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Mean hospital stay has fallen to less than 5 days for hip or knee replacement surgery, and insurance pays for less postacute care than previously. As a result, many patients have to rely on a spouse or other household members for support during their recovery period. Help with basic physical functioning is particularly critical at 1 month after surgery, when joint replacement patients report a decline in physical functioning and are likely to be discharged from structured physical therapy, according to a recent study. The study was supported in part by the Agency for Healthcare Research and Quality (HS06573).
Physicians should identify patients who live alone and target postacute services for their increased need at that time, according to lead author John D. Fitzgerald, M.D., M.P.H., of the University of California, Los Angeles School of Medicine. Dr. Fitzgerald and his colleagues followed 222 osteoarthritis patients undergoing primary joint replacement surgery at a university hospital between 1990 and 1993. They assessed the patients' bodily pain and physical function at 1, 6, and 12 months after surgery using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36).
Bodily pain and physical function improved after both knee and hip replacement. However, at 1 month after surgery, despite reduced bodily pain, physical function deteriorated. Although patients reported significantly improved perceptions of bodily pain (55.6 vs. 36) at 1 month after surgery, they also reported significantly poorer physical function (24.1 vs. 35.9). At 12 months after surgery, bodily pain and physical function scores on the SF-36 were equal to or superior to age- and sex-adjusted mean scores for other patients in the United States. Patients who were married or living with someone reported greater improvements in bodily pain and physical function than those with less social support over the three followup periods.
See "Patient quality of life during the 12 months following joint replacement surgery," by Dr. Fitzgerald, E. John Orav, Ph.D., Thomas H. Lee, M.D., S.Sc., and others, in the February 15, 2004, Arthritis & Rheumatism 51(1), pp. 100-109.
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