replacement (n=751).
  
  
  METHODS
  None; examination of existing practice patterns.
  
  
  METHODS
  FIM discharge motor score.
  
  
  RESULTS
  Freestanding SNF patients entered with higher motor FIM scores and left with higher scores than did IRF patients. IRF patients, however, achieved larger motor FIM gains and achieved them in a shorter time. In multivariate models controlling for patient differences and onset days, IRFs were associated with better discharge motor outcomes, but the overall setting effect was not large. The largest motor FIM differences were between medium-volume IRFs and low-volume freestanding SNFs: 4.6 motor FIM points for patients with knee replacement and 7.3 motor FIM points for patients with hip replacement. Other differences between settings were much smaller. Multivariate models explained between a third and a half of the variance in outcome.
  
  
  CONCLUSIONS
  As a group, IRFs had better motor FIM outcomes than did SNFs, but the size of the IRF advantage was not large. Other important facility and practice characteristics also were associated with discharge outcomes after joint replacement rehabilitation. Earlier and more intensive rehabilitation was associated with better outcomes. The volume of joint replacement patients seen by a facility also plays a part: medium-volume facilities among both SNFs and IRFs had better outcomes.
authors: Center for Post-acute Studies, National Rehabilitation Hospital, Washington, DC 20010, USA. Gerben.DeJong@MedStar.net
authors: Gerben
authors: G
authors: Dejong
authors: Susan D
authors: SD
authors: Horn
authors: Randall J
authors: RJ
authors: Smout
authors: Wenqiang
authors: W
authors: Tian
authors: Koen
authors: K
authors: Putman
authors: Julie
authors: J
authors: Gassaway
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D004282:Documentation; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D014481:United States