Preoperative Physical Therapy Results in 'Significant' Reduction in Postoperative Care Use for Patients Undergoing Hip or Knee Replacement
A new study has found that as few as 1 to 2 sessions of preoperative physical therapy can reduce postoperative care use by 29% for patients undergoing total hip or knee replacement, adding up to health care cost savings of more than $1,000 per individual.
Researchers in Ohio reviewed 4,733 Medicare cases involving total hip or knee replacement from a combination of 169 rural and urban hospitals with wide geographic distribution, and found that 79.7% percent of patients who did not receive preoperative physical therapy required postacute care services. That rate dropped to 54.2% for patients who received even a small number of physical therapy sessions before surgery. The study was e-published ahead of print in the Journal of Bone and Joint Surgery (abstract only available for free).
After adjusting for demographic variables and comorbidities, the study's authors estimated a 29% reduction in postoperative care use among the preoperative physical therapy group, which translated into adjusted cost reductions of $1,215 "driven largely by reduced payments for skilled nursing facility and home health agency care."
Patients with at least 1 billed encounter using CPT codes designating physical therapy evaluation or self-care/home management training were included in the preoperative group, providing they had received the service within 30 days of their surgeries.
Researchers believe that the benefit of preoperative physical therapy was derived mostly from the way it prepared patients for postoperative rehabilitation. In most instances studied, they write, preoperative physical therapy was limited to 1 or 2 sessions, which "suggests that the value of preoperative physical therapy was primarily due to patient training on postoperative assistive walking devices, planning for recovery, and managing patient expectations, and not from multiple intensive training sessions to develop strength and range of motion."
"Our study demonstrates a significant reduction in postacute care use associated with the use of physical therapy during the preoperative period for total joint replacement surgery," authors write, adding that in settings where replacement surgery has been recommended by an orthopedic surgeon, "physical therapy appears to provide value within the structure of a standardized preoperative joint replacement education and planning program in which physical therapists may play an important role."
While researchers acknowledge that more work needs to be done to pinpoint the best way to balance resource allocation between pre- and postoperative activities, they cite the current study's findings as a good first step in refining new models of care.
"As payments in health care move from a fee-for-service basis to more global payments that require some risk sharing by providers," authors write, "the ability to manage populations across the continuum to high-quality outcomes at low cost will be imperative."
It’s important to maintain exercise, especially as you age. As physical therapists, you may be seeing more active seniors looking to stay fit after injuries or orthopedic surgery.
But active seniors who are keen on keeping their bodies fit may be signing up for gym classes or doing routines that are no longer safe. Think of all those Zumba classes or senior weight training classes. Who knows if the instructors are aware of their medical conditions and past injuries.
This can lead to serious complications and even new injuries that can derail a fitness program.
Since active seniors have different exercise needs than a younger population, it might be difficult to determine what kind of program would best serve them. Can they be well-managed by a personal trainer? Or are they better off with a physical therapist? Both are needed, It’s just that they both have different roles.
The Role Of Personal Training
Personal training is a structured workout program that allows clients to exercise on a regular basis under supervision to maximize results.
The Role Of Physical Therapy
Our Physical therapists rehabilitate and educate patients who are hurt and return them to their regular routine, skillfully providing treatment plan designed to correct dysfunctional movement and return Seniors to their previous level of function, inclusive of a daily workout routine to maintain the progress they made during therapy.
Issues With Pain And Mobility
Seniors who struggle with pain, balance, and coordination, and who need rehabilitation are best suited for physical therapy.
Personal trainers are trained to help patients improve their fitness level, not heal injuries or deal with pathology. The danger in relying solely on a personal trainer is if they push a patient too far beyond their limits, there is a risk for injury. There should be a team approach, and we seeing a physical therapist when there’s an existing condition that makes exercise hard. Some preexisting conditions that need to be taken into consideration, extremity asymmetry, gout, or swelling in their knees or other joints that limits normal range of motion. This can also apply to seniors with neurological disorders like Parkinson’s.
It’s A Team Effort
Personal trainers are no replacement for physical therapists and vice versa. However, both have important roles to play in maintaining health as people age.To decide if a patient needs a personal trainer or physical therapist, take into account their fitness level, their health (if their bones or muscles are injured), and their goals (fitness or rehabilitation).When you have an injury, it's always best to see a physical therapist first. Your physical therapist will devise a treatment plan, which may include working with a qualified personal trainer or clinical exercise specialist.
Kenneth Mauck, MPT, MS , Manual Therapy Expert