Tuohy Sharlynn, Schwartz-Dillard Jessica, McInerney Danielle, Nguyen Joseph, Edwards Danielle
Rehabilitation and Performance, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2024 Feb;20(1):29-34. doi: 10.1177/15563316231211318. Epub 2023 Nov 25.
The Risk Assessment and Prediction Tool (RAPT) and the Activity Measure for Post-Acute Care "6-Clicks" Mobility Score (AM-PAC) are validated discharge planning tools for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Planning for discharge with these tools considers very different factors and it is important to determine if they relate. We sought to determine whether the preoperative RAPT score would correlate with postoperative AM-PAC score for predicting discharge destination for THA and TKA populations. Secondarily, we sought to examine whether the AM-PAC and RAPT scores would remain statistically significant predictors of discharge destination despite covariates. A retrospective cohort study was performed for patients who underwent THA or TKA from January 2020 to December 2022 at a specialty orthopedic hospital. Primary variables included the RAPT score, the AM-PAC score, and discharge disposition. Correlation between AM-PAC and RAPT scores was tested using Pearson's correlation coefficient, and association between both scores and discharge destination was tested using chi-square tests and multivariable logistic regression. Our comparison of AM-PAC scores and RAPT scores found a statistically significant, positive correlation in both THA and TKA patients. Regression analysis found that increased RAPT and AM-PAC scores resulted in higher odds of being discharged home for both populations, after adjusting for all other variables. In both cohorts, patients discharged to a facility were more likely to be female, be over the age of 70 years, have Medicare/Medicaid insurance, and have a higher number of preoperative social work visits or any incidence of an intraoperative or hospital complication. This retrospective study found that RAPT score correlated with AM-PAC score for predicting discharge destination for elective THA and TKA populations, suggesting that these scores may be predictors of home discharge destination even when accounting for covariates. Further study is recommended.
风险评估与预测工具（RAPT）和急性后期护理活动量度“6次点击”移动性评分（AM-PAC）是用于全髋关节置换术（THA）和全膝关节置换术（TKA）患者的经过验证的出院计划工具。使用这些工具进行出院计划时考虑的因素大不相同，确定它们之间是否相关很重要。我们试图确定术前RAPT评分与术后AM-PAC评分是否相关，以预测THA和TKA患者的出院目的地。其次，我们试图研究尽管存在协变量，AM-PAC和RAPT评分是否仍为出院目的地的统计学显著预测指标。对2020年1月至2022年12月在一家专科骨科医院接受THA或TKA手术的患者进行了一项回顾性队列研究。主要变量包括RAPT评分、AM-PAC评分和出院处置情况。使用Pearson相关系数检验AM-PAC评分与RAPT评分之间的相关性，并使用卡方检验和多变量逻辑回归检验这两个评分与出院目的地之间的关联。我们对AM-PAC评分和RAPT评分的比较发现，THA和TKA患者中均存在统计学显著的正相关。回归分析发现，在调整所有其他变量后，RAPT和AM-PAC评分升高均导致这两组患者回家出院的几率更高。在这两个队列中，出院到机构的患者更可能为女性、年龄超过70岁、拥有医疗保险/医疗补助保险，并且术前社会工作访视次数更多或发生术中或医院并发症。这项回顾性研究发现，RAPT评分与AM-PAC评分相关，可预测择期THA和TKA患者的出院目的地，这表明即使考虑协变量，这些评分也可能是回家出院目的地的预测指标。建议进一步研究。
