Comparison of home health care physical therapy outcomes following total knee replacement with and without subacute rehabilitation.

PURPOSE: Few studies have examined the rehabilitation progression of patients managed through home health care physical therapy services following total knee replacement surgery. This study compares the episodes of care and functional outcomes of patients sent directly home to those discharged to a subacute rehabilitation setting prior to home health care.
METHODS: Prospective data were collected from 212 consecutive home health care patients referred for physical therapy following total knee replacement surgery. Data routinely recorded by the physical therapist at each home visit related to ambulatory progression and physical status was used in analysis.
RESULTS: Patients admitted to the subacute facilities on hospital discharge were older and less likely to have a caregiver in or near the home. Equivalent physical therapy outcomes were seen regardless of hospital discharge disposition, although patients admitted to subacute rehabilitation settings required an additional 12.4 days. Younger patients admitted to subacute rehabilitation settings demonstrated less desirable outcomes at time of initial home visit, although these differences disappeared by time of discharge from home health care.
CONCLUSIONS: Findings suggest that direct discharge home following total knee replacement surgery is a viable option for many patients. The application of evidence to physical therapy practice can promote more informed decision-making and foster the use of best practice in the home health care setting.