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Fewer sessions of home health care physical therapy linked with worse recovery after TKA
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After controlling for medical complexity, baseline function and duration of home health care episode, investigators found Medicare patients who had five or fewer home health care physical therapy visits after total knee arthroplasty had worse recovery regarding activities of daily living.
“Underutilization of home-based rehabilitation services after total knee replacement may limit early functional recovery,” Jason R. Falvey, PT, DPT, PhD, a post-doctoral fellow at Yale University who did the work when he was a PhD candidate at University of Colorado, told Healio.com/Orthopedics. “Failure to recover physical function during this critical period may leave patients vulnerable to adverse events such as falls or hospitalization and ultimately, increase health care costs. Our study shows that even moderate utilization (six to nine visits) of therapy for patients who are homebound after hospital discharge is highly effective in improving independence with activities of daily living, like bathing and walking. Bottom line: If home health services are required after total knee replacement, appropriate utilization of rehabilitation may improve functional outcomes that are important for patients.”
Falvey and colleagues performed an analysis of Medicare claims data for 5,967 patients who underwent TKA and received home health care services for postoperative rehabilitation. Investigators performed multivariable linear regression models to assess relationships between physical therapy (PT) use and recovery regarding activities of daily living (ADL).
Results showed home health care PT use of five or fewer visits (low use) correlated with less improvement in ADL vs. six to nine visits, 10 to 13 visits or 14 visits or more. Investigators noted use of six to nine visits correlated with 25% greater improvement in ADL during the home health care episode compared with low use. There was a 40% greater improvement seen with 10 to 13 visits and a 50% greater improvement seen with 14 visits or more. After adjustments for medical complexity, baseline functional status and home health care episode duration, the findings remained robust. According to researchers, after adjustment, lower PT use was seen in patients who received home health care from rural agencies, patients with depressive symptoms and patients with any baseline dyspnea. –by Monica Jaramillo
Disclosures: The study was supported by a Promotion of Doctoral Studies II Scholarship from the Foundation for Physical Therapy, the National Institute on Aging Grants T32AG000279 and F31AG056069, and research grants from the American Physical Therapy Association Home Health Section, the Foundation for Physical Therapy and the Center on Health Services Training and Research (CoHSTAR).
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Falvey FR, et al. J Bone Joint Surg Am. 2018;doi:10.2106/JBJS.17.01667.
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