Effect of Outpatient Rehabilitation on Functional Mobility After Single Total Knee Arthroplasty: A Randomized Clinical Trial.

Importance: Even without evidence, rehabilitation practitioners continue to introduce new interventions to enhance the mobility outcomes for the increasing population with a recent total knee arthroplasty (TKA).

Objective: To compare post-TKA functional mobility outcomes among 3 newly developed physical therapy protocols with a standard-of-care post-TKA rehabilitation protocol.

Design, Setting, And Participants: This randomized clinical trial included 4 study arms implemented in 15 outpatient clinics within a single health system in the Baltimore, Maryland, and Washington, District of Columbia, region from October 2013 to April 2017.

Innovative Devices Did Not Provide Superior Total Knee Arthroplasty Outcomes in Post-Operative Rehabilitation: Results From a Four-Arm Randomized Clinical Trial.

Background: Orthopedic surgeons face an increasing array of post-TKA (total knee arthroplasty) rehabilitation interventions that entail innovative equipment and devices, but their relative effectiveness remains unknown. The study compared patient outcomes among primary unilateral TKA patients participating in one of 4 post-TKA rehabilitation interventions-a standard-of-care intervention and 3 more recently developed physical therapy interventions.

Methods: The Knee Arthroplasty Rehabilitation Outcomes Study is a 4-arm randomized clinical trial conducted across 15 outpatient rehabilitation clinics.

Use of rehabilitation after hip and knee replacement in New Zealand: a national survey.

Aims: Our objective was to describe rehabilitation used before and after joint replacement in New Zealand and evaluate variation based on geography and ethnicity.

Methods: In this descriptive cross-sectional questionnaire-based study we recruited participants 45 years or older (n=608) from the New Zealand Joint Registry six months after primary total hip, total knee or uni-compartmental knee replacement.

Results: The cohort was predominantly New Zealand European (89.

Rehabilitation after total joint replacement: a scoping study.

Purpose: The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research.

Materials And Methods: We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement.

Coming to Terms With the IMPACT Act of 2014.

The Improving Medicare Post-Acute Transformation (IMPACT) Act of 2014 will set the course for much of postacute care well into the next decade. It (1) authorizes a uniform method of patient assessment in postacute care; (2) sets a timetable for developing, implementing, and reporting quality measures; and (3) lays the groundwork for future payment reform in postacute care. This article places the IMPACT Act into the larger arc of health care reform and change.

Advancing SCI health care to avert rehospitalization.

This commentary reflects on the high rate of health care utilization among individuals with traumatic spinal cord injury (SCI) in the first year of injury as reported by Skelton et al. in the current issue of this journal. Commentary argues that the variation in risk-adjusted rehospitalization rates suggests that there is considerable opportunity for improvement.

Factors associated with pressure ulcer risk in spinal cord injury rehabilitation.

Objective: The aim of this study was to identify patient and clinical factors most strongly associated with a spinal cord injury patient's risk for developing a pressure ulcer (PU) during rehabilitation.

Design: This is a prospective observational cohort study conducted at an urban rehabilitation hospital-based specialized spinal cord injury center. The main outcome measure was the onset of a stage 2 or higher PU.

Attending to biographical disruption: the experience of rehabilitation following tetraplegia due to spinal cord injury.

Purpose: To explore the experience of rehabilitation from the perspective of individuals with tetraplegia.

Methods: Semi-structured interviews of between 40 and 60 min were conducted with three men and one woman, with spinal injuries at C7 or higher, within 6 months of discharge from inpatient spinal cord injury (SCI) rehabilitation. Data were subject to an Interpretive Phenomenological Analysis (IPA).

Site-neutral payment for postacute care: framing the issue.

This commentary evaluates the merits of proposals in the United States to create a site-neutral payment system for postacute care for patients with select rehabilitation-related conditions. Under a site-neutral payment system, Medicare would pay providers based on patients' clinical needs, not on the peculiarities of individual postacute settings such as skilled nursing facilities and inpatient rehabilitation facilities. This commentary frames the policy choices by taking into account the research evidence on setting costs and outcomes, the policy tools and preconditions needed for an effective site-neutral payment system, and the overall direction of American health and postacute policy.

Are we asking the right question about postacute settings of care?

This issue of Archives includes an article by Mallinson et al that compares the outcomes of patients with hip fracture who received rehabilitation services in 3 different postacute settings: skilled nursing facilities, inpatient rehabilitation facilities, or home health. Except in 1 instance, Mallinson found no setting-specific effects and noted that the issue of defining an optimum postacute rehabilitation program is complex and requires more investigation. Mallinson's findings are interesting in their own right but raise a more fundamental issue.

Acute rehospitalizations during inpatient rehabilitation for spinal cord injury.

