title: Analysis of rehabilitation activities within skilled nursing and inpatient rehabilitation facilities after hip replacement for acute hip fracture.
abstract: OBJECTIVE
  To characterize rehabilitation services in two types of postacute facilities in patients who underwent hip replacement following a hip fracture.
  
  
  METHODS
  Multisite prospective observational cohort from 6 freestanding skilled nursing facilities and 11 inpatient rehabilitation facilities. Patients (n = 218) with hip fracture who had either hemiarthroplasty or total hip arthroplasty followed by rehabilitation at skilled nursing facilities or inpatient rehabilitation facilities were enrolled. Using a point-of-care methodology, we recorded data from actual physical therapy and occupational therapy sessions completed including functional outcomes during the postacute admission.
  
  
  RESULTS
  Onset time from surgical repair to rehabilitation admission was not significantly different between sites. Average skilled nursing facilities length of stay was 24.7 +/- 13.6 days, whereas inpatient rehabilitation facilities was 13.0 +/- 5.7 days (P < 0.01). Total hours of physical therapy and occupational therapy services per patient day were 1.2 in skilled nursing facilities and 2.0 in inpatient rehabilitation facilities. For weekdays only, these data changed to 1.6 in skilled nursing facilities and 2.6 hrs per patient in inpatient rehabilitation facilities (P < 0.01). Patients in inpatient rehabilitation facilities accrued more time for gait training and exercise in physical therapy, which was found to be 48% and 40% greater, respectively, through day 8. In occupational therapy, patients of inpatient rehabilitation facilities had more time allocated to lower body dressing and transfers.
  
  
  CONCLUSIONS
  Significant differences in rehabilitation activities were observed, and intensity was notably different within the first 8 therapy days even though baseline demographics and medical complexity were comparable across facility types. Our data suggest that after more complex hip replacement surgery, hip fracture patients can tolerate more intensive therapy earlier within the rehabilitation program.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Munin
authors.forename: Koen
authors.initials: K
authors.lastname: Putman
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Smout
authors.forename: Wenqiang
authors.initials: W
authors.lastname: Tian
authors.forename: Gerben
authors.initials: G
authors.lastname: DeJong
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D026741:Physical Therapy Modalities; D019095:Point-of-Care Systems / Q000458:organization & administration; D011336:Probability; D015397:Program Evaluation; D011446:Prospective Studies; D011859:Radiography; D012047:Rehabilitation Centers / Q000458:organization & administration*; D018570:Risk Assessment; D012866:Skilled Nursing Facilities / Q000458:organization & administration*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology