Controllable Home Health Rehabilitation Variables That Contribute to Positive Patient Outcomes Following Total Knee Arthroplasty

Context: Care of patients in their own home following total knee arthroplasty is often preferred because of the potential for cost savings over inpatient rehabilitation options; however, no best practice guidelines have been established for the rehabilitation professional to attempt to control for best patient outcomes. Objective: To determine through analysis (regression) what rehabilitation factors that are controllable by the home health therapist are shown to be of aid in achieving positive patient outcomes following knee arthroplasty. Design: Retrospective chart review with multiple regression analyses. Setting: Combination of rural and metro home health care in the mid-Atlantic region of the United States. Subjects: A total of 141 records of patients who had undergone elective knee arthroplasty and who met the study criteria were reviewed. Main Outcome Measures: Outcome measures were change in scores or values between home health admission and discharge in the categories of Tinetti score, knee flexion range of motion, and the ability to ambulate safely (OASIS 1860). Predictor variables examined included patient age, the presence of a rehabilitation stay prior to home health care, days from surgery to start of physical therapy care, frequency of physical therapist (PT) visits, total number of PT visits, frequency of pain that interferes with activity or movement at admission (OASIS 1242), and frequency of pain that interferes with activity or movement at discharge (OASIS 1242). Results: Change in knee flexion was significant (R-2 = 0.171, P = .005) whereas that for the Tinetti score (R-2 = 0.237, P = .064) and functional ambulation (R-2 = 0.112, P = .079) approached significance. Age (r = negative 0.241), frequency of pain that interfered with activity (r = negative 0.269), and total PT visits (r = 0.234) were signifi cant predictor variables. Conclusions: The only variable that made a signifi cant contribution to change in outcome (knee flexion range of motion) is the total number of PT visits. More PT visits equated to improved knee flexion. Tinetti scores and safety in ambulation were also improved. The relatively insignificant cost of a home health PT following knee arthroplasty appears to be a prudent intervention early in the rehabilitation scheme to improve functional outcomes and reduce the risk of other unwanted results.