Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement.

OBJECTIVE: To determine the effects of using a continuous passive motion (CPM) device for individuals with poor range of motion (ROM) after a total knee replacement (TKR) admitted for postacute rehabilitation. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation facility (IRF). PARTICIPANTS: Adults (N=141) after TKR with initial active knee flexion <75° on admission to the IRF. INTERVENTION: Two randomized groups: group 1 (n=71) received the conventional 3 hours of therapy per day, and group 2 (n=70) received the addition of daily CPM use for 2 hours throughout their length of stay. MAIN OUTCOME MEASURES: The primary outcome measure was active knee flexion ROM. Secondary outcome measures included active knee extension ROM length of stay, estimate of function using the FIM and Timed Up and Go test, girth measurement, and self-reported Western Ontario and McMaster Universities Osteoarthritis Index scores. RESULTS: All subjects significantly improved from admission to discharge in all outcome measures. However, there were no statistically significant differences in any of the discharge outcome measures of the CPM group compared with the non-CPM group. CONCLUSIONS: CPM does not provide an additional benefit over the conventional interventions used in an IRF for patient after TKR, specifically in patients with poor initial knee flexion ROM after surgery.

Rehabilitation following total knee replacement, total hip replacement, and hip fracture: a case-controlled comparison.

PURPOSE: To determine whether clinical outcomes and reimbursement for care differed between patients with hip fracture, total knee replacement (TKR), and total hip replacement (THR) undergoing an inpatient rehabilitation facility (IRF) versus skilled nursing facility (SNF). METHOD: A total of 541 patients (IRF = 409, SNF = 131) with unilateral hip fracture, TKR, and THR were recruited. The IRF and SNF patients were matched on age, sex, diagnosis, severity index, and ambulation Functional Independence Measure (FIM) score on admission. Comparisons of discharge motor FIM scores, length of stay, discharge ambulation devices, discharge disposition, use of home health services, transfer to acute care, and total reimbursement for the inpatient stay were carried out between matched pair groups. RESULTS: From a sample of 541 patients, 102 matched IRF-SNF pairs were created. The mean length of stay for those receiving care in IRF was 10.7 (4.2) days, compared to 25.5 (16.5) days for those receiving care in SNF (P < .001). Costs of care in the IRF setting were $11,984 ($5254) compared to that in the SNF setting, that is, $10,001 ($7141) (P = .008). As compared to patients receiving care in the SNF setting, those in the IRF were more likely to ambulate independently (87.5% vs 74.0%; P = .019), manage stairs independently (68.4% vs 34.7%; P < .001), require less home care (33.7% vs 76.4%; P < .001), and were less likely to use a walker at discharge (41.7% vs 67.7%; P < .001). There were no differences between settings in terms of transfers to acute care, ability to dress the lower body, toilet transfers, and discharge to home. CONCLUSION: When patients were matched for age, gender, operative diagnosis, severity index, and admission ambulation FIM score, those who received rehabilitation in the IRF had shorter length of stay and superior functional outcomes than those in the SNF setting. Cost of stay in an IRF was, however, significantly greater.