Stern Brocha Z, Sabo Graham C, Balachandran Uma, Agranoff Raquelle, Hayden Brett L, Moucha Calin S, Poeran Jashvant
Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Phys Ther. 2025 Apr 2;105(4). doi: 10.1093/ptj/pzae183.
Prehabilitation may have benefits for total hip arthroplasty (THA) and total knee arthroplasty (TKA), given an aging population with multimorbidity and the growth of value-based programs that focus on reducing postoperative costs. This study aimed to describe prehabilitation use and examine predictors of utilization in fee-for-service Medicare beneficiaries.
This retrospective cohort study using the Medicare Limited Data Set included fee-for-service Medicare beneficiaries who were ≥66 years old and who underwent inpatient elective THA or TKA between January 1, 2016, and September 30, 2021. The study assessed predictors of receiving preoperative physical therapist services within 90 days of surgery (prehabilitation) using a mixed-effects generalized linear model with a binary distribution and logit link. Adjusted odds ratios (ORs) were reported.
Of 24,602 THA episodes, 18.5% of patients received prehabilitation; of 38,751 TKA episodes, 17.8% of patients received prehabilitation. For both THA and TKA, patients with medium or high (vs low) frailty were more likely to receive prehabilitation (OR = 1.72-2.64). Male (vs female) patients, Black (vs White) patients, those with worse county-level social deprivation, those with dual eligibility, and those living in rural areas were less likely to receive prehabilitation before THA or TKA (OR = 0.65-0.88). Patients who were ≥85 years old (vs 66-69 years old) and who underwent THA were also less likely to receive services (OR = 0.84). Additionally, there were geographic differences in prehabilitation utilization and increased utilization in more recent years.
The need factor of frailty was most strongly associated with increased prehabilitation utilization. The variation in utilization by predisposing factors (eg, race) and enabling factors (eg, county-level social deprivation) suggests potential disparities.
The findings describe prehabilitation use in a large cohort of fee-for-service Medicare beneficiaries. Although services seem to be targeted to those at greater risk for adverse outcomes and high spending, potential disparities related to access warrant further examination.
鉴于人口老龄化以及关注降低术后成本的价值导向型项目的增加，术前康复可能对全髋关节置换术（THA）和全膝关节置换术（TKA）有益。本研究旨在描述术前康复的使用情况，并调查按服务收费的医疗保险受益人中术前康复使用的预测因素。
这项回顾性队列研究使用医疗保险有限数据集，纳入了年龄≥66岁、在2016年1月1日至2021年9月30日期间接受住院择期THA或TKA的按服务收费的医疗保险受益人。该研究使用具有二元分布和logit链接的混合效应广义线性模型，评估在手术90天内接受术前物理治疗服务（术前康复）的预测因素。报告调整后的比值比（OR）。
在24,602例THA病例中，18.5%的患者接受了术前康复；在38,751例TKA病例中，17.8%的患者接受了术前康复。对于THA和TKA，中度或高度（与低度相比）虚弱的患者更有可能接受术前康复（OR = 1.72 - 2.64）。男性（与女性相比）患者、黑人（与白人相比）患者、县级社会剥夺情况更差的患者、具有双重资格的患者以及居住在农村地区的患者在THA或TKA术前接受术前康复的可能性较小（OR = 0.65 - 0.88）。年龄≥85岁（与66 - 69岁相比）且接受THA的患者接受服务的可能性也较小（OR = 0.84）。此外，术前康复的使用存在地理差异，且近年来使用率有所增加。
虚弱的需求因素与术前康复使用率的增加最密切相关。易患因素（如种族）和促成因素（如县级社会剥夺）导致的使用率差异表明存在潜在的差异。
研究结果描述了一大群按服务收费的医疗保险受益人的术前康复使用情况。尽管服务似乎针对不良结局和高费用风险较高的人群，但与获取相关的潜在差异值得进一步研究。
