Which Patient Factors Best Predict Discharge Destination After Primary Total Knee Arthroplasty? The ARISE Trial
| Autor: | Wayne Hing, Larissa Nicole Sattler, Christopher J. Vertullo, Evelyne Rathbone |
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| Rok vydání: | 2020 |
| Předmět: |
Inpatients
030222 orthopedics medicine.medical_specialty Rehabilitation business.industry medicine.medical_treatment Total knee arthroplasty Aftercare Logistic regression Arthroplasty Patient Discharge Regression Odds 03 medical and health sciences 0302 clinical medicine Odds Ratio medicine Physical therapy Humans Orthopedics and Sports Medicine Functional status Arthroplasty Replacement Knee business Patient factors |
| Zdroj: | The Journal of Arthroplasty. 35:2852-2857 |
| ISSN: | 0883-5403 |
| DOI: | 10.1016/j.arth.2020.05.056 |
| Popis: | Background The role of inpatient rehabilitation after total knee arthroplasty (TKA) remains uncertain, with evidence suggesting no better functional outcomes for those who discharge to rehabilitation to those who discharge home. The aim of this study is to develop and implement a pre-operative predictive tool, ARISE (Arthroplasty Rehabilitation Initial Screening Evaluation), that incorporated psychological, functional, and socio-demographic factors to determine discharge destination. Methods One week prior to TKA, the ARISE tool was administered to 100 patients, in addition to an EQ-5D-5L survey and other demographic data being recorded. The primary outcome was discharge destination. An enhanced recovery pathway, which included an anesthetic protocol designed to optimize early mobilization, was utilized. Univariable and multivariable logistic regression analysis was performed to determine the likelihood of discharge destination. Results Patients in the rehabilitation group were, on average, 4.5 years older than the home group (P = .036). After multivariable regression, ARISE questions were predictive of discharge destination related to beliefs around the superiority of inpatient rehabilitation (odds ratio = 9.9 [2.6-37.9]) and post-discharge level of support (odds ratio = 6.3 [1.5-26.8]). No question around self-reported physical function was predictive. Conclusion Pre-operative patient beliefs regarding rehabilitation and future home support are highly predictive of discharge destination after primary TKA. Pre-operative patient-reported functional status and demographic variables, with the exception of increasing age, were not shown to be predictive. Predicting those that are most likely to discharge to rehabilitation allows for early, targeted interventions to optimize resources and increase likelihood of home discharge. |
| Databáze: | OpenAIRE |
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