Comparison of Day Rehabilitation to Skilled Nursing Facility for the Rehabilitation for Total Knee Arthroplasty

Kathrins B, Kathrins R, Marsico R, Frank M, Stevenson-Marshall B, Orozco F, Ong A: Comparison of day rehabilitation to skilled nursing facility for the rehabilitation for total knee arthroplasty. Am J Phys Med Rehabil 2013;92:61-67. Objectives: Day rehabilitation (DR) is emerging in the United States as an alternative postacute rehabilitation setting. There have been no published studies focused on the efficacy of DR for a postacute orthopedic population. This study investigated the efficacy of DR as an alternative to inpatient skilled nursing facility (SNF) status post total knee arthroplasty. Design: A retrospective chart review was conducted. Subjects were 50-75 yrs old, underwent total knee arthroplasty in 2009, and were discharged from an SNF or DR affiliated with a postacute healthcare system. The sample consisted of all DR (n = 56) and randomly selected SNF (n = 45) subjects. Results: Upon admission, there were no differences between DR and SNF groups for age, sex, comorbidity score, pain score, knee range of motion, ambulation distance, locomotion Functional Independent Measure score, or body mass index. Upon discharge, there was no difference in knee range of motion or pain between groups. Discharge ambulation distance (P = 0.000) and locomotion Functional Independent Measure score (P = 0.001) were greater for the DR compared with the SNF group. Cost was lower (P = 0.000) and length of stay was shorter (P = 0.000) for the DR compared with the SNF group. Conclusions: Subjects discharged from DR had similar or improved outcomes compared with subjects discharged from SNF at a lower cost and shorter stay. Results suggest that DR delivered significant cost savings when compared with SNF without compromising patient outcomes.