Author Interviews, Hip Fractures, JAMA, Orthopedics / 31.01.2020 Interview with: Alison MCoganPhDOTR/L Polytrauma/TBI Advanced Fellow Washington DC VA Medical Center Washington DC What is the background for this study? Response: Medicare is shifting from a volume- to value-based payment for postacute care services, in which value is determined by patient characteristics and functional outcomes. Matching therapy time and length of stay (LOS) to patient needs is critical to optimize functional outcomes and manage costs. The objective of this study was to investigate the association among therapy time, LOS, and functional outcomes for patients following hip fracture surgery. This retrospective cohort study analyzed data on patients from 4 inpatient rehabilitation facilities and 7 skilled nursing facilities in the eastern and midwestern United States. Participants were patients aged 65 years or older who received inpatient rehabilitation services for hip fracture and had Medicare fee-for-service as their primary payer. We categorized patients into nine recovery groups based on low, medium, and high therapy minutes per day and low, medium, or high rate of functional gain per day. We measured the groups for functional mobility independence and self-care capabilities at the time each patient was discharged. (more…)
Author Interviews, JAMA, Orthopedics / 14.03.2017 Interview with: Justine M. Naylor, PhD Braeside Hospital, HammondCare, Australia South West Sydney Clinical School, University of New South Wales, Liverpool Hospital South West Sydney Local Health District, Liverpool 2170, NSW, Australia What is the background for this study? Response: Total knee arthroplasty (replacement) for end-stage arthritis is a very successful procedure for relieving the associated pain and functional impairments. Formalized rehabilitation following the surgery is also considered an essential adjunct to optimise recovery. World-wide, the volume of knee arthroplasty surgeries is increasing each year. In the US, for example, the prevalence of this surgery increased 11-fold from 1980 to 2010. The costs of the procedures (including the acute and rehabilitation costs) are also increasing. Because of these trends, there is concern for the future sustainability of these procedures. Research devoted to identifying the most cost-effective strategies in this field is required. Our group conducted a randomized trial comparing 10-days of inpatient rehabilitation to a simple, clinician-monitored home program in people who underwent total knee arthroplasty for end-stage osteoarthritis. Inpatient rehabilitation in a rehabilitation facility is commonly provided after knee arthroplasty in various countries including Australia, the US and Switzerland, and is comparatively expensive. In particular, it is a commonly available option for people with private healthcare insurance. Essentially, we wanted to compare 2 extremes – a resource-intensive program to one with far less resource requirements. Because patients who experience complications immediately after surgery may require inpatient rehabilitation to aid their recovery, we only included patients who did not experience a significant complication while in hospital, thus, were otherwise deemed able to be discharged directly home. (more…)
Author Interviews, Hip Fractures, Orthopedics, Surgical Research / 27.10.2016 Interview with: Tom Withers Research Student, School of Health Sciences University East Anglia Norwich, UK What is the background for this study? What are the main findings? Response: There is a lot of subjective evidence to suggest that physical activity does not improve following hip replacement we wanted to therefore synthesise the current evidence to come to a more objective conclusion. The main finding from this study is that physical activity does not significantly change pre-operatively compared to up to one year post-operatively. (more…)