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  • Recovery Room Mobilization Can Make a Difference in Length of Hospital Stay

    A new study has reinforced the idea that for total hip and knee replacement patients, rehabilitation that begins in the recovery room can reduce the length of hospital stays. Researchers in the study found that 70% of rapid rehabilitation patients spent less time in the hospital than patients whose first rehabilitation session occurred the day after surgery.

    The study (.pdf), published in a recent issue of the Bulletin of the Hospital for Joint Disease, reviewed 900 hip and knee replacement patients divided into 1 group of rapid rehabilitation patients (331) and 1 group of standard rehabilitation patients (569). The 2 groups were comparable for sex, age, ASA class, anesthesia type, comorbidity groups, and time of physical therapy, although procedure length and estimated blood loss did vary somewhat between the groups, with the rapid rehabilitation group recording less of both.

    The therapy program for both groups was the same, with the only difference being when and where it began: the rapid rehabilitation patients were mobilized in the recovery room, while the standard rehabilitation patients were mobilized on the morning of postoperative day 1.The results showed that hip replacement patients averaged a 3.9-day stay in the rapid rehabilitation group and a 4.6-day stay in the standard rehabilitation group. Knee replacement patients saw a less dramatic difference, with the rapid rehabilitation group averaging a 3.6-day stay and the standard rehabilitation group recording a 4.1-day average.

    Researchers called the differences significant and cited benefits of shorter stays that included decreased patient needs for services such as blood transfusion, reduced risk of postoperative complications, and increased cost savings.

    APTA is a strong supporter of rehabilitation research, and APTA members were part of the Blue Ribbon Panel on Medical Rehabilitation Research at the National Institutes of Health (NIH). The panel's findings, which included recommendations for the development of a research plan and elevation of the National Center for Rehabilitation Research within the NIH structure, were recognized in a statement issued by APTA in January 2013.

    'Washington Post' Story Questions Effectiveness of Spinal Fusion Surgery

    The Washington Post recently looked at the rise in spinal fusion surgeries and uncovered more questions than answers when it comes to the procedure's effectiveness over therapy.

    Post reporters Peter Whoriskey and Dan Keating examined spinal fusion surgeries as an example of how the debate over what is considered medically necessary can be colored by politics and business. According to the article, spinal fusion surgeries have increased sixfold over the past 20 years in the United States, whose citizens undergo more such procedures than any other country.

    The Post report states that "more than 465,000 spinal fusions were performed in the United States in 2011, according to government data, and some experts say that a portion of them — perhaps as many as half — were performed without good reason." The lengthy article includes summaries of the debate over the procedure's efficacy and the ways in which Medicare has approached the issue of payment. A recent APTA News Now story reported on research that found physical therapy to be as effective as fusion surgery for treatment of degenerative disc disease.

    The APTA patient-focused Move Forward website offers a host of low back pain resources for physical therapists (PTs) and their patients, including audio presentations and an e-book on low back pain and how PTs can help. Treatment of low back pain was the subject of a 2-day series of presentations at the 2013 APTA Conference in Salt Lake City in June, as well as the focus of several CEU courses in APTA's Learning Center.

    NY, CT Medicare Contractor Makes Official Announcement of Documentation Rule Changes

    Physical therapists (PTs) in New York and Connecticut have received official word that 2 burdensome requirements have been lifted. The changes reduce reporting and documentation rules that were in conflict with national Medicare policy.

    National Government Services, the Medicare administrative contractor (MAC) for the 2 states, released a statement on October 24 announcing that PTs are no longer required to submit progress reports every 5 days after services exceeded the therapy cap, and that requirements for documentation of a physician reexamination for services that exceeded either 90 days or the therapy cap have been removed. The changes are effective for dates of service on or after August 1, 2013.

    APTA and chapters in New York and Connecticut advocated for changes to the NGS requirements, which directly conflicted with national Medicare policy. NGS posted detailed information about the changes to Outpatient Physical and Occupational Therapy Services (L26884) Local Coverage Determination (LCD) on its website.