title: A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery.
abstract: OBJECTIVE
  To examine differences in outcomes of patients after lower-extremity joint replacement across 3 post-acute care (PAC) rehabilitation settings.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Skilled nursing facilities (SNFs; n=5), inpatient rehabilitation facilities (IRFs; n=4), and home health agencies (HHAs; n=6) from 11 states.
  
  
  METHODS
  Patients with total knee (n=146) or total hip replacement (n=84) not related to traumatic injury.
  
  
  METHODS
  None.
  
  
  METHODS
  Self-care and mobility status at PAC discharge measured by using the Inpatient Rehabilitation Facility Patient Assessment Instrument.
  
  
  RESULTS
  Based on our study sample, HHA patients were significantly less dependent than SNF and IRF patients at admission and discharge in self-care and mobility. IRF and SNF patients had similar mobility levels at admission and discharge and similar self-care at admission, but SNF patients were more independent in self-care at discharge. After controlling for differences in patient severity and length of stay in multivariate analyses, HHA setting was not a significant predictor of self-care discharge status, suggesting that HHA patients were less medically complex than SNF and IRF patients. IRF patients were more dependent in discharge self-care even after controlling for severity. For the full discharge mobility regression model, urinary incontinence was the only significant covariate.
  
  
  CONCLUSIONS
  For the patients in our U.S.-based study, direct discharge to home with home care was the optimal strategy for patients after total joint replacement surgery who were healthy and had social support. For sicker patients, availability of 24-hour medical and nursing care may be needed, but intensive therapy services did not seem to provide additional improvement in functional recovery in these patients.
authors.affiliation: Department of Occupational Science and Occupational Therapy, the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA. trudy.mallinson@usc.edu
authors.forename: Trudy R
authors.initials: TR
authors.lastname: Mallinson
authors.forename: Jillian
authors.initials: J
authors.lastname: Bateman
authors.forename: Hsiang-Yi
authors.initials: HY
authors.lastname: Tseng
authors.forename: Larry
authors.initials: L
authors.lastname: Manheim
authors.forename: Orit
authors.initials: O
authors.lastname: Almagor
authors.forename: Anne
authors.initials: A
authors.lastname: Deutsch
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012648:Self Care; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D016896:Treatment Outcome