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Rehabilitation Following Total Knee Replacement, Total Hip Replacement, and Hip Fracture: A Case-Controlled Comparison

Herbold, Janet A. PT, MPH1; Bonistall, Kristen MS1; Walsh, Mary Beth MD1,2

Journal of Geriatric Physical Therapy: October/December 2011 - Volume 34 - Issue 4 - p 155–160
doi: 10.1519/JPT.0b013e318216db81
Research Reports

Purpose: To determine whether clinical outcomes and reimbursement for care differed between patients with hip fracture, total knee replacement (TKR), and total hip replacement (THR) undergoing an inpatient rehabilitation facility (IRF) versus skilled nursing facility (SNF).

Method: A total of 541 patients (IRF = 409, SNF = 131) with unilateral hip fracture, TKR, and THR were recruited. The IRF and SNF patients were matched on age, sex, diagnosis, severity index, and ambulation Functional Independence Measure (FIM) score on admission. Comparisons of discharge motor FIM scores, length of stay, discharge ambulation devices, discharge disposition, use of home health services, transfer to acute care, and total reimbursement for the inpatient stay were carried out between matched pair groups.

Results: From a sample of 541 patients, 102 matched IRF-SNF pairs were created. The mean length of stay for those receiving care in IRF was 10.7 (4.2) days, compared to 25.5 (16.5) days for those receiving care in SNF (P < .001). Costs of care in the IRF setting were $11,984 ($5254) compared to that in the SNF setting, that is, $10,001 ($7141) (P = .008). As compared to patients receiving care in the SNF setting, those in the IRF were more likely to ambulate independently (87.5% vs 74.0%; P = .019), manage stairs independently (68.4% vs 34.7%; P < .001), require less home care (33.7% vs 76.4%; P < .001), and were less likely to use a walker at discharge (41.7% vs 67.7%; P < .001). There were no differences between settings in terms of transfers to acute care, ability to dress the lower body, toilet transfers, and discharge to home.

Conclusion: When patients were matched for age, gender, operative diagnosis, severity index, and admission ambulation FIM score, those who received rehabilitation in the IRF had shorter length of stay and superior functional outcomes than those in the SNF setting. Cost of stay in an IRF was, however, significantly greater.

1Burke Rehabilitation Hospital, White Plains, New York.

2Weill Medical College of Cornell University, York Avenue, New York.

Address correspondence to: Janet A. Herbold, PT, MPH, Burke Rehabilitation Hospital, 785 Mamaroneck Ave, White Plains, NY 10605 (

Partial funding for the 3M APR DRG severity and mortality index analysis was provided by the ARA Research Institute of the American Medical Rehabilitation Providers. None of the authors have conflicts of interest. FIM is a trademark of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

Copyright © 2011 the Section on Geriatrics of the American Physical Therapy Association
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