Initiating Physical Therapy on the Day of Surgery Decreases Length of Stay Without Compromising Functional Outcomes Following Total Hip Arthroplasty


Karen Juliano, PT
Department of Rehabilitation, Hospital for Special Surgery


Danielle Edwards, DPT
Department of Rehabilitation, Hospital for Special Surgery


Daniel Spinello, DPT
Hospital for Special Surgery


Yolanda Capizzano, DPT
Hunter College


Emie Epelman, DPT
Hunter College


Jennifer Kalowitz, DPT
Hunter College


Adina Lempel, DPT
Hunter College


Hassan Ghomrawi, PhD, MPH
Division of Health Policy, Department of Public Health, Weill Cornell Medical College
Hospital for Special Surgery

Abstract 

In response to rising health care costs, hospitals are implementing clinical pathways in order to standardize care, improve cost efficiency and outcomes. The purpose of this study was to evaluate the effect of initiating physical therapy (PT) on post operative day 1 (POD1) compared to initiating PT on day of surgery (DOS), on length of stay and in-hospital rehabilitation functional outcomes in total hip arthroplasty patients. This change in PT guidelines was part of the implementation of a new multidisciplinary clinical pathway, adopted by the institution in 2007. A retrospective descriptive study of 408 subjects undergoing unilateral THA compared two groups (204 in each group): those who initiated PT on POD1 and those who initiated PT on DOS. Compared to the POD1 group, patients in the DOS group stayed on average 0.21 days less in the hospital. There was no difference in the achievement of functional milestones in spite of the shortened hospitalization. The initiation of a new clinical pathway was successful in reducing mean length of stay while still allowing patients to achieve all necessary functional outcomes, required for discharge home.

This article appears in HSS Journal: Volume 7, Number 1.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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