Study: Inpatient rehab shows no advantage over at-home therapy

Bundled payments and dual-eligibles bring opportunities to long-term care operators, experts say
Bundled payments and dual-eligibles bring opportunities to long-term care operators, experts say

Inpatient rehabilitation following knee replacement surgery provides no advantage over at-home therapy in terms of mobility, recovery and pain management, according to new study findings. Researchers also reported finding little difference in two-year outcomes among patients who were sent to a nursing home or a standard inpatient rehab center.

Study authors said they were encouraged by the findings because many patients already tend to prefer treatment in a home setting. The difference in costs are about $4,000, according to published reports.

Dr. Douglas Padgett, chief of the Adult Reconstruction and Joint Replacement Service at the New York-based Hospital for Special Surgery, released findings from his study before the annual meeting of the American College of Orthopaedic Surgeons. The four-year study explored cases of 2,400 knee surgeries. About 90% had undergone knee replacement as a result of debilitating osteoarthritis.

Padgett said Thursday at the ACOS conference that he and his colleagues are “encouraging more patients to consider … aftercare in a home environment instead of at an inpatient rehab facility.” He noted the study was designed to verify whether the growing tendency to send more joint surgery patients home instead of inpatient rehab centers was producing different outcomes — a trend he says has been partly influenced by a growing reluctance from private insurance companies and Medicare to cover the cost of in-patient rehab expenses, according to HealthDay.

The study found that patients recovered at the same rate at home and in inpatient rehabilitation facilities after choosing physical therapy following knee surgery. Moreover, Padgett and his colleagues found no differences in complications at six months or at two years for pain and mobility.

Over the course of the average post-op recovery of two to four months, inpatient rehab occurs six days a week for about two weeks, followed by outpatient or at-home care. Those sent directly home typically receive home care physical therapist visits three times a week for up to six weeks.