Objectives: To investigate frequency of and reasons for readmission to acute care (RTAC) during inpatient rehabilitation after traumatic spinal cord injury (SCI), and to identify factors associated with RTAC.

Design: Prospective observational cohort.

Setting: Inpatient rehabilitation.

Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation.

Objective: To determine rates of rehospitalization among discharged rehabilitation patients with traumatic spinal cord injury (SCI) in the first 12 months postinjury, and to identify factors associated with rehospitalization.

Design: Prospective observational cohort study.

Setting: Six geographically dispersed rehabilitation centers in the U.

Association of various comorbidity measures with spinal cord injury rehabilitation outcomes.

Objective: To investigate the amount of variation in short- and medium-term spinal cord injury (SCI) rehabilitation outcomes explained by various comorbidity measures, over and above patient preinjury characteristics and neurologic and functional status.

Design: Prospective observational cohort study of traumatic SCI patients receiving inpatient rehabilitation and followed up at 1 year postinjury.

Setting: Inpatient rehabilitation and community follow-up at 6 SCI treatment centers.

Comparing rehabilitation services and outcomes between older and younger people with spinal cord injury.

Objective: To compare patient and injury characteristics, rehabilitation services, and outcomes between people incurring traumatic spinal cord injury (SCI) at younger and older ages.

Design: Multisite prospective observational cohort study.

Setting: Six acute rehabilitation facilities.

Relation between inpatient and postdischarge services and outcomes 1 year postinjury in people with traumatic spinal cord injury.

Objective: To examine the association between inpatient and postdischarge rehabilitation services and function, life satisfaction, and community participation 1 year after spinal cord injury (SCI).

Design: Prospective, observational.

Setting: Six rehabilitation facilities.

Role of body weight in therapy participation and rehabilitation outcomes among individuals with traumatic spinal cord injury.

Objective: To examine the association between body weight, therapy participation, and functional outcomes among people with spinal cord injury (SCI).

Design: Multisite prospective observational cohort study.

Setting: Six acute rehabilitation facilities.

Practice-based evidence research in rehabilitation: an alternative to randomized controlled trials and traditional observational studies.

Sound rigorous methods are needed by researchers and providers to address practical questions about risks, benefits, and costs of interventions as they occur in routine clinical practice such as: Are treatments used in daily practice associated with intended outcomes? For whom does an intervention work best? With limited clinical resources, what are the best interventions to use for specific types of patients? Answers to such questions can help clinicians, patients, researchers, and health care administrators learn from, and improve, real-world everyday clinical practice. In this article, we describe existing research designs to demonstrate clinical usefulness and comparative effectiveness of rehabilitation treatments. We compare randomized controlled trials and observational cohort studies of various types, including those that use instrumental variables or propensity scores to control for potential patient or treatment selection effects.

Outcomes and weight-bearing status during rehabilitation after arthroplasty for hip fractures.

Objective: To examine the association of weight-bearing status with patient-related variables and outcomes of inpatient rehabilitation after hip arthroplasty for acute hip fracture.

Design: A multi-site prospective observational cohort study.

Setting: Eighteen skilled nursing and inpatient rehabilitation facilities.

Initial recovery trajectories among patients with hip fracture: a conceptual approach to exploring comparative effectiveness in postacute care.

Objective: To assess whether clusters of patients with hip fracture and with distinct initial recovery trajectories (IRT) could be identified by using practice-based evidence data and to examine the validity of these data.

Design: Analysis of multisite prospective observational cohort study database.

Setting: Eighteen skilled nursing and inpatient rehabilitation facilities.

Physical therapy activities in stroke, knee arthroplasty, and traumatic brain injury rehabilitation: their variation, similarities, and association with functional outcomes.

Background: The mix of physical therapy services is thought to be different with different impairment groups. However, it is not clear how much variation there is across impairment groups. Furthermore, the extent to which the same physical therapy activities are associated with functional outcomes across different types of patients is unknown.

Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

Objective: There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS).

Methods: This study used a prospective multisite observational cohort design.

Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions.

Objective: To assess black-white differences in functional outcomes, controlling for patient characteristics, use of nontherapy ancillaries (NTAs), and use of physical (PT) and occupational therapy (OT) activities and interventions.

Design: Multicenter prospective observational cohort study of poststroke rehabilitation.

Setting: Six U.

Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation.

Objective: To describe racial differences in patient characteristics, nontherapy ancillaries, physical therapy (PT), occupational therapy (OT), and functional outcomes at discharge in stroke rehabilitation.

Design: Multicenter prospective observational cohort study of poststroke rehabilitation.

Setting: Six U.

Patterns of rehabilitation after hip arthroplasty and the association with outcomes: an episode of care view.

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

Design: 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.