Patterns of rehabilitation after hip arthroplasty and the association with outcomes: an episode of care view.
OBJECTIVE
To examine the patterns of rehabilitation after elective and nonelective hip arthroplasty and its association with outcomes over an episode of postacute care.


METHODS
Data were obtained from a multisite prospective observational cohort study and its companion follow-up study. Patterns of care were measured by the combination of settings of care where hip arthroplasty patients received rehabilitation therapy. Main outcome measure was motor portion of the functional independence measure.


RESULTS
Approximately 90% of hip arthroplasty patients received rehabilitation care from more than one setting. Eight patterns of care were identified in the follow-up period. Patterns of subsequent care were driven more by initial setting than by etiology. Nonelective hip arthroplasty patients had lower motor functional independence measure scores and used more rehabilitation services than did elective hip arthroplasty patients. Patterns of care were modest factors (accounted for only 7% of variance) in predicting patient motor functional independence measure over an episode of postacute care.


CONCLUSIONS
Etiology of hip arthroplasty is associated with amounts of rehabilitation care used and outcomes. After the initial postacute rehabilitation setting, patients continued to receive considerable amounts of therapy in various settings. It is important to look beyond a single setting of care to an entire episode of care when examining clinical outcomes.
Tian
Wenqiang
W
Center for Post-acute Studies, National Rehabilitation Hospital, Washington, DC 20010, USA.
DeJong
Gerben
G
Munin
Michael C
MC
Smout
Randall
R
D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D015897:Comorbidity; D004185:Disability Evaluation; D017558:Elective Surgical Procedures; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D006304:Health Status; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009788:Occupational Therapy / Q000706:statistics & numerical data*; D015207:Osteoarthritis, Hip / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life